Advancing Health Podcast

00:00:01:04 - 00:00:36:12
Tom Haederle
Welcome to Advancing Health and part two of the conversation on cybersecurity attacks against rural hospitals, and what can be done to protect against them. In this conversation between John Riggi, the American Hospital Association's national advisor for Cybersecurity and Risk, and Justin Spelhaug, corporate vice president of tech for Social Impact, Microsoft Philanthropies, we learn more about the role tech leaders can play in helping rural health care providers cope with cyber attacks and preserve their ability to care for the nearly 60 million Americans who depend on them.

00:00:36:14 - 00:00:45:02
Justin Spelhaug
So the impact is clearly disruptive on these hospitals, clearly disruptive. Now, John, what can these hospitals do to protect themselves?

00:00:45:04 - 00:01:04:21
John Riggi
So there's many things that they can do. There's many things they need to do. But again, it generally comes down to a resource issue. So we generally say start with the basics. Look at your tools and policies. We know that there are certain cybersecurity practices, basic practices that can help mitigate the risk of the majority of cyberattack.

00:01:04:27 - 00:01:33:13
John Riggi
So example: multi-factor authentication, unified identity management, cybersecurity training for staff. We know that most of the attacks still start with those phishing emails, a psychological technique versus technological. Another step: join the Microsoft cybersecurity program. You all have been very generous in offering free cybersecurityassessments, curated learning pass product discounts to all rural hospitals in the U.S.

00:01:33:16 - 00:01:53:03
John Riggi
And I mean, these are the type of things that we need to do together to help shore up the defenses of rural hospitals. Now, Justin, can you tell us more about the Microsoft cybersecurity program for rural hospitals in the role you see technology leaders having in addressing these challenges?

00:01:53:05 - 00:02:17:22
Justin Spelhaug
Yeah, for sure, John. And of course, the technology leaders in these hospitals are on the frontline of driving change, and they're managing everything end to end with really limited resources. And so we wanted to pull together a program that would provide them more capacity, more capability to respond to the threats that you've just highlighted. And really, there are three big buckets. New offers that help make our technology more affordable.

00:02:17:24 - 00:02:41:18
Justin Spelhaug
That's bucket one. Bucket two is capacity building services to help organizations respond. And then bucket three is new innovation to help rural hospitals have more impact, particularly with AI. So let me click into those just really specifically for just a moment. In bucket one, in terms of new affordable offers, we're providing those hospitals that typically have the least resources.

00:02:41:18 - 00:03:28:10
Justin Spelhaug
And so that's independent critical access hospitals and rural emergency hospitals, those that are not in a health system, they can access Microsoft nonprofit pricing, which can provide up to a 75% discount for things like Microsoft 365 off of commercial pricing. So that goes a big way in helping some organizations really get access to affordable technology. Now, all other rural hospitals in the U.S. that are using Office 365 or M365 can get access to one year free of our most advanced security suite, Microsoft 365, E5 security and EMS E3 for one year to ensure that they can take action on their infrastructure immediately.

00:03:28:13 - 00:03:55:22
Justin Spelhaug
We've also for everybody, we've extended one year of Windows 10 Extended Security update at no cost. So that's on the technology side. On the capacity building side, we're providing every rural hospital in America, over 2000 hospitals, free security assessments, through a pre-vetted Microsoft security partner to help them evaluate their risks and identify strategies to mitigate those risks.

00:03:55:24 - 00:04:19:08
Justin Spelhaug
We've also, in this bucket, put together curated learning pathways for both technical staff and non-technical staff. And then the third area is AI innovation. Now, John, you were highlighting how stretched the finances of rural hospitals are, and CHQPR reports - and you said, John, that 30% of all rural hospitals are at risk of closure - that's a real statistic.

00:04:19:10 - 00:04:46:20
Justin Spelhaug
And that means that funding is limited and funding is limited for security expertise and the services that they need. So to help tackle this challenge, we've launched a Microsoft Rural Health AI lab, which we affectionately call RAIL, that is developing tools to help improve both financial and health outcomes. The first tool we built, which is in testing now with a number of hospitals, is an AI tool to support managing denied insurance claims.

00:04:46:27 - 00:05:08:15
Justin Spelhaug
We know that's a massively manual process for many hospitals. We know that if we can manage that more effectively, we can improve hospital revenue, which improves all outcomes. We've also been working to deploy nuance to improve patient and physician nurse experience through AI. And we continue to look at how we can use AI to support hospitals for a number of other scenarios.

00:05:08:18 - 00:05:40:22
Justin Spelhaug
Since we launched it, nearly 500 hospitals have registered for the program. That's about 24% of all the hospitals in the country. And that's in about the last four months. Over 335 hospitals are participating in a cybersecurity assessment, and many are getting access to the offers as well. And this is, John, part of a broader commitment to rural communities. We've been investing for years, actually, in rural communities, both tackling the broadband divide in America, as well as investing in innovation in rural communities through our Tech Spark initiatives.

00:05:40:22 - 00:05:46:26
Justin Spelhaug
So this is just the next step that we're taking for this acute challenge that we're dealing with at the moment.

