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Advancing Health
Encore: Bridging Distances with AI and Telemedicine and Destigmatizing Mental Health for Health Care Workers
00:15:42
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- [00:01]
A
Happy holidays from the American Hospital association and thanks for listening to the AHA's Advancing Health podcast. As we wind up 2025, we wanted to highlight some of our most notable episodes from the past year. First up, a selection from bridging distances with AI and telemedicine, a discussion between AHA's chief physician, executive Dr. Chris Di Rienzo, and Dr. David Newman, chief Medical Officer for Virtual care with Sanford Health. Advancing Health will return with a new schedule in 2026, so be sure to look for new episodes every Monday and Wednesday wherever you get your podcasts. In the meantime, enjoy these podcast highlights and we hope you and your family have a safe and wonderful holiday and a happy new year.
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B
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.
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C
Yeah. So at Sanford Health, we're the nation's largest rural healthcare system. We range all the way from Wyoming to Michigan. We have lots of hospitals, we have got big hospitals, we've got small hospitals, we've got critical access hospitals, we'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. We realize that we have to jump to innovative care models to survive because our patients really need it.
- [01:30]
B
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. Talk to us about that and then we'll 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.
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C
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.
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B
Holy crap.
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C
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.
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B
Whoa.
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C
And oftentimes it's for a 15 minute appointment.
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B
Oh my goodness.
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C
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's 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. Yep. To miss time away from their loved ones, to do something that can be.
- [02:46]
B
Easily done virtually, 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 reminder our listeners what an andrologist is in just a moment.
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C
Yeah, yeah.
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B
You know, I mean, I would drive 400 miles and spend the night just so I don't, I don't miss that because it can be such a key conversation in a family's life.
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C
Right. Absolutely.
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B
Yeah.
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C
So andrology is sex hormones. So it's a lot of if your testosterone is low or if you're having troubles reproducing.
- [03:13]
B
Yeah. 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.
- [03:38]
C
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 of 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. So, for example, pediatric infectious disease. If a patient needs a pediatric infectious disease consult, they often had to be transferred to Fargo, Worcester Falls for the higher level of care.
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B
Wow.
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C
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 and disease doctors into their hospitals. We can keep the patient there. Sometimes you can just see how relieved the patients are knowing that they're not going to have to be transferred and knowing that they still get the same high quality special specialty care in their hometown hospital.
- [04:33]
B
Let's talk a little bit about follow up, because it's not just in hospital care. And we got to visit Dickinson, North Dakota and one reason that you all took me there is it made national news. The virtual care setup that you had in Dickinson was such that patients who had pediatric patients actually who had chronic conditions that were requiring them to drive 1100 miles round trip to see subspecialists, you could now set them up in that building. 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.
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C
You have to be very intentional about.
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B
Designing a system to work like that. How do you do it?
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C
Yeah, so a lot of it is what the patient wants and from provider buy in. 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 a patient. It's the easy button for the patient. So if they're not tech savvy can go to the clinic, 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. If they need blood tests, they're there and it is their trusted provider. Those labs are going to go straight to their in basket and they're going to have follow up there. So it's defragmentizing care.
- [05:50]
B
I love this example because medicine is always a spectrum. I'm a neonatologist, your endocrinologist. I see babies at the super critical, hyper acute end of the spectrum and out in follow up care. And telemedicine is no different. There are telemedicine visits you can do in a patient's home with the technology that just exists on their phone. 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 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 though of innovation. 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?
- [06:41]
C
Yeah. 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 on their belt that talks to a sensor, which is a sticker on your skin that continuously checks your blood glucose. 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.
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D
Wow.
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C
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 have it downloaded.
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B
Okay.
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C
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 of their work virtually. So for a condition like type 1 diabetes that is like a part time job, that it is four hours a day, we have completely revolutionized it. So sometimes I see a patient once a year for their type 1 diabetes and once a year, yeah. So it's partnering with the technology.
- [07:45]
A
Next, a selection from Being okay with Not Being Destigmatizing mental health for healthcare workers. Your host is Rebecca Chicky, senior director of behavioral health with aha. Talking with Corey Feist, co founder of the Dr. Lorna Breen Heroes foundation, and Tiffany Little, director of Cultural integration with Centra Health.
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E
Corey, some of the listeners may not understand when you say removing the barriers to access for mental health care. They may think they're working in hospitals and health systems, so of course they have access to mental health care. Can you go a little deeper on that and describe some of those barriers that you're trying to remove and mitigate?
