Rapidly advancing technological developments are helping
rural hospitals save patients—and themselves.
Throughout the country, hospital leaders are looking at
ways they can strengthen their bottom line using
technologies that better serve their communities and keep
patients closer to home.
In Michigan, urban surgeons perform complex procedures at
small Critical Access Hospitals (CAHs). Robotic surgery
expands physician and hospital capabilities in Minnesota.
And in Washington, medical robots place remote physician
specialists at the bedside of critically ill patients.
“Ten years ago, what we're doing wouldn't have
been possible,” asserts Michigan Rural
Healthcare Preservation (MRHP) CEO Ethan Lipkind.
“There have been astronomical strides in
medical technology that have improved engineering, and
advancements that have made it possible to provide
sophisticated procedures in settings that were previously
impossible. And we can do all of it in an exceptionally
safe environment that benefits both patient and
Today's patients are smart and savvy, and they request
best practice options such as robotic surgery, according
to Joy Johnson, chief operating officer at
Sanford Bemidji Medical Center (SBMC) in Bemidji,
Minn. Patients want to stay close to home for care but
they will travel long distances for best practice
surgical options, Johnson said, adding that rural
hospitals must be proactive technologically to maintain a
solid bottom line.
“The old paradigm was that a hospital's purpose
was to aggregate all the professionals in one place and
bring patients there,” says Tom Martin, CEO at
Hospital in Davenport, Wash. “Now that
ability is changing to us bringing the professionals to
where the patients are.”
Increasing Treatment Access
Lipkind knows of no organization similar to MRHP, a
nonprofit network created in 2010 to help remote rural
hospitals remain operational by developing environments
that offer patients the advantages of the latest
technologies. MRHP collaborates with CAHs in Deckerville and West
Branch to operate a surgical program where four urban
surgeons travel to the CAHs to do neurosurgery, complex
urology, spine and orthopedic surgeries, fusion
procedures and advanced pain care management.
“The traveling surgeons are the lifeline of
this arrangement,” Lipkind commented.
“Patient outcomes have been stellar. In these
small rural hospitals, the focus is on one individual
patient at a time. So these patients get more
Mary Ann*, a patient with a lumbar disk injury, terms her
surgical experience “fantastic.” Dr.
Gerald Schell, a board certified neurosurgeon with
Neurosurgery in Saginaw, performed Mary Ann's
multilevel spinal fusion in the Operating Room of the
15-bed Deckerville Community Hospital (DCH).
“I was treated like family from walking in the
door until being discharged,” Mary Ann said.
“The staff went above and beyond the call of
According to DCH Chief Financial Officer Valerie Bryant,
the surgical program has stabilized DCH financially,
improved employee morale and been embraced by patients.
DCH's upfront investments included equipment upgrades and
“It takes additional nursing and clinical staff
because we need all hands on deck the days these surgeons
come in,” Bryant said. “We have to
take care of our patients in the hospital and put more
staff in the OR. But the benefit has definitely
outweighed our additional expenses.”
Robotic Surgery Offers New Options for Rural Patients
Sanford Bemidji Medical Center in Bemidji and
Essentia Health-St. Joseph's Medical Center in
Brainerd are two rural Minnesota hospitals that have
installed the da Vinci Surgical System, the first robotic
surgical system approved in 2000 by the FDA. The system
has a camera that provides a multi-dimensional view
inside the patient's body and a minimally invasive
robotic arm with a pivoting wrist that can manipulate
microscopic instruments in tiny areas inside the body.
The surgeon navigates all aspects of the surgery from an
Currently, both hospitals are offering robotic procedures
in the areas of general surgery, urology and gynecology.
