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    📍 Today on Keynote

(Intro)   📍 we need to have a no fear attitude towards change and innovation because what we do for healthcare is not going to change, but how we do it has to change

  📍

📍 My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

📍 Today's episode is sponsored by Quantum Health, Gordian, Doctor First, Gozio Health, Artisight, Zscaler, Nuance, CDW, and Airwaves

Now, let's jump right into the episode.

  (Main) 📍 All right, it's Keynote, and today we're joined by Brad Reimer the CIO for Sanford Health. Brad, welcome back to the show. Yeah, thanks. How you doing, Bill?

Good. Do you have the CDO title as well?

I do not. We actually have a separate chief digital officer at Sanford. That's a paramount.

Awesome. So the distinction between the CIO and the CDO? No. getting off track already, which is great.

No,

there's

it's actually a peer of mine that we work hand in hand.

And it essentially is the types of projects and Things that we, operate on a daily basis. So, Jared Antczak is our Chief Digital Officer. A lot of focus on data, analytics, AI, digital experiences you know, patient experience, provider experience health plan member experience. and really transforming the way that that looks from a digital interaction perspective.

My side of the world is I would say a lot more of what would have been the traditional CIO role. So all of your infrastructure, your applications and systems. Data management, privacy regulatory information security but obviously our teams work and pair together a lot because when he's looking at transforming something from a patient engagement experience, say it's virtual check in and all of that type of stuff, we obviously have to make the corresponding changes in workflow on the back end systems and then bring it into, you know you know, the 24 7 operations perspective.

So yeah, it's a great partner. And we feel that we're able to. Divide and conquer a little bit more and actually get the right level of, let's say C level leadership on both what we really call our rock solid operations as well as our digital and innovative strategies.

You know, as you're talking about that, I'm reminded, like, back in the day when I came in, all of security was under the CIO and one of the first things I did was we split that out and we hired a separate chief security officer and it was chief security, so he's over physical and digital security.

Now, we still implemented it under IT, right? So they looked at things and they said, Hey, here's the direction it's going. And we have to do different layers of stuff, but we implemented it. And I remember when I did that, people were looking at me like, you're insane. I'm like, well, if we hire the right person and I have the right relationship with that person, it's going to work, but if we don't, it doesn't work.

And so what you described is a very cohesive

relationship. Yeah, when we look at like enterprise prioritization, it's all under one umbrella. The end goal and folks on the mission and enterprise priorities, that really aligns us. And just our teams work well together. It just hasn't been a problem.

And I can see where that may, depending, you know, on what the organizational dynamics are for different organizations and how people were brought in and what their history is. Could cause some issues, but I've got a great partnership with him and really enjoy

it. All right, let's start with a little bit of history.

Yep. Yeah. So it's coming on seven years here this summer. So it's been a great transition. I spent. Time prior to this in a high growth healthcare SaaS software company as their CIO and product leader when they're going through the venture capital and private equity funding and those types of things.

So it was on the vendor side in healthcare prior to that. And that's what really got me tied into just wanting to get actually closer to patient care. So made the switch over to Sanford like I said, seven years ago, prior to that, actually spent 16 years in banking. lot of large institution banking background that it's interesting how much of that still does apply to healthcare.

I remember we talked to Lassa Sanford from a geography standpoint, covers. just a massive amount of territory. give us a brief overview of how broad the coverage is for Sanford.

So Sanford Health is the largest rural health system in the United States. We're headquartered in Sioux Falls, South Dakota, and essentially have geography coverage of South Dakota, North Dakota, and the western half of Minnesota.

And there's some that kind of sprinkle outside of that, but it's 250, 000 square miles. Obviously the population is much different when you get into rural Upper Midwest. But our mission is to be able to still provide world class health care to everybody in our geography, regardless of their zip code.

So there's, lot of different things that kind of play into that, and we can kind of talk about some of the uniquenesses, not necessarily of rural health care, but when you have it across such a wide geographic distribution. Then we also have Good Samaritan Society, which is an integrated senior care organization as well, that has a much broader footprint across the nation.

We're trying to consolidate that down into a core 789 Midwest states, but we'll always have some broader coverage there. But we've got a couple hundred facilities for, you know, assisted nursing care, skilled nursing care. Some assisted residential home health care on that side of the business.

We also have a small health plan that we are continuing to grow. And then we have nine world clinics that are, in different countries across the world.

didn't recognize it was that diverse. I mean, that's several types of different businesses.

