Digital health literacy for patients and providers

Podcast: Sanford Health CIO and CDO hope to make health care as accessible as shopping online

Digital health literacy for patients and providers

Episode Transcript

Alan Helgeson (Host):

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 around the importance of digital literacy in health care. Our guests are Brad Reimer, Sanford Health Chief Information Officer, and Jared Antczak, Sanford Health Chief Digital Officer.

Brad Reimer: Just to kind of kick off, the question we always get asked is, why does Sanford need both a CIO and a CDO?

You know, and at Sanford, I guess I recognize that, you know, the health care industry is going through a ton of change, and there’s a lot of areas that are just really kind of transforming as a whole. And for the size and scope that Sanford is, it just appears to me that we need a full-time job for like my team that is keeping the train on the tracks, really focused on the operations and services and projects and all those types of things for the people that are in our care stream today. And we definitely don’t want to distract from that.

And that’s where, in my mind, the focus on the transformation, the reimagine, where we’re going, really is another full-time job. Because there’s a lot of stuff that health care is maybe a little behind on that your teams are able to kind of bring to the table and focus on with the level of energy and with the level of attention that it needs. So in my mind, that’s why we both need kind of these dual roles and these separate roles. So one doesn’t kind of over-index more than it should on the other.

So would love to hear your perspective on kind of how you’re, how you’re feeling about it now that you’re in the seat for a while. And I’ve really enjoyed working with you. So I, I’m curious on what your thoughts are.

Jared Antczak: You know, it’s a really great question, and it’s one that I get asked a lot. How does a system work that has a Chief Digital Officer and a Chief Information officer? And, you know, I’ve had an opportunity to work with a number of different health systems, and each one is organized a little bit differently in this regard. And, you know, maybe that’s an OK thing. You know, every system is a little bit different, but I think one of the big challenges that every health system, you know, really has is determining where to focus their time and attention and their resources when everything seems so important.

And one of the things I’ve really appreciated about Sanford Health, having both the CIO and a CDO, is how it allows us to the point that you just made earlier, to have sufficient resources and attention spent on the things that matter across the technology ecosystem.

You know, it really mitigates the risk of over-indexing on one end of the spectrum at the expense of the other. And so the way that we’ve defined digital and it, I think, is really important to that: So digital encompasses the front end of technology, the part of technology that people interact with, and IT really encompasses the backend part of technology, the interfaces, the databases, the things that work behind the scenes. And so our roles as Chief Digital Officer and Chief Information Officer really complement each other. And, you know, it requires us to be very tightly aligned, but at the same time to be able to have a distinct area of focus.

And so, you know, as Chief Digital Officer, you know, I view a lot of the outcomes that I’m focused on as concepts like engagement and usability and experience. And as Chief Information Officer, a lot of the outcomes you’re really focused on is around security and scalability and reliability of our infrastructure. Both are really critical and interdependent for success, but, you know, really allow us to shift from technology being a cost center to really being a value enabler for the organization.

Brad Reimer: Yeah, I’ve heard, you know, when I’m just talking with people at different conferences or whatever they are, they kind of question, so are these competitive roles? And the way that we framed ’em up here, they’re really not. They really are complementary. And it’s really been fun to kind of see how our teams are starting to work together in a new way. And it really is something that, that truly can be synergistic, and really excited about that.

So, as you’ve been, I know you’ve been at a couple of conferences in different speaking engagements here lately. One was Modern Healthcare and you talked a little bit about the future of digital health. And specifically with that rural lens. What were some of the key takeaways you had from that conference and some of those key messages you were hoping that people would hear from you?

Jared Antczak: The Modern Healthcare Leadership Symposium was really a great conference attended by several different executive leaders from various different health care organizations. And at that conference, I had the honor of joining a panel that was entitled Smart Digital Health Investments, Reshaping and Reimagining Healthcare Delivery, along with David Lubarsky, who’s the CEO of UC Davis Health, moderated by Jeff Terry, who is the CEO of GE Clinical Command Centers.

You know, every time I attend a forum like this, I’m reminded that every health care system is on a similar journey. And, you know, some are further along in some areas and further behind in others, but we’re all somewhere on the path and there’s so much that we can learn from each other. One of the concepts that I spoke about at this particular conference was the difference between digitization and digital transformation. Yeah, right. Both are really big buzzwords that you hear a lot about in the industry, but sometimes people get confused and think that they really just mean the same thing, but they use those terms interchangeably. But from my perspective, there are some really significant differences between the two.