00:05:46:28 - 00:05:54:12
John Riggi
Since launching the cybersecurity program for rural hospitals. Let me ask you, Justin, what has Microsoft learned?

00:05:54:15 - 00:06:15:25
Justin Spelhaug
Yeah. You know, John, we've learned a lot. And, you know, as I mentioned before, we've engaged just about 500 hospitals. And our learnings really break into two categories. So if you're watching this and you are a cybersecurity professional, pay attention to this next section because I want to tell you what we're learning from the hospitals that we're engaging with directly.

00:06:15:27 - 00:06:42:06
Justin Spelhaug
Four key technical learnings that we're having. Number one, privileged account management is the top liability that we're seeing in many rural hospitals. Only 25% of rural hospitals adequately separate end user and privileged accounts, i.e. those accounts that have broader access to systems and data. Getting that segmentation is critical in terms of protecting your footprint. That's probably learning

00:06:42:09 - 00:07:11:20
Justin Spelhaug
number one. Learning number two is mitigating known vulnerabilities, running basic vulnerability scanning, doing timely patching, establishing processes to remediate those issues. Only 49% of hospitals that we're working with right now receive passing scores on being able to mitigate vulnerabilities quickly. That's because they're stretched. They're doing everything. They've got a limited amount of resource. That's really the truth. But it's a challenge nevertheless.

00:07:11:22 - 00:07:45:22
Justin Spelhaug
Number three, less than 65% of rural hospitals have implemented some of those basic cybersecurity best practices that you were highlighting, John. So email security, about 63% of hospitals. NFA, probably the number one thing we need to implement right now to protect against some of these threat vectors, about 64% of hospitals. Network segmentation, about 62% of hospitals. So A, it's good that we've got 60 something percent implementing these technologies, but we have 35-40% of hospitals that remain exposed and uncovered.

00:07:45:22 - 00:08:24:02
Justin Spelhaug
So that's what our program is trying to get at and get across. And then number four, while most rural hospitals scored well across the category of asset management, one subcategory, which is super critical, endpoint management is a substantial risk for rural hospitals. Less than 35% of assessed hospitals met the expert informed passing score for endpoint management. And if you remember what I said about ransomware, the ransomware is coming through those devices that do not yet have endpoint management comprehensively, you know, securing them.

00:08:24:02 - 00:08:46:26
Justin Spelhaug
So that's a real challenge as well. So there's a lot of work to do, a lot of work to do across the community. Now, the second category is that this challenge is enormous. And we're talking about over 2000 hospitals here in the United States. And it is going to take strong public private partnership with, I think, a real shared spirit both of collaboration

00:08:46:26 - 00:09:07:07
Justin Spelhaug
but John, like you have, urgency. Because this is a life and safety issue as you mentioned. This is people's lives at stake and livelihoods of communities at stake. And this relates to technology. Certainly we need to get the technology out there, but it also relates to funding, developing long term cyber skills, job pathways in these communities, broadband access,

00:09:07:08 - 00:09:25:22
Justin Spelhaug
there's a lot of different things that we need to get done. And, you know, Microsoft is all in. I know AHA is all in. And we're going to need more partnerships to tackle the size of this challenge. Another question here for you, John. You know, how can we collectively address the near-term risks of cyberattacks for rural hospitals?

00:09:25:22 - 00:09:29:07
Justin Spelhaug
Some of those issues that I just talked about from your vantage point.

00:09:29:10 - 00:10:07:10
John Riggi
First, I absolutely agree with all of those basic cybersecurity hygiene controls, procedures, policies that you've discussed. In fact, if hospitals are in fact looking for kind of a clear and concise list of these practices, starting with that multifactor authentication, unified identity management privilege accounts, you can go to, HHS' website - Health and Human Services website - where they have a list of ten essential cybersecurity practices and ten enhanced cybersecurity practices.

00:10:07:10 - 00:10:27:01
John Riggi
These are voluntary at the moment. They may become minimum mandatory at some point, but that's a good place to get that concise list, which includes all those recommendations that you made. And then ultimately, hospitals have to have the resources, not just a list to help implement these measures effectively.

00:10:27:03 - 00:10:56:13
Justin Spelhaug
Yeah they do, John. You know, we've also learned to remediate many of the risks that we're seeing to bring partner services in. If a hospital wanted to fund that, let's say they didn't have the staff, maybe between $30,000 or $40,000 per hospital to get those immediate issues addressed. You multiply that by 2000 hospitals. That's $60-$80 million, which in the grand scheme of things, and we're talking about rural America and rural communities, is a big number

00:10:56:13 - 00:11:16:03
Justin Spelhaug
but it's not that big of a number. And we need to be mobilizing all of the resources we can to tackle that. Now, of course, there's more systemic challenges, such as the skills in the community and ongoing challenges to maintain the environments and to upgrade the software and the hardware over time. That's going to require systemic, capacity building, systemic sources of funding.