I'd love to hear your vision. So Technology is going to play a role in rural health care. How are emerging technologies being viewed as playing a role in the delivery of care across your continuum?

it's a lot of the same technology. It maybe just gets applied in a little bit different way.

So, we've always had a mainstay, and it has been for a couple of decades of virtual care. And whether that's through, you know, video or voice, or whatever the different mechanisms are we've had to do that by necessity because of the geography, not necessarily You know, forced into it through COVID like a lot of organizations were, at least they were propelled, you know, more forward with it.

So, expanding on virtual care and just making that reach further and further into our footprint is really critical. And then you pair that up with things like remote patient monitoring, hospital at home. That becomes really impactful for our rural population. Because a lot of times they're driving two or three hours into a doctor's visit.

And to date our virtual care program, for example has saved our patients over 26 million miles. And it's just crazy. And you think about the economic impact of that for those patients, you know, you put the government mileage rate on that, you know, you're close to. Almost even 20 million of you know, maintenance and gas and that type of thing for vehicle.

But a lot of times they're also taking time away from work for those hours. If it's somebody that's in a little bit more of a sensitive situation, they've got another caregiver that's with them. So that really being able to bridge that distance with virtual care and different ways that we can.

keep people in their homes and in a more comfortable spot for that care that is appropriate for that setting, we really see as transforming things. it's for rural specifically or not, we do see the computer vision pieces, you know, like the Artisites of the world, the Cary Is of the world, the way we think about some of that more advanced remote patient monitoring that is going to be more predictive and preventative in health.

We really see that being a huge advantage in rural to where, again, people can stay in their community or stay in their home.

so I'd love to talk to you a little bit about the evolution of telehealth. And you, talked about, you know, phone based. Yeah. The original telehealth, that's why we call it telehealth, I guess and video based and now remote monitoring in the home and whatnot.

are some of the limitations of telehealth?

You know, there always is, and a lot of this kind of depends on the physician's viewpoint and the type of specialty that they're in. Having that face to face interaction to where you're physically in the room, we can see a little bit different in skin tone, tone colors, eye colors, I mean, all the different things that you get in a much more real life fidelity.

I think there, are some gaps there, but they continue to get. I think, honestly, it's probably a little bit a flip of the scenario. I think we're applying too much technology sometimes into the scenario just because we can. One of our most successful behavioral health monitoring programs is just done through text.

I mean, if you think about some the low fidelity, easily integrated with somebody's life, just those quick little check ins you know, as you go through the day with, you know, behavioral health patients can make a big difference. And it's actually probably more intrusive and intimidating and cumbersome to say, hey, let's schedule a video visit for that.

If it's just some of those, more basic check in things. So I think that the key there then is just, let's make sure that we apply the right technology to the right situation, the conditions for those patients. And how we can push that further into just stuff that they're doing in their regular day to day anyway, I think is where

it's going to win.

And so help me understand the, unique challenges of IT infrastructure when you're managing rural health systems like Sanford. assume, just geography based and whatnot, that you've centralized a lot of operations, but then you have some distinct challenges with regard to bandwidth and connectivity and, you know, imaging, imaging reads and those kinds of things.

curious, what are some of the unique challenges?

So, I mean, you hit on some of them. So, we have centralized imaging reads, centralized labs, centralized specialties to where, you know, the specialists are in some of our major medical centers and then do virtual care out to some of the smaller facilities.

And I think That's what a lot of organizations are doing. there are still a few pockets here and there to where there's not appropriate network connectivity availability, but that's, few and far between areas now, because most of the states, especially in our areas, have really Made a big push to make sure that internet is accessible in those rural locations.

the challenge that's now emerging is, does our population have, the economics means to have reliable and consistent internet connectivity. So in our rural geography, we have five of the top 25 forest counties in the us. So you just think about their ability to have. You know, an LTE plan or some type of a home internet connection that is sustainable and reliable.

There are some gaps there, so we've, had to push into that in a little bit different way to where we're maybe sending you know, Wi Fi packs home. Or we're sending different types of monitoring things that don't necessarily have to rely on super high quality. Internet connection. So those are some of the things that we end up dealing with in those scenarios.

the other thing that we get caught on, and again, I think some of the satellite Internet, things like that, are really going to help improve this, is a lot of times there's literally one strand of fiber going into some of these small communities. It's running all the internet in that community and the cell tower.

So, when backhoes start flying in the spring and we get, you know, fiber cuts, that town can be completely wiped off of internet access, both, you know, the physical access as well as wireless, unless they have some type of satellite connectivity. So, that is something that we do encounter. Our network operations teams are fighting those battles every day.

