Impact of Technology on Community Providers

Session Focus

The panel examined how community health systems adopt technology under real resource constraints. Walsh framed community providers as being asked to do more than ever in an increasingly difficult environment, and the discussion centered on what is actually working, how investment decisions get made, what risks come with dependence on vendors, and whether technology can keep more sophisticated care in the community.

Where Technology Is Delivering Today

Allen Smith MD began with strategy rather than technology. South Shore Health is an independent 373-bed system running from Quincy to Plymouth, 13 miles from Boston. His framing was blunt: whatever South Shore chooses to do, it had better do as well as Boston does, or the patient will simply drive in. Technology is what makes that possible.

He offered atrial fibrillation ablation as an example of a procedure that was not previously performed in the community setting.

On the workforce side, he pointed to ambient documentation as a genuine change in physician experience. Clinicians finish clinic earlier, get to family dinners and Little League games, and avoid the after-hours charting known as pajama time.

He also described the patient-side benefit from personal experience as a former primary care physician. He used to see the back of his own doctor’s head because her attention was on the computer. With ambient documentation, they have an actual conversation. His point was that a physician who is not looking a patient in the eye does not learn what is happening in that patient’s life.

Christine Schuster RN said Emerson has to be prudent about where it spends, noting that insurance does not reimburse for innovation. Emerson works from a vision of putting patients at the center, which she said makes decisions easier. Her examples spanned the patient journey: phone-based appointment booking with waitlists and reminders, AI tools across revenue cycle from insurance verification and preauthorization through bill explanation and payment plans, and two AI-enabled MRI scanners through a partnership with Shields.

The MRI investment was the one she was most enthusiastic about. Scan times drop by as much as 60 percent, turning a 60-minute exam into roughly 28 minutes. That improves the experience for claustrophobic patients and raises throughput, which lets Emerson absorb patients facing long waits in surrounding markets.

Colin McHugh described consolidating from five different EMRs onto Epic in 2020, at the height of COVID. That created what he called an Epic-first mentality: the first question about any new technology is whether Epic supports or integrates with it, and if it does not, the organization scrutinizes the investment hard given what it has already put into the platform.

How Investment Decisions Get Made

All three leaders returned to the same constraint. As not-for-profit, mission-oriented systems, McHugh said, they are charitable assets of their communities, which means investments cannot be taken lightly.

Smith described a formal structure at South Shore: a growth council chaired by the chief strategy officer and chief operating officer, with 11 subgroups covering women’s health, musculoskeletal, cardiovascular, GI and other service lines. Physicians are brought in to identify what is new and emerging, then the organization builds a business plan and capital plan around it. Aquablation for prostate conditions came through that process.

Schuster’s method starts with a question rather than a product. Faced with constant vendor outreach, her team asks what problem they are trying to solve, whether it is workflow, process or access. Once that is clear, evaluating options becomes easier.

She was emphatic about who defines the problem. Senior leaders are not on the front lines and do not know where the friction is, so Emerson brings in clinicians, technicians and anyone involved in the process. That creates buy-in at implementation, and she connected the practice to Emerson’s low turnover. Staff should not feel technology is being foisted on them.

Risk and Dependence

Asked what worries him most about growing reliance on technology and outside vendors, McHugh named single points of failure. A small health system has them throughout the organization, and understanding core competencies is how you decide what you can afford to depend on.

He added a caution about individual champions. A new robot or device cannot be adopted because one physician wants it, because that physician could leave within a year and the investment sits unused.

Smith made the financial version of the same point. None of these organizations is making much money, so resources have to be watched carefully. Recovering from a large failed investment is very hard.

What Community Systems Want Technology to Solve

Asked for a one-word wish, Schuster answered labor, calling it a five-letter word rather than a four-letter one. Shortages and cost make workforce the defining problem.

Smith agreed on labor, particularly providing a meaningful wage in an expensive region, and added access to procedures previously available only in Boston. He cited interventional radiology, top-tier cardiac catheterization equipment, one of the busiest 24-7 STEMI labs in the state, and continuous renal replacement therapy in the ICU.

McHugh named patient throughput, describing an organization running with a 15 percent vacancy rate alongside large numbers of patients who are medically ready for discharge but cannot move.

Keeping Care Out of the Academic Medical Center

Smith described two programs run in partnership with Atrius, which is owned by Optum.

ED avoidance uses mobile integrated health. A patient with congestive heart failure or COPD who recognizes early symptoms calls their provider, and paramedics come to the home rather than the patient waiting until they are sick enough to be admitted. Patients like it once they realize they can stay home and do as well or better. He noted a reimbursement gap worth flagging: insurers still do not pay for mobile integrated health, so Atrius pays South Shore directly.

Hospital avoidance uses a team working from noon until 9 p.m. with access to the Epic record. Seeing a stable patient in the emergency department, they can call the physician and offer a cardiology appointment the following day as an alternative to admission.

Schuster credited a 26-year relationship with Mass General Brigham for keeping specialty care local, pointing to Emerson’s community cancer center as an example of patients receiving medical oncology and radiation oncology without traveling downtown.

Closing Note

McHugh described convening 30 community leaders around greater Nashua, a conversation that had never happened before and surfaced a guardianship crisis keeping patients in beds they do not medically need.

He also described the Walk With Me practice, in which staff physically escort anyone who appears lost rather than pointing down a hallway. Driving in that morning he had passed a picket sign reading “nurses, not algorithms.” His answer was that it has to be both.

Key Takeaways

1. Strategy precedes technology. Both Smith and Schuster started from mission and asked what problem needed solving.

2. Platform integration is a gating question. An Epic-first posture shapes what a smaller system can realistically adopt.

3. Single points of failure are the central risk. Small systems cannot absorb a failed major investment.

4. Front-line staff should define the problem. Inclusion at the design stage drives adoption and retention.

5. Labor is the unsolved problem. Both cost and shortage, and no panelist saw technology solving it yet.

6. Reimbursement lags the care model. Mobile integrated health works and prevents admissions, but insurers do not pay for it.