Episode Transcript
Alan Helgeson:
Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.
Today’s topic is a conversation on virtual care and how Sanford Health clinicians are connecting with patients and making a difference. Our guests are Dr. Matthew Eggers and Bonnie Petersen, certified nurse practitioner. Our moderator is Dr. Luis Garcia, president of Sanford Clinic.
Dr. Luis Garcia (host):
Well, Matt and Bonnie, welcome. Thank you for agreeing to do this with me. This is an exciting topic. Sanford recently announced that we’re putting a significant investment in virtual care that has certainly elevated the visibility of many of the things that we were already doing in Sanford, and certainly there’s a lot of questions on what are we going to do with this into the future? So thank you for joining me in this conversation.
Matt, I’ll start with you. Virtual care is quote unquote “new” for some patients and perhaps some clinicians. But in Sanford, we have been doing it for a long time. Can you speak to us about what virtual care means?
Dr. Matthew Eggers (guest):
Sure. Thanks for having me. Virtual care, as it pertains to the service I’ve been involved with, reaching out to patients in rural locations using technology to improve access to high quality health care. This could mean seeing a provider over the computer at your local clinic, or visits at home through another device, a phone or a tablet.
As a psychiatrist, I evaluate mental health needs of patients and collaborate with primary care providers at these sites. It involves medication management and follow up, making referrals to outpatient therapy or locating community mental health resources, referrals to other specialties, collaborating with other clinic staff. The nice part about the system we’re using is we have access to several remote sites, and the messaging is instant. You can see who needs what. If a patient has a question about their medication or treatment, it’s instant access to that as well as collaborating with pharmacies.
Dr. Luis Garcia (host):
Thanks for that perspective, Matt. And it just elevates options for the patient in a non-face-to-face fashion so they can get their needs satisfied. And also, I think you mentioned the interaction between clinicians, right? And it’s not only about patient to clinician interaction, but also learning from each other and providing support to other clinicians. I mean, in your case, mental health is such a hot topic right now, and not everybody has the level of expertise that you have. And how do we help other clinicians to treat patients by utilizing this technology? So thank you for sharing those thoughts with us.
And Bonnie, I’ll ask you a question here about how has virtual care impacted your practice? You know, why did you choose to do it? We talked about how this is not new to Sanford. We’ve been doing it for a long time, but how do you take that leap of faith of this is the way I want to interact with my patients and it will be OK?
Bonnie Petersen (guest):
I think that really what interested me most about it was being able to provide another choice for our patients who maybe in a rural area to access the care at Sanford leap of faith for sure, because we didn’t know for sure what we were getting into, I don’t think. And how great of a service it could be for people.
Dr. Luis Garcia (host):
Yeah. So you do primary care, urgent care, correct? Urgent care in the rural setting?
Bonnie Petersen:
We do urgent care, and we cover the enterprise. It’s acute care providers from Sioux Falls that do the visits. Your patient might be someone in northern North Dakota or could also, really, you could be doing a virtual visit with a mom with a little one here in Sioux Falls too. It doesn’t necessarily always have to be rural, but that was really our main goal, is to reach those patients that don’t have that access. They often have a pharmacy in their town, but don’t have a provider so that we can bridge that gap for them.
Dr. Luis Garcia (host):
It’s interesting that you say that because in Sanford, we have said that we are the premier rural health care system in the nation, right? And 90% of the care that we provide is in the true rural setting. And being able to bring that best care possible to the doorstep is certainly one of the ways that we can achieve that. So thanks for everything that you do.
This is intriguing for me because we always think about how we as clinicians will adapt to the use of new technology. But Matt, talk to me a little bit about how patients actually have embraced the technology. You know, we talk a lot about the importance of the face-to-face interaction, and now we’re putting all these tools and gadgets between the clinician and a patient. How are patients embracing this?
Dr. Matthew Eggers:
We’ve had a lot of positive feedback from patients and their families as well as clinic staff. Not every patient is going to prefer seeing a provider over the computer or some other device at home, but for the most part, the feedback has been very positive and they appreciate having this service being available to them locally.
Dr. Luis Garcia (host):
Matt, and this question to you, again. A lot of people say, well, virtual care should not exist because a lot of the patients that we take care of are in their 60s, 70s, 80s, and they don’t have internet, or they don’t know how to use all these virtual modalities. Have you seen that? Or are patients really engaging regardless of their background and age and all that?