Because we've got 600, 700 different facilities and locations that we're monitoring and managing all those connections for. It just, there's a volume of support there that I think gets underappreciated sometimes.

does Sanford have a policy group that's advocating in the state, advocating on the federal level on behalf of rural healthcare?

We definitely do. We have you know, it's both a community relations and a government relations group that are you know, either part of, other rural consortiums, and we're part of that, or just individual things that we are leading. We've had great partnerships with all of our government officials, you know, across the whole footprint.

We put a lot of effort into making sure that we keep connected with them, and they, for the most part, most of them, grew up in this part of the world. So they understand some of the challenges. And when we talk about doing a virtual visit with a farmer and his combine, because you can't take time away during harvest, they get it.

So those types of things they're easy to talk about, sometimes a little bit harder to, you know you know, influence from a regulation standpoint, but they've been doing a great job on both our team and, the government officials and helping carry our cause and carrying the flag.

Every now and then I'll watch certain shows on TV.

I'm, I'm watching through the food that built America and I thought that was really interesting, but I was watching some show on agriculture. It's amazing how much they are relying on GPS, on you know, technology and I mean, These farms are on the grid, essentially. So we have this picture that they're not, but they, they have significant use cases where they're tapping into the grid.

Now, I don't know if that's prevalent across all of the geography, but it was interesting to watch that even. agriculture and all the things that are going on in farming really becoming high tech.

it's really interesting to see that it's permeating that and making a difference.

Kind of on a similar note, we had we're an EPIC Connect partner program and that's one of the things that, in Sanford's mission in terms of supporting and sustaining care in rural America something that we pour a lot into, but we had our annual Connect Partner, um, Summit, and you pull into the parking lot and it's farm trucks, hay bales in the back but this is, these are the CEOs and CFOs from these rural community hospitals that also have a farm, you know, and it's a, it's a second job or something to supplement that, or they have some responsibility back in their their family farm. So it's not everything's farming community here, but it's definitely a heavy presence and you feel it, and keeping connected in with those.

With that is just their, lifestyle is really important for us as a health system.

I'd love to hear about, so if you could share a recent project or initiative at Sanford that exemplifies the integration of technology in patient care and, I don't know, maybe share some of the outcomes of that project, that would be great.

Yeah, so, you know, as rural as we are, we're not necessarily back country. We have a really good research organization and I've done some pretty good things with the genomic space, and not necessarily just getting your routine pharmacogenetic type information, but we've spent a lot of time really integrating that in with our other systems.

So, we've got that as a direct feed of the genomic information into Epic, into some discrete fields. that we can then play part of the decision aids and those types of things for physicians, BPA alerts. So if we have somebody that went through heart surgery and they were likely to be prescribed Plavix prior to that actually even happening, those alerts and information is going to be in front of the provider as part of their workflow for what they're doing.

Okay. to know whether that patient's going to metabolize Plavix in the right way or not. And it's not something they're having to do to go outside of the system or some other step to go and research that. They're getting it right in front of them as they're going through that care with the patient.

So that, that's really kind of a, Again, I don't know that it's overly high tech, but it's just taking the time to figure out how you're going to take some of the technology advancements and integrate it in with your workflows.

So one of the challenges with all this new technology is just the cost of the technology.

I'm looking at Microsoft had a big announcement yesterday and they're rolling out all this AI. And I'm sure they're not doing it out of the goodness of their heart and out of the kindness and they're just going to give it to you and away you go. There's going to be a cost associated with it, but we're seeing that kind of advancement with AI in a lot of different other platforms that we already use and exist.

how do you govern the desire to move quicker or to be more efficient or to utilize these tools with the pragmatism of, we have to do what is within our means to do. Like we can't do all these things.

there's definitely a delicate balance there.

And I think part of it comes down to how your organization thinks about innovation and funding innovation in general. Organizations that are really intentional about funding that forward seem to have a little bit different means in terms of getting it off the ground. You know, I talked to a bunch of peers and they're just coming out of some of the financial stress and not everybody's obviously out of that.

There still is a very heavy focus on whether there is a dollar ROI on anything that they're going to do. It does seem to be somewhat of a shifting environment a little bit to where the, provider and nursing or clinician experience, you know, what's the value of that? When we know that there's a declining population of, those in that field, how are we going to be able to get ahead of?

Keeping the clinicians that we have, keeping them happy and making them as productive as they can and removing a lot of the barriers and noise. So I think the benefits are going to end up being less tangible, but are going to be seen as a huge benefit in the long run. So you need to have that idea of investing forward and then being prudent around how much and how quickly you roll that out.

