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Bridging Distances with AI and Telemedicine
Sanford Health, America’s largest rural health system, is revolutionizing care delivery with telemedicine and AI. In this conversation, Dave Newman, M.D., vice president and chief medical officer for virtual care at Sanford Health, discusses how innovative virtual care models and AI-powered solutions are breaking down barriers, improving patient outcomes and enhancing provider efficiency.
Transcript
Tom Haederle
Welcome to Advancing Health. South Dakota-based Sanford Health is America's largest rural health care system. But even with its hundreds of locations, some patients still face voyages of hundreds of miles to access the care they need. In today's podcast, recorded at one of the world's largest digital health conferences, we hear how Sanford is innovating with both telehealth and artificial intelligence - AI - to shrink those vast distances and deliver quality medical care to all who need it, regardless of where they are.
::Chris DeRienzo, M.D.
Hi again everyone, this is Dr. Chris DeRienzo, AHA’s chief physician executive and I am super excited to be here on the sidelines of one of the world's largest digital health conferences with Dr. Dave Newman. Dave and I have known each other for a while now. He is an endocrinologist up at Sanford Health in the Dakotas, and he is the chief medical officer of virtual care for a health system that knows a little bit something about how to serve rural and frontier populations.
::Chris DeRienzo, M.D.
And you can hear in the background, we are on the sidelines of this, this large conference, and both of us happen to be talking innovation. We got you to agree to jump on the podcast with us and talk a little bit more about it.
::Dave Newman, M.D.
Yeah, thanks for having me, I appreciate it.
::Chris DeRienzo, M.D.
So for you all, innovation is really grounded in your need to serve your population. So remind our listeners a little bit about Sanford Health and the populations you serve and why innovation has been so core to what you do from the beginning.
::Dave Newman, M.D.
Yeah. So at Sanford Health, we're the nation's largest rural health care system. We range all the way from Wyoming to Michigan. We have lots of hospitals. We have got big hospitals. You got small hospitals, we've got critical access hospitals. You've got clinics. We've got a health network. We've got a nursing home. One thing that we don't have, though, is a problem that a lot of rural America has is enough providers.
::Dave Newman, M.D.
We realize that we have to jump to innovative care models to survive because our patients really need it.
::Chris DeRienzo, M.D.
Well, it's innovative care models and you need providers, but you also have patients who are spread far and wide. I mean, you all were incredibly generous with your time. We spent some time together, in the fall and you showed me what it really is like in parts of rural North Dakota where your patients live.
::Chris DeRienzo, M.D.
Talk to us about that. And then you will return to given that this is who you all serve, and it really is a sacred mission that you have, the kinds of innovative approaches that you're taking, both with virtual care and with AI.
::Dave Newman, M.D.
Yeah. So when I say rural, I mean really rural. So in, North Dakota, I live in Fargo, North Dakota. I'm the only andrologist for the state of North Dakota. And Fargo is in on the eastern part of the state. And, a lot of my patients come from western North Dakota or even Montana. It is a 400 mile drive one way to get to see me.
::Chris DeRienzo, M.D.
Whoa.
::Dave Newman, M.D.
And oftentimes it's for a 15 minute appointment.
::Chris DeRienzo, M.D.
Oh my goodness.
::Dave Newman, M.D.
And so if they're coming to see me for their hypogonadism or infertility or another thing, I'm the only option in town. You can imagine how frustrating it is if there is a blizzard, or even if there's not a blizzard for them to have to drive that far, take a day off of work, have multiple tanks of gas, to missed time away from their loved ones, to do something that can be easily done virtually.
::Chris DeRienzo, M.D.
And that might even be two days, because I could imagine, you know, if that's an appointment you've been waiting on and you described a little bit about what you do, but remind our listeners what an andrologist is in just a moment. Yeah, yeah. You know, I mean, I would drive 400 miles and spend the night just so I don't, I don't miss that.
::Chris DeRienzo, M.D.
That can be such a key conversation in in a family's life.
::Dave Newman, M.D.
Right. Absolutely. Yeah. So andrology is sex hormone. So it's a lot of, if your testosterone is low or if you're having troubles, reproducing. Yeah.
::Chris DeRienzo, M.D.