Difficult surgeries that couldn't have been done in the
past at Essentia Health have become common procedures
because of the minimally invasive technology using the
robot, according to Essentia Health Urologist Dr. Scott
“Robotics take the minimally invasive world one
step further,” commented Dr. Hal Leland, an
Essentia Health obstetrician/gynecologist who performs
“Robotic surgery is significantly less invasive
with less trauma to the body than there is even with
minimally invasive surgeries,” Johnson
concurred. “Patients want robotic surgery
because it means shorter hospital stays and faster
recoveries for them. New physician surgical grads are
trained in robotic surgery and they want to use those
skills. If patient retention and physician recruitment
are negatively impacted, that can impact a hospital's
SBMC, which has 90 acute care beds, is at least 150 miles
from the nearest tertiary centers so patients were
traveling or being transferred long distances for
critical services. Four years ago the board of directors
adopted a strategic plan to improve patient care and
safety by developing SBMC as a regional referral center.
In addition to the robotic program, other high-tech
improvements since then include a new cardiac program
STEMI service, and a cardiac catheterization
laboratory and a chronic wound program that includes
hyperbaric oxygen therapy and advanced wound care.
“Hawkeye” the Robot Brings Specialty
Care to Local Hospitals
According to the Washington
State Hospital Association, the state's 38 CAHs are
the healthcare cornerstone in rural communities, and
their viability is threatened. Among the CAHs
implementing innovative approaches to stabilize their
operations is Lincoln Hospital,
the first Washington CAH to use a robot to manage care for
patients who have had strokes. Lincoln soon
extended the program to include hospitalist management
for all complex care patients. Within the first year of
Lincoln Hospital adding the robot (which they call
“Hawkeye”) to its staff in 2010,
patient transfers decreased by 24 percent and admissions
increased by 21 percent, representing a $1 million
increase in revenue. Martin said other benefits include
shorter patient hospital stays, fewer patient hospital
readmissions and improved post-discharge patient
Contrary to the administration's fears that patients and
staff might react negatively to a robot, Hawkeye was an
immediate hit. “It's really amazing to watch
Hawkeye at work,” Martin commented.
“These remote specialists basically see
everything in the patient that a doctor in our hospital
does. And the stethoscope quality is so good that there
isn't any deterioration transmitting heart and lung
A 25-bed critical access hospital in a CMS-designated
frontier location, Lincoln Hospital simply didn't have
high enough patient volumes to justify hiring a full-time
critical care specialist. But an outside review indicated
that 38 percent of patients transferred to Spokane over a
six-month period could have remained at Lincoln if
critical care management was available.
“Our doctors are very competent but they
weren't getting that inpatient exposure and skills usage
that urban specialty doctors do, so they didn't always
feel comfortable keeping complex patients
here,” Martin explained. “As they
started using Hawkeye, they agreed it was extremely
beneficial to have another set of eyes on their patients.
With this additional clinical support, they have the
ability to care for more patients here.”
Currently, 14 rural hospitals in Washington state use
TeleStroke, and three are developing TeleHospitalist.
Critical care specialists or hospitalists at
Providence Health Care (PHC) in Spokane provide
24-hour support to the rural physicians and hospitals.
According to PHC Telehealth Program Coordinator Denny
Lordan, PHC is developing TelePediatrics, TeleMental
Health and TeleCritical Care. PHC also assists the rural
hospitals with implementation to assure adherence to
standard practice guidelines.
“Having subspecialists that we can make
available to partner hospitals in the region elevates the
level of care that rural patients receive in their own
communities and helps to keep care local,”
Lordan said. “When we keep appropriate patients
in their own communities, we also free up higher acuity
beds at Providence for patients that need that level of
While these administrators are enthusiastic about
high-tech solutions, they also agree that success won't
happen without community education and support, a
financial investment, and willingness to partner or
network with other healthcare providers.
“I think as rural hospitals we have to realize
if we are going to grow and use our facilities to the
fullest extent, it's essential that we bring specialists
into that mix,” Martin said. “Newer
technologies offer opportunities that rural hospitals
should be evaluating. Clearly, we have to be willing to
become part of a system of care where integrating
clinically with large systems using this technology
affords us the ability to remain independent. Technology
affords us a new perspective. We've stopped looking at
our feet and started looking at the sky.”
* To ensure patient privacy, the Rural Monitor only
uses patients' first names.