Dr. Matthew Eggers:
I think patients are very engaging. I think as long as you’re showing them that you’re listening to them and their needs and they feel that their needs are being met during a visit, they’re very engaging no matter the age. And also response time – if they need something in a timely fashion. The local clinics have been great to work with as far as that goes.
Dr. Luis Garcia (host):
You know, it’s interesting that you mentioned that. I just recently read some data from our own marketing department and in our own internal surveys, 80% of our patients actually prefer to have a virtual option when possible. So I think that data validates what you just said, Matt. But let me ask you, so we put, once again, a lot of emphasis on a productive relationship between a clinician and a patient to be face to face, and perhaps the use of these virtual care modalities would prevent us from having a good rapport or a good relationship with our patients. Can you talk to me about how do you engage your patients? How do you foster that relationship so the technology doesn’t get on the way and is as meaningful as a face-to-face interaction?
Bonnie Petersen:
I think that we engage with that patient through a virtual visit the same way that we do with that urgent care visit. We maybe don’t have that long-term primary provider relationship with them, but we tailor that visit to what are they looking for and how can we help them with that? And to have it be personal, we actually message them back through their MyChart to give them the opportunity to add anything to that. Or the video visits are especially easy to do that. You can still see that patient and they might be bouncing their little one on their knee or the cat might walk by or whatever, but it’s just engaging their whole family, I guess.
Dr. Luis Garcia (host):
So in your case are patients that you perhaps have not seen before and they request a last minute visit because they have something that is an urgent type of need. So I’m going to put you on the spot: as a surgeon, you know abdominal pain and we have to see the patient and we have to put our hands in the patient’s abdomen. How do you navigate those things virtually?
Bonnie Petersen:
Our nurses screen all of the requests that come in e-visit or video visit or Tyto Care for that matter. And if a request comes in for a visit for abdominal pain, our nurses will call that patient, get a little information from them, knowing full well that the final answers will be to them that you’ll need to be seen in person. Virtual care isn’t for everything and there’s no shame in saying, no, you need to be seen in person. You aren’t trying to handle their problem just because they’ve asked to do it this way. Sometimes they just want to know, should I go in for this or can it wait? But definitely it’s a certain group of chief complaints that you would treat virtually.
Dr. Luis Garcia (host):
Yeah, that’s, that’s really a good point, and I love your comment about there’s no shame on still asking the patient to take the next step if necessary. I think that as clinicians, we always want to do the right thing with the best of the knowledge that we have, and sometimes we just need to take the next step. So I appreciate that.
Matt, as clinicians, some have been really forthcoming with this and really want to do it, want to offer it. Our patients want it, and some others are a little bit hesitant for one reason or the other. What would you tell your colleagues as they try to embrace this model? Go for it, or pay attention to this, or what has worked for you or not? Help me a little bit about that.
Dr. Matthew Eggers:
Yeah, I would say go for it. It’s about reaching out and helping people in areas that otherwise wouldn’t normally have access to certain specialties. And I think as far as embracing these models, yeah, there will be some things out of your control. And working with as many sites as we do, not every site has the same capabilities. There are different staff availability, technology advantages or limitations. But I think it helps if you can be laid back and just work with staff and to troubleshoot any areas.
And the other thing I would say, doing what I do, is it’s a little bit different because I don’t have any direct interaction with staff colleagues or face-to-face with patients. When I was in med school in the late ‘90s, they had us complete the Myers-Briggs personality inventory, which I really gives you kind of a nice snapshot of your genetic personality, extroverts versus introverts. And I think if you are somebody who’s probably more extroverted and likes that interaction with staff and colleagues and gets energized by that, I think that’s probably going to be a little more difficult to do something like I am, just where everything is virtual. But all in all, I think it’s a really good service and a great way to reach out to patients in remote sites.
Dr. Luis Garcia (host):
Thank you to both of you. And I think you both highlighted the differences on the provider end, right? Sometimes you need to rely on your team to assess certain things before you even talk to the patient. In your case, Matt, a lot of that, you do it at on your own without need of staff. Some are patients that have a long-standing relationship with you, and the urgent care is quite the opposite. And on the back end, we are providing all that support for the visit, and that’s our responsibility as Sanford, right? But on the patient, we want to make it as simple and as fast as possible so the patient has a good experience.
