Northeastern Vermont Regional Hospital in St. Johnsbury is a critical access hospital serving one of the most rural and aging regions in the state. The nearest tertiary care is an hour or more away by car. With an emergency department, an ICU, primary care, and a range of specialties, the hospital delivers care across the full continuum for its community.
When Vermont opened its Rural Health Transformation Program (RHTP) funding, Northeastern Vermont Regional Hospital saw a chance to fix two problems in one project: a documentation workflow that looked different for nearly every provider, and a revenue cycle that spent most of its effort correcting errors after the fact. Shawn Burroughs, MBA, Chief Innovation and Security Officer, wrote and led the hospital's application. Commure worked alongside his team to shape it.
Too many workflows and no room in the budget
Northeastern Vermont Regional Hospital's providers had no single way to document care. Some typed their notes, some relied on quick text, some used voice dictation, and a group used another ambient tool. Many combined methods, starting a note one way and finishing it another. Each option was another tool for IT to support, and leadership had no consistent way to compare performance.
“It's really hard to compare providers when their workflow is nothing alike,” Shawn said.
The revenue cycle carried its own strain. Northeastern Vermont Regional Hospital runs a lean coding team, so a single absence can back up coding and slow cash flow.
"If someone is sick or out unexpectedly, it's a problem. It turns into a very big operational problem quickly," Shawn said. "We really weren't doing much on the front end to improve the provider documentation.”
Bringing every provider onto one tool would take new money. A state budget order held the hospital to zero expense growth for the fiscal year, and Vermont's funding rules didn't allow RHTP dollars to expand tools a hospital already had. The hospital needed a new solution, and a way to pay for it. RHTP could close that gap, but only with an application that tied the technology directly to Vermont's priorities.
That’s where Commure came in.
Building the application together
Vermont released its Notices of Funding Opportunity (NOFOs) gradually, and application details arrived close to the deadline. Shawn checked the state's website once or twice a day so he wouldn't fall behind. Once a NOFO posted, applicants often had two weeks or less to gather, organize, and submit everything.
Northeastern Vermont Regional Hospital brought Commure in to help shape its responses.
“Where Commure helped was we gave them the NOFOs and the RFP wording and said, let's work together on crafting language we're all comfortable with that meets the criteria.”
Vermont's plan gave weight to revenue improvement as well as clinical tools. Working through the requirements with Shawn, Commure helped expand the request beyond Commure Ambient AI to include Commure Charge Capture and Commure Autonomous Coding, so Northeastern Vermont Regional Hospital could address documentation and revenue integrity in a single project.
Commure's MEDITECH experience also made it a clear choice as a partner. Northeastern Vermont Regional Hospital didn't want to spend the project teaching a vendor its EHR.
"You know a lot about the system already, so we're not having to show you what you should already know."
Commure brings that same collaboration to rural health systems applying for RHTP funding, helping them interpret state requirements, tie each investment to a stated priority, and build a clear case for funding on tight timelines.
Documentation that feeds the revenue cycle
Northeastern Vermont Regional Hospital wanted more than ambient listening, which Shawn sees as standard across tools today. Commure Ambient AI adds CareCues and suggested edits that help providers produce complete, accurate documentation.
Northeastern Vermont Regional Hospital already used autonomous coding from another vendor. Moving to Commure Autonomous Coding puts documentation and coding with one vendor, so the system that captures the visit also informs how it is coded. Shawn's goal is to prevent errors at the source.
"We don't want expanded AI capabilities to fix something. We want expanded capability to prevent edits, potential errors, unspecified code, and missing charges in the chart."
When errors are caught downstream, a coder sends a query back to the provider, sometimes a week later, when the details of the visit have faded. The claim goes out with what the chart supports.
"It's not the best we could do. It's the best we could do in that situation," Shawn said.
What the rollout looks like
Northeastern Vermont Regional Hospital plans to bring every provider onto Commure Ambient AI, across the emergency department, inpatient hospitalists, primary care, and specialists. Everyone starts with the full ambient toolset, and providers who prefer another workflow can still choose it.
“If they still feel like they want that control and choice, we're still going to provide it. But I want everybody to start at that full ambient tool."
On the coding side, the goal is to support the existing team. Coders will move from touching every chart to auditing the coding agent, updating rules, and reviewing what may have been missed.
“Right now we need humans overseeing exactly what's being done,” Shawn said.
Northeastern Vermont Regional Hospital will track documentation time, after-hours work, accuracy, and provider queries through Meditech's Provider Efficiency Dashboard. Baseline surveys will measure provider satisfaction and burnout over time.
Advice for rural systems applying now
- Choose a technology partner before the application opens. Tight turnarounds favor teams that already know what they are asking for. Shawn shared, "I would definitely say have your vendor selected before you even want to go to apply. You need the numbers. You need your budget."
- Read your state's plan for every category it funds. Clinical and financial goals often reinforce each other. Northeastern Vermont Regional Hospital's request covered documentation and revenue integrity because Vermont's plan supported both.
- Plan for a compressed timeline. Awards can arrive later than scheduled, and the federal funding window does not move with them. For example, Northeastern Vermont Regional Hospital’s AI Scribe contract is for 11 months rather than 12.
- Build sustainability into the request. Vermont's NOFOs put heavy weight on investments that can sustain themselves after funding ends. Northeastern Vermont Regional Hospital is reducing costs for the future by replacing multiple point solutions, increasing provider efficiency, and decreasing the time revenue cycle teams take to process a claim.
- Act this cycle. RHTP dollars are designed as one-time funding, and unspent funds are redistributed among states the following year.
Where Northeastern Vermont Regional Hospital goes from here
Shawn sees this project as a starting point. He plans to look at other parts of the Commure portfolio in future funding cycles, with the goal of fewer vendors and more continuity across the hospital.
"We really want to broaden our interaction with the Commure portfolio ... to make this kind of a single system approach: fewer vendors, fewer people to reach out to, more continuity throughout the whole process."
Talk with our team
Commure works with rural health systems across the RHTP process, from reading the state's plan and matching technology to its priorities to shaping the application and planning implementation. If your organization is preparing an application, contact us to start the conversation.
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