Digitization, from my perspective, really takes existing processes and workflows and essentially digitizes them or lifts and shifts those into a new tool. In many respects, I would say the rush to implement EMRs (electronic medical records) over the past 10 to 15 years really was primarily a digitization event. We took the existing workflows and processes that our clinicians did every day, either in a different tool or on paper, and we digitized it into a new tool.

Brad Reimer: Just replicated it.

Jared Antczak: Yep. Yep. Digital transformation, on the other hand, really addresses the people, the process and the technology holistically and really fundamentally transforms the business and care delivery model. It doesn’t just superimpose technology on top of, you know, existing labor-intensive processes, but really transforms the who, the what and the how to create greater efficiencies, you know, improve productivity and enhance health care experience.

I think it’s really interesting, you know, a study from McKenzie a few years ago showed that over a 15-year time span health care delivery accounted for 9% of US economic growth, but a whopping 29% of net new jobs created during that same period. Yeah. So, you know, in other words, as health care demand increased, we as an industry hired more people and threw more bodies at it and deployed more technology when our productivity actually declined. Well, why is that?

And you know, as you look over the last decade or so, the primary technology that we’ve deployed in health care has been the HER (electronic health record). And I think it’s important to note that the EHR isn’t necessarily designed to improve productivity. It’s designed to document ever increasingly complex requirements for regulatory and billing. And it really serves that purpose well. But the result has been that we’ve implemented a lot of technology and we’ve invested a lot of technology, but we haven’t recognized a whole lot of productivity gains.

So again, we did a whole lot of digitization, but not a whole lot of digital transformation. And that isn’t to say that digital transformation is easy. There’s a lot of culture change that comes with it. But we’d really like to hear some of your insights as well.

Brad, you know, I know you attended recently the, the Becker’s Health IT conference where you spoke on three different panels. I’d love to compare notes and better understand what are some of the key themes that you discussed with other experts in our industry? What did you think sets us apart as we think about our approach when it comes to technology?

Brad Reimer: We had some really good discussions at Becker’s and there were a few themes that kind of seemed to always be the undertone of each of those panels. One of ’em is just around the pressures of the health care industry is under.

I think it’s, you know, everybody that’s in the industry or is watching the industry knows that staffing’s a really, really big challenge. And it’s not just for nurses and caregivers, it’s across the IT spectrum. It’s across the data spectrum. HR, you name it, everybody is really under a lot of stress just from being able to have enough trained people in the right places to be able to care for our patients and take our business forward in the way that it needs to.

And then, you know, the financial pressures, and that’s part of it is when you don’t have the staffing in house, you’re having to pay more for contractors and temp staff and those types of things. Yeah. And that, along with supply chain challenges, the inflation, just some of the global unrest. There’s a lot of things that are influencing and impacting kind of the slim margins that health care already has.

And at the same time, we’re trying to figure out how do we invest more in digital? So we’re getting pressure from the expense side, but we also know that we’ve got this transformation that needs to happen. And that’s not free to do. So finding that right balance is tricky. And I think that every health system is trying to figure out right now is how do we make sure that we do pay attention to the financial situation that everybody is in, but not stop investing in what the future is.

We also talked a lot about and what I’m kind of terming is the modern data health care ecosystem. And there’s, I think, a growing acknowledgement that data systems, just like you said, have really been focused around the EMR the last 10, 15 years. And it has been an appropriate center of gravity for a lot of those solutions and the way that we think about things.

But the tide definitely is shifting and we’re seeing so much more data created outside the EMR that we’ve gotta figure out what are we gonna do with it? Cuz not all of it belongs back in the EMR. Some of it does, and some of it is truly patient record type things, especially if they’re, if it’s data that’s used in assessing a patient’s condition or in providing some type of a treatment, we do need to make sure that that’s back in part of the medical record, but not all of it. Not every heartbeat that your watch is monitoring needs to flow back into the EMR.