So Bonnie, talk to me a little about that. I’m a patient, I want to see you, what do I need to do? Do I get on my phone and my computer?
Bonnie Petersen:
From the patient’s standpoint that visit is requested through their MyChart. So first of all, they have to have a MyChart account, but say you don’t, but you really are interested in still doing this visit, our nurses will walk you through that. And if you’re having trouble, they’ll say, see, you know, go down to the bottom there, see, push that, and whatever we can do to help them, because the IT side of it is the most frustrating for patients, being able to figure out how to make that connection.
And then you can only do so much if they’re in rural South Dakota and their internet access isn’t so great to begin with. That’ll be a struggle for both sides. But just to help that patient know that we can troubleshoot that with them. We’re not in a hurry. We can figure that out. Otherwise, it can be very frustrating if they feel like they’re having connection problems. I can hear you, can you hear me? And things like that. It’s not a satisfying experience for the patient at all. So I would think those are the main things really.
Related: Sanford Virtual Care opens first satellite clinic
Dr. Luis Garcia (host):
I tell you, I’ve never done a virtual visit myself, but I can see myself doing it in certain instances. And it’s just really nice that we offer those options for our patients. Speaking a little bit about the complexity, that even though this is advanced technological approaches to a human to human interaction, it does require a whole lot of infrastructure kind of behind the scenes. And Sanford has been committed now to provide that support for our clinicians of and our patients. And we recently announced this virtual care center that is going to coordinate a lot of the activities that are already happening.
But Matt, give me a sense of how many visits, do you know what Sanford has done? How do we transition from the last year into this new virtual center? A little bit of the philosophy behind that.
Dr. Matthew Eggers:
Virtual care is nothing new to Sanford. They’ve been at it since 2011. And I was kind of amazed when I looked at all the stats. We’re talking about 270,000-plus video visits, close to 80,000 verbal visits and 77 originating sites receiving telemed services. And I think they estimate that it’s saved 20 million miles of traveling. And as far as purpose and vision of the virtual care initiative, obviously to make high quality health care accessible through the use of technology and Sanford’s vision is to become known and nationally recognized for the virtual care services.
Dr. Luis Garcia (host):
You know, Matt, you mentioned the amount of miles, that we have saved our patients 20 million miles in the last year just on virtual visits. But I think a little bit more to the story, is that what that means for our patients. And I heard about a story where a lady for her standard routine prenatal care had to travel two, three hundred miles. And what it meant for her, where her husband was working, she needed to take not only days off of work to come to a visit, but find day care for her children, and the cost of having to travel those miles, and between gas and expenses and food and all that.
So what for us might be a simple 15, 20 minute visit for a patient could be a day changing activity. And this type of support certainly facilitates still that productive and quality interaction with our patients and taking a lot of burden off of our patients. So any of you share stories that you have heard where the patients are really appreciative or the clinicians are really appreciative of that interaction with other colleagues virtually?
Bonnie Petersen:
I think the first one that comes to mind for me, the toddler with conjunctivitis, they have pink eye. They can’t go back to day care. Mom’s got to load them up, go to the clinic however far away that is, sit in a waiting room and the child is exposed to germs that he didn’t have when he came in there just to get the eyedrops. We can talk to that patient over that (virtual) visit and handle something simple like that, tell them what to watch for, and screen the symptoms, make sure that is all it is. The patient has that visit done before they even go to work.
Dr. Luis Garcia:
One of the things that is pretty evident and clear for us nowadays is the lack of access to mental health clinicians. And in your case you’re in high demand right now and your patients absolutely need your services. So how has this virtual care facilitated improvement in access? Can you speak to that a little bit?
Dr. Matthew Eggers:
I started in late 2018 under a, I believe it was a HRSA grant. And the goal was obviously to grow the service and make it sustainable. First six months were a little slow and there were, there’s a lot of virtual meetings with providers to kind of let them know that, hey, this is available. Mental health services are here. A lot of the primary care providers, a lot of providers are comfortable in managing mental health medications to a certain degree. And basically just to get the word out there that this is available. It works. The technology is good, and we can meet patient needs. Feedback has been positive.