From a health perspective, even having one provider like that in that part of North Dakota is great, but you need to reach a massively spread out population. So, obviously you're the CMO of virtual care. Let's talk a little bit about how Sanford and you think about the kinds of virtual care options that allow a provider with your experience to reach people who are hundreds, if not a thousand miles away.
::Dave Newman, M.D.
Yeah. So we've really been listening to patients and what they want. So one of the big things we heard is that they don't want to be transferred to our flagship hospitals. So we've got lots and smaller hospitals that feed the larger hospitals. One of the big issues is the lack of some of the pediatric subspecialties in the smaller hospitals.
::Dave Newman, M.D.
So, for example, pediatric infectious disease. If a patient needs a pediatric infectious disease consult, they often had to be transferred to Fargo or Sioux Falls for the higher level of care.
::Chris DeRienzo, M.D.
Wow.
::Dave Newman, M.D.
You can think about as a parent, if your child is transferred, you're missing work. You have other children that you can't attend to. It's a big burden. So now leveraging technology and leveraging virtual care, we can beam our own providers, our own pediatric infectious disease doctors into their hospitals. We can keep the patients there. Sometimes you can just see how relieved the patients are knowing that they're not going to be transferred, and knowing that they still get the same high quality specialty care in their hometown hospital.
::Chris DeRienzo, M.D.
ere requiring them to drive a: ::Chris DeRienzo, M.D.
so now maybe it's an hour's drive from the ranch that they live to Dickinson rather than seven hours each way. That doesn't happen accidentally. You've got to be very intentional about designing a system to work like that. How do you do it?
::Dave Newman, M.D.
Yeah. So a lot of it is, is what the patient wants, and from provider buy-in. And so we've had some champions that have driven this. And we have failed fast on a lot of these models that didn't work. For our hub and spoke model, it's the easy button for the patient. So if they're not tech savvy they can go to the clinic.
::Dave Newman, M.D.
They can have a nurse, room them in a regular exam room, and then the provider beams into the room. So it's just like a normal visit. One of the great things about that is they're already there for labs. So if a patient needs an X-ray, they're there. Yeah. If they need blood test, they're there. And it is their trusted provider.
::Dave Newman, M.D.
Those labs are going to go straight to their in-basket and they're going to have follow up there. So it's defragmented care.
::Chris DeRienzo, M.D.
I love this example because that medicine is always a spectrum. I'm a neonatologist, you're an endocrinologist. You know I see babies at the super, you know, critical hyper-acute end of the spectrum and you know, out in follow up care. And telemedicine is no different, right? There are telemedicine visits you can do in a patient's home with the technology that just exists on their phone.
::Chris DeRienzo, M.D.
But these kinds of visits that we're describing here, you need really special setup so that, for example, a pediatric pulmonologist can know what they need to know about, you know, a child who has a chronic condition, to say, no, you're good. You don't have to make the thousand mile round trip drive this month. That's sort of one part of an innovation.
::Chris DeRienzo, M.D.
We're both here at this conference and innovation takes lots of forms. I know you all are early users of any number of AI enabled solutions. Where are you seeing an impact today? Either for your physicians and APPs or for patients?
::Dave Newman, M.D.
Yes. So one of the best use cases of AI that I've seen in my career has been artificial intelligence for diabetes. In my previous career, I treated a lot of type 1 diabetes. And patients had an insulin pump, which you can imagine is like a cell phone that they wear in their belt that talks to a sensor, which is a sticker on your skin that continuously checks your blood glucose.
::Dave Newman, M.D.
There is an artificial intelligence algorithm that tells you when you need more insulin and when you need less insulin, and it will do it for you. Wow. It's the easy button. So that was really cool technology that came out several years ago, but the software was clunky, so they had to come to a major diabetes center to download it.
::Dave Newman, M.D.
Okay. With our feedback, a lot of the companies have been able to bring this into the patient's home. So there's an app or a program on their home computer that they can use, and we can do all their work virtually. So for a condition like type 1 diabetes, it is like a part time job.
::Chris DeRienzo, M.D.
Yeah.
::Dave Newman, M.D.
ly kind of the stethoscope of: ::Chris DeRienzo, M.D.
I mean, for those, you know, listening to the podcast, that's the type of diabetes that you're typically are diagnosed with when you're young. And for generations that meant, you know, throughout childhood and your adolescent years, your blood sugars were way off. And so that that changed the trajectory of sort of the health band that you could live in for the rest of your life.