And when you think about the proliferation of wearables and wellness wearables and the remote patient monitoring devices that we’re gonna provision and send out to patients to take home with them, all of that data, we’ve gotta figure out what the value is and where we should put it, and then how we should leverage it. So there definitely needs to be a new model, and hopefully it is somewhat standardized across the industry of how we do that.

And one of the challenges that everybody kind of acknowledged is we’ve got a lot of investment with venture capital and those types of things in the health care IT right now. And a lot of ’em are focused on this digital transformation and the new patient journey and new patient experience, but they’re all these little siloed applications, right? And they all have their own data model, and they all have their own way of communicating or not communicating with the EMR.

And we’re gonna have to synthesize that. We’re gonna have to figure out how is that gonna work from a real-time transaction standpoint, how is it going to, from an analytics standpoint, how does it eventually feed into AI and those types of things. So I think the advancement of what we need to do with our data systems is paramount as we kind of think about the upcoming years.

And then I try to, when I know you do this as well, try to really kind of put that rural lens on just everything that’s happening with health care. And in Sanford, you know, 80% of our patients are really in that rural footprint. For other health systems it’s kind of the 80-20. There may be 80% urban, 20% rural. And if we’re able to find ways to implement best practices and we really understand the patient behaviors and those types of things for rural, we can actually set those and allow those best practices and those ways of doing care differently for health systems that aren’t necessarily focused on that as their primary constituency. So I do think that there’s a lot of opportunity for us to really be, not necessarily trendsetters, but really raise the tide for a lot of the nation that has rural health.

Jared Antczak: I love that. Couldn’t agree more.

Brad Reimer: So as you think about rural health and you think about digitization, what are some of the biggest things that you think are gonna be game changers?

Jared Antczak: Digital in rural, the digital landscape is constantly evolving. You know, new technologies emerge all the time. Consumer or patient preferences and expectations are constantly changing based on, you know, the interactions they have with other, you know, sophisticated digital experiences in their day-to-day lives. Caregivers’ workflow – caregiver workflows evolve the macroeconomic conditions that you just talked about exert pressure in different ways, right? And so, you know, I think for a lot of those reasons, you know, I always try to resist the temptation to propose you know, a big long three or a five year roadmap for our digital strategy.

Instead, we need to embrace, you know, an agile culture that really allows us to be nimble, responsive, and iterate quickly on the things that bring value into people’s lives. So that said, you know, when I consider I think some of the greatest opportunities in, you know, this next wave of digital solutions, I think there are many sources of inspiration all around us that can help us envision what the Sanford Health digital consumer experience could look like.

So, for example, I imagine a health experience that makes finding care just as easy as finding a product on Amazon and making a purchase or preparing for your visit. As simple as, and as intuitive as booking a ride with Uber, you know, managing my care as personalized as my Netflix profile that prompts me with, you know, recommendations for something to watch based on my interests and my viewing history.

So, you know, in order for that to happen though, these solutions, I think to your point earlier, need to be easily integrated into our core platforms and solutions. We can’t just have a bunch of standalone point solutions and expect it to be a good experience. There are way too many point solutions out there in the marketplace today. I’m reminded back in 2009 when Apple coined the phrase, there’s an app for that, right? And, and at the time that was really a good thing, but nowadays, nobody wants to download yet another app, right? Consumers want those frictionless, seamless, personalized digital experiences that meet their needs at every step of the journey. Not a bunch of fragmented point solutions that only solve bits and pieces along the way. So I think integration is really key to making that whole digital front door concept come to life that we’re all striving for.

Brad Reimer: Yeah. I’ve got way too much clutter on my phone. I’m deleting apps <laugh>, it’s like crazier right now. Yeah.

Jared Antczak: So Brad, there’s a lot of discussion in the industry around digital literacy, you know. What areas is Sanford investing in to help the adoption and the effectiveness of different solutions?

Brad Reimer: My view is that society as a whole is fairly literate with digital experiences and tools. It’s really in most parts of people’s lives other than health care. And it just hasn’t permeated health care in the same way. So I really look at the digital literacy piece kind of from two lenses. One is from the perspective of our patients and our communities, so those that we serve. And then we also have the digital adoption and digital literacy for our caregivers and our employees.

