Health Tech, Physicians

How a Rural Health System Is Looking at Virtual Care and Remote Patient Monitoring

In a wide-ranging interview, Sanford Health's president of virtual care explained how virtual care may be well suited to rural populations.

By Arundhati Parmar on May 16, 2023
Sioux Falls, South Dakota-based Sanford Health is attempting to complete a merger with Minneapolis-based Fairview Health Services after failing to merge the first time nearly a decade ago and after a failed merger with UnityPoint Health and another with Intermountain Health. In a meeting at the Reuters Digital Health conference in San Diego on Monday, Brad Schipper, president of virtual care at Sanford, steered clear of discussing the merger more broadly, which has hit a few snags. Instead, in a wide ranging interview, he addressed it briefly describing how the merger can bring complementary skillsets to a single organization,

Below is a slightly edited version of the interview.

MedCity News: The merger announcement with Fairview follows the trend of cross-market mergers. What do you hope to achieve through this merger?

Schipper: So I’m best suited to speak about what we hope to achieve as it relates to virtual. So I think some of the things that Fairview does in virtual are things that we may not do and some of the things that we do are things that they may not do. So kind of cross pollinating the best practices across our system helps us to achieve things and actually some of the lessons learned we have in our rural geography fit very well for the inner city urban geography and vice versa. It’s not as different as you think when it comes to underserved and health disparities. We both have the same challenges. We may be more specialist heavy in terms of how we use our digital or virtual care because of the nature of our world, geography; they may be more primary care heavy because of their geography. So it’s kind of a perfect match to try to bring both the primary preventive and the specialty services together. So, there’s a lot of opportunity that I’m excited about.

MedCity News: When it comes to your rural populations who are older and using virtual care, how much education do you have to do? Do they face more tech challenges that patients in urban areas don’t? 

Schipper: I’ve actually been surprised at how tech savvy the majority of all of our segments are regardless of age  or anything else. Having said that, in our rural areas where our population is older, there are some unique challenges to technology. So we have Tech Point, what we call our information technology team. that historically would’ve functioned just within the walls of an IT building and now we’ve embedded them within some of our medical centers, our clinics to help people before they get discharged, to have them understand how to use the technology and how to connect it. And even broadening that now to potentially come to their home to help them get connected if we have hospital at home or other services.

MedCity News: So you said that there’s some commonality between a health system serving urban populations and those serving rural in that both are addressing under-served communities. But are there some unique problems or issues or challenges that rural health need to address?

Schipper: Yeah, so I would say while there’s similarities, some of the glaring differences are that we cover 250,000 square miles and because of that geography and because of our weather in the Dakotas, often you cannot travel on the roads and our closest access point to a specialist within our system, or a non-specialist can be up to 7.5 hours, for example, on good roads.

Now a pediatric subspecialist can virtually see somebody in Dickinson, North Dakota, or from Sioux Falls, South Dakota. So if I can have a specialist that doesn’t have to drive eight hours round trip, they maybe can fit in another 30, 40 patients that otherwise wouldn’t be seen. So I think that’s very different than in a more traditional urban area. Its maybe 20, 30, 40 minutes to get to an access point. We don’t have that luxury in the rural area. We’re pretty remote, pretty desolate.

MedCity News: What kind of remote monitoring devices are you using within your organization? 

Schipper: Currently one of the devices we’ve used most heavily is TytoCare and it’s a device that a  lot of our specialists are using when a patient comes to a remote clinic to be able to check in the ears or in the mouth, some respirations or other things. We also use a little CareSignal product, which is used to text patients, [now part of Lightbeam) but those would be two that I’d say we use the most with by far the heaviest so far is TytoCare, There are so many products now coming to market. The challenge is trying to assess which ones fit our need, because a lot of them aren’t necessarily just developed for us.

It’d be great if we can find one product that can do about six things so we don’t have about 12 wearables that somebody’s going to have to coordinate. So that’s our other challenge – what is the platform, in the backbone that they’re connected to? And, and then ultimately, does it fit within the workflow and do our providers trust the data that’s coming out of it.

MedCity News: Urban health systems are investing a lot in hospital-at-home programs. Is that even an option for Sanford Health because in urban areas, they do a 10 mile radius, but you wouldn’t reach your patients within 10 miles, right?

Schipper: You know, in Fargo, North Dakota, our medical center is reaches bed capacity often. So if it reaches bed capacity and there is a segment of the population that are in those beds that could otherwise be treated at home, and we could partner that with our paramedic program that we already have along with our hospitalists and nurses and our home health program to free up additional beds so we don’t have to spend the infrastructure, our capital on those beds, and it’s a better outcome for the patient, then we’re absolutely going to do that. We’re currently  evaluating a pilot right now.

MedCity News: A lot of pilots fail. Can you talk about a pilot that didn’t work out as planned and what you learned from it?

Schipper: What I can speak to is there  have been specialists, like we have an endocrinologist out of our Fargo market right now who’s doing just an incredible job of doing things virtually, but there [are] partners of his in that practice or within our whole system that that may not do as much or any virtual visits. So while I wouldn’t call it a failure, I would just say there are some early adopters. So we’re learning that you just can’t say, ‘One of your providers or partners is doing it. Why aren’t you doing it? Why wouldn’t it work for your patient panel?’ Because sometimes patient panels are different, sometimes people adopt things at a different pace.

The other times we’ve failed on is if we try to roll something out too fast, that’s completely a different process than what they’re currently used to.

Or we’ve tried to push technology to patients at time thinking, ‘You’re gonna love this, it’s only gonna cost 200 bucks and you’re gonna be able to use it at home. You can avoid a clinic visit.’ And some of our rural population says, ‘I don’t want to buy that thing for 200 bucks. I’d rather go into the office because I like to get out of my house.’

I think we have failed on that at times that we’ve bought some remote units believing the patient could test some of their [vitals] at home, thinking this is perfect because of all the reasons we just said with geography and weather and when we really talked to our customer, they’re saying, ‘Well you didn’t really ask us. You thought that, but we don’t feel that way.’

Photo: elenabs, Getty Images

Correction: An earlier version of the article incorrectly noted which state Sioux Falls is located. Also, the description of how CareSignal is used by Sanford Health has been updated.