St. Mary’s Demaree Says Small Rural Hospitals Can Achieve Top Safety Grades Without Big Budgets

This article was originally published on healthsystemCIO

A 130-bed independent hospital in Amsterdam, New York, earned a Leapfrog B safety grade by tackling one of the most daunting challenges in clinical IT: getting medication alerts right. St. Mary’s Healthcare, a rural safety net hospital where roughly 70% of patients are covered by Medicare or Medicaid, had long delivered strong clinical care, but its Leapfrog score told a different story. Because the hospital had not participated in the Leapfrog survey between 2020 and 2024, its grade was based entirely on publicly available data and did not reflect the quality of care the staff was providing. When leadership decided to take control of that narrative by submitting its own data, the organization turned to its CPOE system and set out to maximize every point it could earn.

Julie Demaree, VP and Chief Technology and Digital Innovation Officer at St. Mary’s Healthcare, said the hospital already had a medication alerting tool in place, but the organization had been cautious about expanding its use. Concerns about alert fatigue, physician disruption, and the governance required to manage changes had slowed adoption. “Safety isn’t about size,” she said. “It’s about discipline and culture and being committed to patient care.”

The Leapfrog initiative gave the team a clear reason to accelerate: Demaree and her colleagues formed a cross-functional committee with the chief medical officer, the director of pharmacy, and the informatics team to determine which alerts to activate and in what order. The Leapfrog Hospital Safety Grade is one of the few national ratings that evaluates hospitals exclusively on their ability to prevent errors, injuries, and infections. Hospitals are scored whether they submit data or not; those that don’t participate have their grades calculated entirely from public sources.

Getting the Alerts Right

The CPOE component of the Leapfrog score requires two things: proof that prescribers enter their own orders and evidence that the hospital’s system can flag more than 60% of serious medication errors. The first criterion was easy; St. Mary’s quickly got over 92% compliance by identifying the few outliers who weren’t entering their own orders. The second criterion required expanding the alert categories the system monitored, including drug interactions, drug-allergy conflicts, dosing errors, drug-lab levels, and drug-age warnings. The hospital had a solid alerting foundation in place; the Leapfrog standard called for broadening it. The challenge was doing so without creating alert fatigue among physicians who would encounter notifications dozens of times a day.The governance model made the difference. The committee recruited volunteer physicians from both inpatient and outpatient settings to pilot the new alerts before a broader rollout. The feedback was immediate and specific. A GI physician assistant reported that every bowel prep order triggered a dangerous-dose alert; the team suppressed it before the systemwide launch. Physicians also flagged the lack of appropriate override options: the only choices available forced them to acknowledge a dangerous situation and proceed anyway. The committee added options such as “this is a home medication” and “these medications have a synergistic effect,” giving clinicians a way to document sound clinical reasoning when dismissing an alert.

A dedicated physician trainer rounded daily during the rollout, asking clinicians what was popping up and what felt unnecessary. That in-person presence proved more effective than any help desk ticket system. Physicians don’t call the help desk, Demaree noted; they’re too busy, and many have concluded that IT can’t help them. Having someone physically at their side, capturing frustrations in real time, created a feedback loop the organization had never had. “If we are living in a world where we think no one complaining means things are going well, we are fooling ourselves,” Demaree said. When a clinician flagged an alert as unnecessary, the team evaluated the data, made a decision, and communicated the rationale. That transparency built trust and sustained momentum.

Rebounding from a Sub-Optimal EMR Go-Live

The Leapfrog journey built on years of EMR optimization work. Demaree joined St. Mary’s nearly three years ago after spending 23 years at Saratoga Hospital, where she evolved from a physician assistant into an informatics and operational transformation leader. The hospital had implemented a new Meditech Expanse system in 2022 under challenging circumstances: it had divested from a national health system in 2020, lost significant IT resources, and completed the build during COVID with consultants cycling in and out. Some legacy workflows and data from the old Meditech Magic system carried over into the new platform, creating optimization opportunities.

Demaree’s initial mandate was to bridge clinical leaders and technical teams, fine-tuning the EMR and driving adoption of structured data. She credits the clinical informatics team already in place with having done significant post-go-live work before she arrived. Through reorganization, her role expanded to encompass IT strategy, clinical innovation, and biomedical engineering.

The culture she found surprised her. At a hospital where many employees have worked for 30 or 40 years, she expected resistance to change. She found the opposite. OR nurses who once documented on paper, physicians who trained before gloves were standard: these staff members had already absorbed enormous change over their careers. They asked questions and wanted to understand risks, but they were not rigid. Demaree credits the hospital’s deep ties to its community for that resilience. St. Mary’s, founded in 1903 by the Sisters of St. Joseph of Carondelet, is the only hospital for miles. Closing would leave 400,000 patients a year without a local provider. That urgency shapes every technology decision the organization makes.

AI, Payer Denials, and the Fight to Stay Open

St. Mary’s uses AI primarily through vendor-embedded tools: ambient documentation, payment posting automation that frees billers for higher-value denial management, and features baked into the Meditech Expanse platform. Vendors are now integrating AI directly into their products, which is exactly what smaller organizations need. Demaree is also collaborating with vendors on a project she considers high-impact. “I think AI has a real potential to aggregate and reconcile medication data across disparate sources, which is a huge opportunity right now,” she said. Patients frequently arrive at the emergency department with incomplete or inaccurate medication lists, and unintentional omissions during transitions of care are a persistent concern.

The financial pressures on rural hospitals are intensifying. Payers have deployed AI-driven algorithms to process and deny claims at a scale and speed that small billing departments cannot match. Even if payers deny 10% of claims and half go uncontested, the savings for insurers are enormous; the losses for rural hospitals are existential. Demaree’s billers must now spend their time working denials and rebuilding claims, a labor-intensive process that pulls staff away from other critical revenue cycle functions.

That pressure extends to every corner of the organization: vendor contracts are negotiated with extreme precision, technology investments are evaluated for their ability to attract surgeons and generate downstream revenue, and infrastructure upgrades compete for scarce capital. Vendors who stayed engaged after a major grant application was denied in December 2025 earned Demaree’s loyalty. Those who walked away did not.

Take it Away

• Leapfrog scores hospitals whether they participate or not; submitting your own data ensures your grade reflects actual performance.
• Form a cross-functional committee with clinical, pharmacy, and informatics leadership before activating new medication alerts.
• Provide clinically appropriate override options so physicians can dismiss alerts with documented reasoning.
• Round in person during rollouts; silence from physicians does not indicate satisfaction.
• Respond to feedback transparently, even when changes take weeks to propagate through governance cycles.
• Rural hospitals should expect AI to arrive through vendor products; focus vendor partnerships on collaboration and long-term value.

For Demaree, every budget line and every technology decision at St. Mary’s connects back to a single reality. “We are here because we love this community,” she said. “And we know that nobody else is rushing in to build a hospital here.”