And there’s two different ways I think that we really need to kinda look at how we’re approaching that for patients. Data privacy’s always gonna be a concern, and I think it’s something they’re used to dealing with, like in their life around banking and those types of things. Health care brings a little bit different sensitivity to the privacy of my data. And I do think that that is something that may not be quite the barrier it would’ve been five years ago, but it is still something that is top of people’s minds.

We need to make sure that part of that literacy is their trust in the app or the solution that they’re using to make sure that their personal privacy is taken care of.

Aside from that, I think our patients and our communities aren’t only ready. They’re asking for more digital health care, like you said with Amazon. They’re using it in all other parts of their life, and they’re looking for that very similar experience. And I think as an industry, we do still have some settling in to do on are we going to provide too many apps and there’s gonna be clutter and there’s gonna be almost app fatigue, and we could over-index on just providing way too much technology rather than really having that empathy focused. Patient empathy is the center of how we’re designing these things, because not every moment that matters for a patient should be done digitally.

When you start looking at digital literacy from a, from a caregiver standpoint, we need to be able to make sure that we can differentiate those points that matter and approach them differently. So I’ve kind of compared it to, you know, fast food versus a home cooked meal. You know, there’s a lot of times where a very quick light touch routine and transactional experience is what you want. And it’s probably more efficient, it’s probably less expensive, it’s a lot more convenient, and there’s a lot of transactions that probably should be done that way. It’s your sore throat, it’s your skin rashes, those types of things.

But when you’re dealing with something that’s more serious, more personal, more life-changing in, it’s, it’s sensitive, the stakes are a little bit higher, you’re looking for a little bit more of a sit down home cook type meal situation, in my mind. You wanna be able to sit across the table from somebody, put some real meaty conversations on the table, and make sure that you can understand ’em and dive deep into ’em. And those are the situations that as a health care organization, we should be able to leverage digital tools to augment and help that situation. But it still needs to be a personal relationship built encounter with that patient. So part of the literacy is making sure that we’ve got the right focus on that.

Jared Antczak: I’ve always said that digital, the digital experience in health care can’t just be another lane in the highway. It has to complement and interweave. You know, patients need both, and we need to make it as seamless as possible.

Brad Reimer: The other thing that we’re thinking about with digital literacy was around the caregiver, specifically around AI or artificial intelligence. It’s a term that’s overused, and it’s a term that’s a lot of times misunderstood or underappreciated. So we’ve started to put some efforts towards demystifying AI for our caregivers. And what that looks like is helping them understand truly what is AI and what isn’t it.

When we talk about algorithms and models that have been trained within that AI situation, they should know how was the model trained? What data was used to train that model? Were the patients used in training that model representative of the patient sitting in front of me today or not? And so there’s a lot of things that are maybe a little intimidating for those that don’t understand the technical components. We need to get them comfortable asking the questions because it does make a difference in terms of how they’re thinking about incorporating AI into their care experience for their patients and making sure that it’s a good thing.

So we also talk about website manners versus bedside manners. And, you know, you hear a lot about that in the industry. It’s not something that we’ve came up with, but there definitely is, as we do more and more virtual visits, and especially as we’ve seen the adoption of virtual visits for behavioral health and those types of services, again, that patient empathy and being able to read body language and have a different type of experience through a video rather than in person. We do need to raise our game on that and make sure that we’re understanding some of the differences and some of the advantages it brings and some of the disadvantages that it brings and make sure that we’re bridging that gap.

Jared Antczak: I love that. I mean, the way that health care is delivered nowadays is very different. Technology is such a big part of every interaction. And so being able to empower our workforce and our clinicians with that website manner, I think is a really great concept.

Brad Reimer: So as you’ve been thinking about, you know, the opportunities in rural America and how we connect to our patients, what are the things that excite you the most?

Jared Antczak: I go back to a lot of, you know, the question that I just asked you around digital literacy, right? And I think that it’s so important to understand our patients, our consumers, and, you know, the needs that they have in their lives, and what their preferences and expectations are.

You know, building a new digital app or a website does no good for someone who doesn’t have the ability to use it. So, you know, that’s, it is just another example of a solution looking for a problem. So really starting with our patients and taking a very consumer first, patient first kind of approach to understanding the people in our communities and what their needs and their underserved needs are, I think is absolutely critical. So, you know, as the largest rural health system in the United States, we do have some unique challenges and opportunities that we need to address in order to make health care more accessible, equitable and affordable, you know, for everyone that we serve.