You may have a pilot of something that works really well. It's like, okay, yeah, but we can't put this in every patient room. Okay. Well, how about we focus on the ICUs if it's something for them or in the cardiology floor. So part of it is just being really intentional again, around how. you take that investment and put it in the right places that are going to get the highest value for the organization.

Because I think health systems historically, in the time I've been here, it's easy to just make it black or white and all or nothing, rather than thinking about how you can slice and dice and iterate and those types of things. So I think it is going to take the technology areas, kind of a new discipline of thinking more agilely.

Thinking about organizational change management and how you're ruling out those solutions. You're actually getting the value, measuring the results coming out of those projects, I think is really critical as well. So you know when to pivot and when to maybe say, okay, we need to be done with , this part of a project.

Or when do you want to invest more?

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I think I'm going to pivot. want to talk to you a little bit about that digital divide. So you alluded to it a little earlier that there could be a digital divide that exists across your geography. by the way, I believe there's a digital divide that exists across every geography.

It doesn't matter what health system you are. And so, guess the question is, you know, how do you ensure That we can bridge the gap over that digital divide with either literacy on the technology or patient access to the technology or just ensuring patient access to care, I guess.

Yeah, it's, interesting because everybody kind of defines digital divide a little different. There's the physical aspect of it. Do you have the connectivity? Do you have the technology and the tools and those types of things? I also think that a lot of the divide that's created that where patients would say, this is too confusing, this is hard to use, I don't get it, is because we've made the technology too hard.

Not because the technology can't solve the problem we maybe haven't thought about the supporting resources around it or how we are training. our clinicians and those that are rolling it out to be able to bridge that gap for the patients, or just make it so, so simple that they're really not having to feel like they're taking a whole bag of technology home that they don't know what to deal with.

So I think, again, we talk a lot about organizational change management of How do we influence change and bring adoption in the highest value within the organization? I think there's this, I don't know if it's emerging or if it's just a different way to look at it, probably more from a product management standpoint, is what's your patient change management, your community change management to really think about how you can't just drop somebody and, you know, drop it on their lap and assume that they don't know exactly how to use it.

So as you're looking ahead. What's a project that you're excited about that maybe is already started and you're in the process of rolling out, your team's in the process of rolling out, you're working with the clinicians. Is there something that's top of mind right now that you're looking at going, yeah, I'm excited about the opportunity here?

So yeah, there's a couple things. Computer vision, I think, you know, the things that Artisight and those groups are doing it's phenomenal. It is, I don't want to say bleeding edge, but it's leading edge on the way that we're able to potentially transform the care within our facilities and outside of our facilities.

I just think we're scratching the tip of the iceberg

there. So what's the hope with computer vision or Is it on the clinician side to make their life easier? Is it on the patient side? I mean, what would make those projects a success? think

it's both. You know, there's some debate around does it make it easier for a clinician, and you know, what portions of their job are you making easier.

I think if you look at it as how can we, Reduce alert fatigue and get verification of whether that alert is really something that is critical that a nurse needs to respond to really urgently versus not. I do think that there's some really impactful things that could happen there. I do think from a quality perspective, you know, reducing safety events and those types of things is there could be a game changer there.

And I think that's already starting when you look at some of the solutions. And then it's maybe not that individual solution that brings it all together. It's a combination of some different solutions. And they're not necessarily always having to all be the leading edge stuff. So, yeah. I was at a peer organization a couple months ago and they took us through their innovation unit, their post innovation unit, which post innovation unit was really interesting because that means that you're taking it to scale.

That's another whole discussion around how do you build innovation culture within your organization? But what they did is they paired computer vision, two way video, 24 7 vital monitoring, and their centralized monitoring center. And they were completely able to transform the workflow and the productivity.

And the fatigue on nurses in in their footprint and the number of critical alerts that nurses were giving dropped significantly, quality events dropped significantly, number of codes dropped significantly, and it wasn't just one of the technologies, it was how they put it together in an overall program and then worked on how are they going to integrate that into transforming their clinical flows.

So that was really. Impressive to kind of see that. The other area that I think is, it was talked about a lot, I don't know that anything ever super productive came out of it, is just the big data conversation. So I saw a it's actually something that chief physician and medical director are looking at right now, is how can you scrub all the different social media sites for healthcare misinformation.

like a spoonful of bleach is not going to cure your child of whatever. But you can source all of that across those platforms, reference some of that potential misinformation against known good medical sources and documents and studies and all those types of things, and actually provide a heat map.

that says this county is trending with this information that could have this type of an impact on healthcare, and then you can arm your ERs with it, your school nurses with it, your community health officials with it, and get ahead of do you need to have some proactive messaging around something that could be a dangerous trend, because people are taking that information as real, and they don't have any way of kind of countering it with good factual information.