Dr. Luis Garcia (host):
We’ve been talking about the patient, right, and what it means for them and make it better for them. But one of the topics that continues to serve as for clinicians is the work-life balance and the burnout. Has the virtual strategy supported your work-life balance and your adaptability to work to have a better life? Can you give me some perspective of around that? And maybe I’ll start with you, Matt.
Dr. Matthew Eggers:
For one thing, less road time. I used to travel a lot to remote clinics in South Dakota and Iowa. So less road time means more time with family. And I would say also it’s important to take care of ourselves as providers. The first year I did this, I learned the hard way that you should get up and move around, take breaks, get your heart rate up. I ended up developing piriformis syndrome and was sort of limping around all summer, but I’ve recovered from that and I have a treadmill and an exercise bike at my office now, so I get up and take breaks. And also just nice to take a break from screen time, also give your eyes a rest.
Dr. Luis Garcia (host):
Unquestionably. Often we forget about taking care of ourselves as caregivers, right? Bonnie, what are your thoughts about that?
Bonnie Petersen:
I think early on it was quite a commitment from our providers. We weren’t quite busy enough to have a dedicated virtual care provider, so you were mixing that in with your regular patients going from just daytime hours to 24/7. And now we have enough virtual care appointments that we have an acute care provider, staff 24/7 just for that most days. And what it’s helped for me in my work-life balance is the opportunity to do a different type of patient care. Maybe I could do an overnight shift from home rather than in clinic it’s worked well. We’ve had young mothers who have been able to, I think, work longer through their pregnancy, because they were able to do a more sedentary virtual care than the in-clinic part of it. There’s many ways we can creatively now help give us that work-life balance.
Dr. Luis Garcia (host):
Well, Bonnie and Matt, you guys are pioneers in all this and you have really helped to shape up Sanford’s path into this future of health care and into providing the same quality of care through different methodologies to our patients. I just would like to ask you for any closing thoughts. This has been a phenomenal conversation and I think it highlights the importance of meeting our patients where they need to be met and facilitate in any way possible that interaction with their clinicians, but Bonnie, I’ll ask you first if you have any closing thoughts about this conversation on virtual care.
Bonnie Petersen:
In order to help our Sanford providers embrace the virtual world, we need to get them comfortable with it early on. That was probably one of our biggest frustrations was the technical side of it. It takes too long to do this, it’s just quicker to make them come in or whatever. If that provider’s comfortable with doing that kind of visit technically as well as through their health care, then it will be easier for them to adapt it into their practice. And we don’t see just everybody. That’s I think what providers worry about is that we’re out there telling people how to take their appendix out or something like that. We screen our patients carefully.
Dr. Luis Garcia (host):
Certainly the technological advances have allowed us to overcome some of the initial hesitancies. And of course now we’re dealing with our other things like reimbursement and policy around this. But in Sanford, we’re just committed to do it right. We’ll figure that out later. We need to provide a service to our patients. We’re committed to that. And then on the back end we work on whatever policy influence we might have to facilitate and solve that. But Matt, any closing thoughts?
Dr. Matthew Eggers:
I just want to say thanks to all the remote sites we’ve been working with. Everybody’s been working hard to make this service what it is, and I think it’s a great service and I’m excited to be part of this moving forward. And would also like to thank Casey Westphal, who has continued in a nursing role working with me, but she’s also had a virtual behavioral health strategy. Patients can reach out to her to schedule her if they have questions. And also like to thank Susan Berry for being part of this. She’s the vice president of operations of virtual care.
Dr. Luis Garcia (host):
Sanford, for very valid reasons, continues to be the most trusted health care system in our regions. And we have the commitment that we’re going to provide the best care for every patient that we touch. And it is because of people like you, Matt and Bonnie, that we are the most trusted system. Not only you bring your heart and your talent to work, but you’re always looking at how can you do it in different ways to meet patients where they need us to meet them. So thank you very much for everything you do. This has been a great conversation. I appreciate everything you do every day. Thank you.
Alan Helgeson:
You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.
Learn more about this topic
- Ep. 19: Start a mindfulness routine for mental health
- Ep. 16: Virtual clinic shortens distance to health care
- Sanford launches virtual behavioral health appointments
Get more episodes in this series
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Posted In Behavioral Health, Community, Company News, Family Medicine, General, Leadership in Health Care, Physicians and APPs, Rural Health, Virtual Care