And, you know, digital literacy is just one component of a bigger category that we’ll call digital equity. And recent studies have suggested that digital equity is a social determinant of health, but it looks at things like digital literacy or, you know, how comfortable and confident are people downloading, registering, and navigating a digital experience, right?

But it also looks at things like internet access. Do people have access to broadband either through Wi-Fi or through a cellular signal? It looks at things like device availability. Do they have access to smartphones and tablets or laptops with cameras so that they can engage in a virtual care kind of experience? And so as we look at all of those different components, you know, that helps us to kind of hone in on how do we remove some of the physical, social and intellectual obstacles in people’s lives that would limit their ability to receive really equitable access to world-class care that Sanford Health can provide, especially in some of these rural communities.

You know, that said, as we’ve done some of our research and talked to our actual patients, we have learned some things. You know, going back to I think your earlier comment, many of our consumers in rural areas do in fact have similar expectations as our consumers in more urban areas.

You know, as an example, we found that more of our patients would prefer to schedule an appointment for a checkup online than to call and talk to somebody to schedule their appointment. We know that throughout the U.S. over 85% of the population has access to a smartphone. And so your earlier comment about the same people that use Sanford Health, even in our rural communities, are the folks who are ordering products from Amazon and who are engaging in other digital experiences on a regular basis – I think rings very true.

You know, we’re still learning more and more about the consumers in our communities and, you know, we’ll use those learnings to best inform how we might be able to serve them best. I think one of the most exciting prospects to me though, is the ability to leverage digital and virtual care tools to reach our consumers wherever they are, so that they can have access to care when, where, and how they want it.

So for our rural patients, that means, you know, not having to drive for hours in harsh winter weather, taking time off of school or work, or finding reliable child care or transportation just to be able to see their doctor. How might we be able to use some of these tools to make health care easier for them?

Brad Reimer: So can you talk a little bit about, you know, obviously the patient is the center of our focus, but a key component of that is the interactions that the caregivers are gonna have with those patients and their experience. And we all hear about the level of fatigue that there is right now within the industry with those caregivers. Can you talk a little bit about the type of experience changes that we could give to those providers? How do we get their buy-in into changing some of their behavior to leverage those tools and making sure that we can help reduce some of the burnout and the fatigue rather than adding to it?

Jared Antczak: Yeah, I appreciate that because I think it’s important to note that our digital strategy focuses on our caregivers and consumers alike. It’s just as important to serve our caregivers as it is to focus on our patients when we talk about how do we leverage technology in meaningful ways to remove friction in people’s lives and to create a good experience.

You know, throughout my career, I’ve heard sometimes this notion that if we do something that improves the patient experience, it must come at the expense of the clinician or vice versa. And I don’t think that that’s true. I believe that that’s a logical fallacy. I think there’s plenty of opportunities to really leverage technology and digital tools to benefit both the patient and the clinician simultaneously.

When I think of the caregiver or the clinician experience, I think of the ability for digital tools to really assist, augment, and automate tasks. You know, the three A’s that can really support our workforce. Caregivers enjoy their work more when they’re free to operate at the top of their license or at the top of their skillset. So, you know, to your question, getting buy-in from providers and clinicians means bringing them to the table from the very beginning and really understanding their needs and preferences, just like our consumers. And, and that really helps to ensure that we aren’t wasting our limited and valuable resources building the wrong things.

I think it’s important to note too, that, you know, sometimes I’ve seen organizations kind of get caught in the trap of focusing on the number of features that they’re able to develop, and the feature becomes the goal. Our measurement of success shouldn’t be necessarily the number of features we create, but really the outcomes that we achieve. So there’s sometimes a false premise that a good digital experience is all about, you know, the volume or the quantity of features, but they’re just really a means to an end.

You know, the goal is really the results and the outcomes that the features actually enable. We need to challenge the notion sometimes that, you know, we’ve always done it this way, and so we always have to do it that way and really ask ourselves why we sometimes make health care overly complex and complicated. In health care, we’re incredibly risk averse, and I think for good reason, right? If Amazon messes up your order, you might have a delay in receiving your product, or you might have a few extra dollars charged to your account that can ultimately be refunded. But if we make a mistake in health care, the results can be disastrous. Right? Right. Yeah. We’re dealing with people’s lives. Stakes are much different. Stakes are very high, right? So there’s very low tolerance for risk and for mistakes.