And then you add the generative AI to it. And it can link it to the sites of here's where the true clinical information is. And here's a, already generated public service announcement of how you can communicate that out to somebody in, a third grade level without having to feel like really intimidating them from a high tech solution.

So that, sourcing data, being able to get it in something that helps us be more proactive with health. And you think about that with what's happening with consumerization of health care, I just think there's a lot of potential in the way that we're going to look at broad data sources in the future that help care in ways that we're not even thinking about today.

You know, I love the social media use case and looking for misinformation. some healthcare organizations have really gotten good at the social listening and being able to be responsive.

And I remember hearing a story where somebody posted something on social media about their room or something at the hospital, and they were able to send somebody up to the room to address the problem. And I'm like, Oh my gosh. At the time, I'm looking at that going, we wouldn't know about that until the person had been discharged.

And there's so much value in having that real time information, keeping them from taking that spoonful of bleach and, you know, having access to real information.

Hey, as a CIO give me an idea of how you foster that culture of innovation. You alluded to it in the last question. just curious, strategies, programs that you've done at Sanford to to foster that culture.

Yeah, first off, I think we always want to get better at this. This is an area hard for organizations to get really mature in. And, like I mentioned, now starting to come out of as much financial stress as we had is allowing those things to kind of bubble up, you know, in a more productive and viable way.

When I think about an innovation program, I think the innovation culture is one big part of that, is, you know, is your top leadership talking about that we're going to need to change? In our annual meeting, our CEO, Bill Gassen, had a couple different mantras that he kind of baked into the whole thing.

was we need to have a no fear attitude towards change and innovation because what we do for healthcare is not going to change, but how we do it has to change. And then that was resonated in almost every discussion as we went through that annual meeting over those two days. And just seeing that from the top, seeing it then supported in terms of even the roles and the way that Bill is organizing our C suite.

Is really setting the tone within the organization that innovation is necessary, and it's encouraged, and we need to lean into it. So I think first it's, it's culture. Second is I do think you need to spend some time on having somewhat of a structured program. And I know a lot of organizations or people will say, well, innovation can't be structured.

And I'm not saying that you find ways to go tell people what to innovate on, but curating ideas identifying priorities, determining how you are going to fund and to what level you're going to fund different innovative opportunities. And have a, cross organizational view into what truly could be a benefit.

Because, just because an innovation can make something different doesn't necessarily mean it's always going to translate into the value you think, especially when you think about our organization that is so diverse. We're, we call ourselves, and we are an integrated system, but the impact on a change to the health plan is much different than it would be to our long term care, much different to our research lab versus our health services division.

So making sure you've got a cross functional group that really is involved in supporting and curating and identifying those ones that you really push forward, I think is key. And then being able to get behind them and have this is hard for healthcare systems to do, you know The iterative, agile kind of mindset, it's really difficult for healthcare providers to consider failure in anything.

So when you think about the fail fast scenarios, you've, you've got to make sure that that is in context and that you're explaining that to Clinicians or whoever the stakeholders are, they're rolling out the change to say we're not saying failure is something that is going to be even close to patient impacting or patient harmful.

But we need to try new ways of doing things. We need to be a learning organization. And we need to be able to say, hey, this isn't working like we expected and be able to pivot. And I think that is good recipe for having a healthy innovation kind of mindset and process within your organization.

That's fantastic.

Brad, I want to thank you. I want to thank you for your time sharing your experience at Sanford and lot of times you know, when we look at rural healthcare, a lot of the stories we're reading around rural healthcare kind of alarming at this point. We see the a HA sharing some stats and whatnot.

and so it's good to know that there's models that work. There's models that are advancing the care of the communities that are rural communities. So I really appreciate the work that you guys are doing.

Yeah, thanks, Bill. Appreciate you taking the time with me today.

I do think that we've got a great story as a rural health provider and our mission is to be able to kind of label ourselves as the premier rural health provider in the nation. And what we mean by that is being able to create those models. That we can then export to other organizations to where they have a real footprint but it's maybe not the majority of what they do.

And those best practices are going to do nothing except just help care for people across the nation. So, really excited about it and appreciate all This Week Health does. It's a great program and so happy to be part of it. Appreciate it.

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