::Chris DeRienzo, M.D.
Getting to press this easy button for patients with type 1 diabetes who are much younger, I mean, help me understand, you're talking about generational shifts in health outcomes.
::Dave Newman, M.D.
Absolutely. So these patients are now not dying from their diabetes. It is giving them their life back, that they're no longer in the road for appointments, that they're able to go on cruises, they're able to go to on family trips, they're able to do those things, and they're able to be normal kids and normal adults. You use the term easy button.
::Dave Newman, M.D.
So we are fully committed to not just our patients but our providers, leveraging technology to make things easier. Yeah. That if the solution is to add something more to our patients or my providers, I'm not interested in it. I'm interested in taking things away. I'm interested in making life simpler.
::Chris DeRienzo, M.D.
And it doesn't have to be in cities with 8 million people. You're making life simpler for patients who get to stay where they want to live with their families for more of the time now. I don't think we think about this burden enough in health care. But we have patients who - it's days, it's weeks. It's months of their life, you know, to be able to access our services.
::Chris DeRienzo, M.D.
And we are we are experts in lots of different things. You're almost turning that around, by being able to project care into people's homes using technology. But let's talk about the providers for a minute, because I've been there right with you as a CMO of a health system before joining AHA. You don't want every new innovation to workflow to be an addition.
::Chris DeRienzo, M.D.
And I, frankly, is one of the technological revolutions I'm seeing that actually is beginning to deliver a little bit on what you said, which is we can actually take some things away that have been layered on. Got any examples of those?
::Dave Newman, M.D.
Oh yeah. So the best example is one that's really hot right now is ambient listening. Yeah. So we rolled this out recently and I cannot believe how well it works. So for the listeners, this is an AI program that the provider, during your clinic visit with them will turn on their phone and it'll listen to you and it will write their note for them.
::Dave Newman, M.D.
One of my buddies is a pediatric oncologist. Really a good guy, he was really bad at writing his notes. So he was always on the naughty list, is what he called it. So he was getting messages from the CMO saying, you need to close your charts. And he did this for 12 years. We opened ambient listening to him, and he texted me the other day and he said, Dave, I didn't miss my daughter's recital.
::Dave Newman, M.D.
I'm not on the naughty list. Like, this is giving me my life back.
::Chris DeRienzo, M.D.
A little bit depressing, frankly. The baseline it's just an expectation that, yeah, I'm going to miss the recital. That's what you and I, that's the that's the culture that we've grew up. It doesn't have to be that way anymore. And I'm hearing the same things. I've now heard from multiple systems in multiple states on multiple different platforms that, on average, ambient listening seems to be decreasing in EMR time by double digits.
::Chris DeRienzo, M.D.
Some sort of high double digits.
::Dave Newman, M.D.
Absolutely.
::Chris DeRienzo, M.D.
And that time is being returned to us to do the things that the human part of health care.
::Dave Newman, M.D.
Yeah. So it was interesting. I was talking with a patient the other day, who was in a clinic visit with one of their providers that was using this. And they had a real conversation. Because now being a provider, it's harder. You're always ordering things on a computer. You're looking at labs, you're trying to type your note as you go, and it's lost the human element.
::Dave Newman, M.D.
Ambient listening has given that human element a chance.
::Chris DeRienzo, M.D.
I mean, we shifted to electronic technologies for all of the right reasons, you know, and it certainly led to some positive outcomes, for sure. But you're exactly right. Health care is and always has been and always will be a uniquely human experience. And we need to keep threading that thread of humanity through the needle of technology.
::Chris DeRienzo, M.D.
If we're going to be able to experience the stuff that brings us joy as doctors, right? Getting to spend time with our patients, getting home and getting to our kids recitals. You know, as long as we've got folks like you, Dave, out there, leading the innovation, I tell you what, I am incredibly optimistic, about the current generation of trainees walking into a practice of medicine and of nursing, respiratory therapy and lab techs and all of the professions.
::Chris DeRienzo, M.D.
That is only going to keep getting better. Thank you so much for joining the podcast. It's been a total privilege.
::Dave Newman, M.D.
Thank you, Chris.
::Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.