But that said, I think what we’ve essentially done is we’ve built a lot of our clinical and operational workflows around the exceptions rather than the rules because we’re so risk averse.

Yeah. And what I mean by that is we design our processes and our policies around those edge cases, but we apply those processes universally. So we might ask every patient at every encounter questions that only apply to a select few. And in some cases we build processes around a hypothetical situation that’s never even been experienced. But then we wonder why we have so much waste, inefficiency and diminished productivity in some of our processes. So I think that there’s a huge opportunity to create, you know, some smart logic and rules that can help us catch those edge cases and we can mitigate them, but at the same time, really design our processes around the majority of people that we serve. And that can help us to become, I think, a lot more productive and really alleviate a lot of the manual lift and burnout that our workforce, unfortunately, experiences at times.

I think of the best digital experiences are the ones that are the most simple. I think some of the best results often come from a removing things that don’t add value. You know, one of my favorite quotes from Steve Jobs, you know, the founder of Apple was when he said, I’m actually as proud of the things we haven’t done as the things that we have done. Innovation is saying no to a thousand things. So again, when I talk about digital transformation, addressing the people process and the technology holistically, you know, this is really what I mean, how do we simplify it and create a good experience.

Brad Reimer: Yeah. And focus on the right stuff.

Jared Antczak: All right, Brad, so this last question is for you. Sanford has provided more than 600,000 virtual consults with patients over the last decade. What have we learned about what works and what doesn’t?

Brad Reimer: So, one of the statistics that our vice president over virtual care gave me a couple months ago that just always sticks my mind, is that those 600,000 virtual consults that we have done has saved our patients over 20 million miles. And that’s just – that’s just astounding. That’s incredible. And you put, you know, like a mileage rate on that, you think about the gas at that cost, you know, even if it’s a, you know, a dollar per mile that’s $20 million back in the pockets of our patients. In my mind, that’s meaningful, especially for some of the areas that we serve that have some of the highest poverty levels, you know, across the U.S., those dollars make a difference. And it really is impacting the cost of health care, and I don’t think we can look away from that.

And that’s not considering, like you said, the time away from work people are having to take, typically it’s not just one person taking, you know, the drive and maybe the car ride’s not gonna be comfortable for ’em, depending on what their condition is. You know, in this neck of the woods we’re talking about winter roads and those types of things.

So there’s a lot of other benefits that we’re realizing that I think we kind of take for granted. And we’re still used to in rural America, you know, not thinking twice about driving an hour or two to get to a store, whatever it is that we want to get to. But if we can minimize that for this population, it really can be impactful. And then you start talking about, I think, more of the future with devices at home, hospital, at home being able to more proactively interact with patients to keep them healthy rather than just dealing with them when they are sick.

The future of virtual care, in my mind, is really, really positive. It has a lot of potential. And I think that the way we treat and the way we care for our patients and our communities over the next five years is gonna look much, much different than we have today. And it should be able to be better and it will be better.

The other part of it is part of those 600,000 visits have been more provider-to-provider. It’s been from maybe an ER that has a particular specialty physician in it to a rural critical access hospital. Maybe it’s for burn or for stroke, or for something that you want a specialist, but that specialist may not be in the most rural parts of the of the area. And we’ve had really, really good success. And I know that that’s a common model across a lot of health systems, but it’s particularly important around keeping health care close to these rural communities. And that’s what’s helped sustain some of these critical access hospitals in being able to financially be stable through COVID and through these other areas. They need that specialty care.

It is much better for the patients to be able to be treated close to their home and not have to jump in an ambulance and go for an hour. And it’s really impactful for the for the care and well-being of our patients. And really excited to see how that continues to expand over the next few years as well.

Jared Antczak: So, a lot of really exciting work. I appreciate the conversation, the dialogue. This has been fun. I’ve learned a lot from you and look forward to continuing to work together to serve our clinicians and our caregivers and our consumers and our communities. I think the future is very bright for Sanford Health.

Alan Helgeson (Host): 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 For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

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