During ViVE26, Panelists Express Enthusiasm for The Rural Health Transformation Program

After his introduction, Brandon Talley expressed excitement about the RHT program. We can think about how to do public health differently in many ways, he stated, from access to care to how data systems work to how they integrate across jurisdictions and share information.

Sarah Lampe underscored that there are many local public health agencies in rural communities. In Colorado, she said, there are 55 local public health agencies, ranging from serving a million people to fewer than 1000. “The difference between what public health is able to provide and what healthcare needs to do in the rural communities is really hand in glove.” “And,” Lampe added, “when you're talking about modernizing rural communities, you have to have a conversation with both of them at the table.” “Having the conversation is to say, how are we both modernizing our systems in a way that is both collaborative and partner-driven for both the public health and the rural provider places….I think there is a huge opportunity there in rural public health.”

“We have this fantastic opportunity for rural health transformation,” Daniel Carnegie articulated. “I would like to see a system that is designed to make sure that we don't overburden our providers and build capability faster than patients are able to react and be engaged.” For example, Carnegie explained, an issue currently being addressed in North Carolina is ensuring people have access to their patient portal. “Public health needs to function more as a muscle.”

“I personally think that we did break public health,” Kat McDavitt stated. “It's been slowly breaking for a long time,” she added, while expressing agreement that the RHT Program presents a great opportunity. “So it's broken, and now we're building it.”

Sarah Lampe explained that there are a couple of opportunities, beyond the rural health transformation, that are being worked on in Colorado. Data modernization work being one of them. A lot of current conversations, Lampe said, are around artificial intelligence (AI) and the ethics of it. “A lot of the conversations in public health are really high-level and getting super philosophical.” “We need to know and understand what is behind the data, how it's been built historically by U.S. data. But it doesn't mean that we aren't also using and understanding the pragmatic use of it.” Many local public health agencies in rural communities have policies that say you cannot use AI, which then leads to using it on the side, Lampe explained. “What we're trying to do is then work with those communities to understand what the utilization of it could be and try to work towards the changes of policies and local spaces.”

With this funding opportunity, we want to make sure we design the program well, Daniel Carnegie remarked on AI. “If you're less digitally capable, maybe we don't talk about AI bots running your front desk.” “Then we talk about expansion to HIE or getting an EHR so that you can start to have stabilization in practice,” he added. Then there needs to be a measurement of whether these technologies are actually making a difference to workflows, Carnegie pointed out.

“What was interesting for me, coming into public health, is realizing innovation might not be super flashy fun,” Kat McDavitt commented. “It might be as simple as addressing the workforce.”

“If I think about data modernization, particularly having real-time, real-world data that's useful for public health action immediately, there are structural barriers to getting over it; that's often not a technological issue,” Brandon Talley remarked. “A lot of that is solvable technologically, but there are structural changes that need to be made….There are some key issues that we could focus on that help unlock innovation more creatively in the space, that help get some of the barriers out of the way.” Talley added that without addressing some of those entrenched barriers to progress, having innovation take hold is going to be really important, particularly amid ongoing episodic surges of funding.

"The question is, what is public health?" - Lampe added. “What is innovation in public health right now? Currently, it's finding around the edges the things that need to shift change to make things just a little bit better, because public health is so entrenched in evidence-based practice and the necessity for proof that it lends itself to being risk-averse.” Lampe continued, “We need to think about how private funding can actually support what public health is trying to do and ensure that we are bringing those partnerships together so that it can be effective.” “If we're going to actually innovate in the field, it's going to take some real bold action from leaders across the country, from leaders in state and local health departments who are saying, I don't care that this is risky,” Lampe added. “If we really want to have transformative systems in a time when public health is broken, we have to stop innovating around the edges.”

“I think innovation sometimes is very much driven by the bright and shining,” Carnegie said. “But what does it look like when we start thinking and designing differently, bringing everybody to the table, and creating that space? We work together….Innovation is collaboration.”