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D
And it's a great point, Rebecca, because when my sister in law took her life In April of 2020, I had been in healthcare for many dozens of years, actually many decades, I should say. And I was a leader at University of Virginia Health System, yet I wasn't a clinician. And so I was completely unaware of the stigma as well as the professional barriers and really potentially penalties that healthcare professionals in the United States have. These mostly appear in the form of overly invasive and really inappropriate questions that clinicians are asked about whether they've ever been diagnosed or treated for mental illness, whether they've gone to therapy. And these are the same questions that my sister in law was terrified that she would have to respond to following a singular mental health episode. And so what we have been able to do at the Lorna Breen foundation through our all in Coalition and Caring for caregivers is to get tools to the front lines, whether it's a licensing board that's asking these questions or hospitals who ask these questions most commonly in credentialing applications and have them change those questions and then importantly communicate the changes to the workforce. As I sit here with you Today, there are 1.5 million health workers in the United States that are benefiting from the changes that we've made, which we hold out in the all in well, being first for Healthcare Champions Challenge for Licensing and Credentialing badge that we give out to hospitals as well as the licensing boards for doing that important work.
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E
Thank you. I mean, I don't think many of the listeners may have realized that those questions were have you ever, as you noted, have you ever been treated?
- [10:12]
D
And if I could just add one thing, because the American Hospital Association a couple years ago published their first ever suicide prevention guide, at least the first ever that I'm aware of. And in that suicide prevention guide, you identified three key drivers of suicide among health workers. And the first one that you all identified is is this concern around the loss of license and credentials associated with the stigma for mental health care. So we know that for Lorna, this wasn't just an isolated incident. And it's something that we hear from health workers all over the United States that they are fearful for these repercussions. And so we need to do something about it and address it, which is what we've done across the country. We've made great strides.
- [10:53]
E
Thanks for mentioning that. There's a variety of drivers for this concern and this stigma. And so thank you. I want to turn now towards another thing that you mentioned earlier, Corey, and that is working with states, working with large health systems in order to advance this in their own organizations and across a particular geography or a regional area. And I'm going to call out specifically the Caring for Virginia caregivers work. Can you describe that a little bit and then we'll bring Tiffany into the conversation.
- [11:26]
D
Absolutely. Two seconds of background. When the President of the United States signed into law the Dr. Lorna Breen Healthcare Provider Protection act, it created two spheres of programs. And one of those sphere of programs was learning materials for healthcare leaders to address the root cause of burnout as well as mental health challenges. That was called the Impact Wellbeing Guide, which was led by the cdc and our all in coalition provided guidance on it. What we heard from the large health system across the country that was implementing the guide is they like to do this work together at a learning Collaborative and they need some help. And so caring for Virginia's caregivers, caring for North Carolina's caregivers, caring for New Jersey's caregivers, and now caring for Wisconsin's caregivers are all efforts for us to take organizations through the phases of work from the Impact well Being guide. And that begins by addressing these mental health barriers. It then moves ToWards education of 10 person teams across health systems to address the issues at the root cause and become educated about the solutions. And then finally culminates in a learning collaborative focused on an operational initiative that drives burnout. And that's what we've done with Tiffany and the team in Virginia, now North Carolina, New Jersey and recently expanded into Wisconsin.
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E
That's fantastic, Tiffany. I bet the question on many listeners minds is why did CINTRA decide to join the work of all in of caring for Virginia caregivers?
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F
At the time we had some really innovative leaders that understood that well being wasn't just a nicety, but rather a necessity for us to drive health care forward not only to our communities, but also to our healthcare workers. So 2019, we really started pulling together the evidence base for this work. And what we saw is that healthcare workers were far more likely to suffer from depression, to have thoughts of suicidal ideation, to have biopsychosocial disturbances, and of course use substances to help them cope with their roles. But we had never provided health care workers with the avenues, tools and support that they needed to be able to speak up and say, hey, we need help for coping with the very large burden of taking care of our communities and healthcare in the United States. Those were all published before 2019. Of course, you know what happened after 2019, we went into a global pandemic. We really need to find avenues that we could help support our healthcare team members, not only address their own well being so that they can carry that forward, but also not place calluses where we should have compassion because we were facing a compassion crisis, right? And when we tell people, you know, you have to be strong, you have to be confident, and yes, we are all of those things. But we also have to deal with messy, beautiful situations of life and humanity. And that can take a toll on us. It can leave echoes and it can leave scars. But we are well practiced in taking care of code situations. I mean, if you think about a code situation, we are practiced, rehearsed, we simulate it, we educate to it, we certify to it every single year. We have avenues and tools to help us be better at coding situations and situations. Of that nature. What do we have in place for taking care of ourselves?
- [14:48]
E
Nothing.
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F
We don't teach that in school. We don't simulate that. We don't go over it. We don't get certified to it. I mean, now we are starting to see some certifications for healthcare organizations come through. But that was about the time that we found the Lorna Breen foundation. And what perfect timing that we really needed to find a place for getting those tools for helping support us in that work and removing the stigma. And I have to say that's been one of the most important parts of engaging in our healthcare workforce's wellbeing is destabilizing stigmatizing healthcare.
- [15:18]
A
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