Harvest time, competing with the coasts on salary: The world of a rural health system CIO

Running health IT for a rural health system presents a unique set of challenges — and opportunities. Just ask Brad Reimer.

He's the CIO of Sioux Falls, S.D.-based Sanford Health, the nation's largest rural health system with 47 hospitals and hundreds of clinics across eight states.

For one, the rise in remote work left him competing for rural IT workers with businesses in other parts of the country that can pay a lot more.

"It's probably hurt us more than benefited us," he told Becker's of the shift to remote. "The Midwest traditionally has been a little bit lower on salary and wages because the cost of living has been lower. Now, our staff are getting cherry-picked from people on the coasts, basically giving them 20 percent, 30 percent, 50 percent increases to do the exact same job. So there's something that's fundamentally going to have to change there."

For another thing, he has to figure out how to use tech to support patients who might lack solid internet connections and be hundreds of miles from their nearest hospital. Some of Sanford's smaller, critical access hospitals also don't have on-site IT staffers, so he works to support the facilities remotely.

The equation for virtual care and remote monitoring is also different for a mostly rural patient population that spans a geographic area the size of Texas.

"So what situations do we send somebody home?" Mr. Reimer said. "What are the prequalifications, even from a technical standpoint, before we would send them home to make sure we can monitor them adequately for the condition they're working through?"

Sanford Health has been talking to internet providers about doing connectivity checks on patients before they're eligible for at-home care.

But Mr. Reimer also has the flexibility — and cultural understanding — to give local IT workers late start times during harvest season if they're working remotely from the family farm.

He has met these challenges and opportunities head-on since joining Sanford Health in 2017 (he has been CIO since October 2021). He previously worked in IT leadership roles at Wells Fargo and urgent-care EHR vendor DocuTap.

His time with a health IT startup gives him a unique perspective when these companies come calling to partner with Sanford Health. For one, they don't always understand the nuances of rural healthcare.

"A lot of vendors don't recognize some of the differences when we're sending somebody 100 miles away [for remote monitoring] versus how they're dealing with that in some of the metros," Mr. Reimer said. "Let's say a farmer's wife was a candidate for going home early, and you assume there are going to be caregivers. Well, if that's during harvest time, everybody else is out in the field. They're not going to have that same level of care."

The rural areas Sanford Health serves also have some unique ethnic makeups, making for innovative possibilities for genomics. Mr. Reimer and his team have worked to integrate genomic workflows and data into the system's Epic EHR, helping providers identify disease risk and targeted medicine for patients who've submitted DNA samples.

"We have towns that are like 80 percent Dutch," he said. "If they have a predisposition for a certain type of cancer, it probably impacts more people in that particular community. So you might market to that community in a different way. You might try to engage them in pre-screening in a different way, which would be different than the Native American reservation.

"I think we get five years down the road and the majority of people will have some type of genome sequence that can help them out quite a bit."

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