00:11:16:03 - 00:11:37:05
Justin Spelhaug
But that has certainly been a learning we've had as well. So, John, as we kind of conclude the discussion, how are you thinking really about insuring rural hospital resilience long into the future? Sure, we're facing these challenges right now, but how do we create resilience over time?

00:11:37:07 - 00:12:23:28
John Riggi
Again, great question, Justin, because that's really what this is about. It's about the long game. If we just address the near-term tactical threat that will not secure our future against these threats, nor will it secure our rural communities in the future. So really, what we do need is this sustained support from both public and private sectors to kind of help bolster these resources and really this continuing partnership in innovation across the rural areas, these public private partnerships, and we need to continue to invest in innovative solutions, workforce development, collaborative efforts to address these both systemic challenges, these international challenges, the strategic threat and then ultimately which translates down to the patient care and safety

00:12:24:00 - 00:12:32:07
John Riggi
risk. Again, what good is needed this continued whole-of-nation approach, and we're proud to have Microsoft as a partner in that effort.

00:12:32:10 - 00:13:12:15
Justin Spelhaug
Now we're proud to partner with you, John. AHA has been just such a staunch supporter, first of the rural hospital community and really advocating for that community broadly, getting partners like Microsoft to the table, helping us formulate effective strategies that provide as much capability to as many hospitals as we possibly can. And, we remain super committed to this effort and look forward to working both with you, other public and private sector partners that want to come together, that are of like mind, that want to collaborate, that are feeling the urgency like we're feeling and seeing the urgency and support these essential hospitals and these essential communities all across America.

00:13:12:18 - 00:13:25:18
John Riggi
Thank you, Justin, and thank you Microsoft. It's been a great pleasure discussing this important topic with you today, and look forward to our continued partnership to help defend America's hospitals against these cyberthreats.

00:13:25:20 - 00:13:34:02
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:00:01:04 - 00:00:45:24
Tom Haederle
Health care tops the list of critical infrastructure targeted by cybercriminals. These threat to life crimes hit every hospital hard, but rural providers even harder due to fewer resources and generally smaller IT staff. The average recovery cost from a ransomware attack is $11 million, a vast sum that leaves many rural hospitals one cyberattack away from closure. In today's podcast, we hear from John Riggi, the American Hospital Association's national advisor for Cybersecurity and Risk, and Justin Spelhaug, corporate vice president of tech for Social Impact, Microsoft Philanthropies, about the steps rural providers can take to reduce the risk and impact of a ransomware attack.

00:00:45:27 - 00:01:13:18
Justin Spelhaug
I'm Justin Spelhaug the corporate vice president of tech for Social Impact here at Microsoft Philanthropies, and I'm joined by my co-host John Riggi, the national advisor for Cybersecurity and Risk at the American Hospital Association. And we're here today to discuss critical issues of cybersecurity in rural hospitals, and how our partnership is coming together to tackle the challenges that so many rural hospitals are facing across America.

00:01:13:19 - 00:01:17:09
Justin Spelhaug
So thank you for joining us. And John, thank you for joining us. Good to see you here today.

00:01:17:12 - 00:01:20:24
John Riggi
Good to see you too, Justin. It's always great to partner with you.

00:01:20:26 - 00:01:30:09
Justin Spelhaug
Well, John, you know, as the expert in hospital cybersecurity, can you tell us why rural hospitals are particularly vulnerable to cyber attacks?

00:01:30:11 - 00:01:58:19
John Riggi
Justin, great question. There's really a number of factors about that. First, the impact of the physical distance on patient care and mortality when a hospital is shut down by a ransomware attack. For example, rural hospitals provide critical health services to about 60 million Americans, or nearly 20% of the US population. Rural residents already must travel more than twice as far as urban residents to reach the nearest hospital.

00:01:58:22 - 00:02:30:22
John Riggi
So when you have this increased travel distances, they are directly associated with higher mortality rates for time sensitive conditions like heart attack, stroke or trauma. And then you're diverting these patients during a ransomware attack, again just magnifying that risk. Then there are the resource challenges, financial constraints and skill shortages. Low operating margins due to patient volumes, high fixed costs relative to urban hospitals. And rural hospitals are more likely to have older technology and smaller IT support staff.

00:02:30:27 - 00:02:59:06
John Riggi
This impacts the resources to implement key cybersecurity measures, creating really, unfortunately, an ideal opportunity for exploitation for cyber criminals. The average cost of addressing cyber attacks - now this is the cost after you've been attacked - the cost to recover is almost $11 million. I mean, just an enormous, staggering amount for the average rural hospital. Thirty percent of all rural hospitals are already at risk of closing,

00:02:59:08 - 00:03:22:09
John Riggi
so they can be only one cyber attack away from closure. And then, of course, as I indicated, there's a skill shortage. Very difficult to get your best cyber security professionals to work in rural areas. The salaries are generally not as competitive as urban areas or even other industries, so you compile that...it's extremely challenging to get good experienced

00:03:22:10 - 00:03:53:22
John Riggi
IT staff to work in rural America. And then we have geopolitical factors making rural hospitals kind of unique targets. So over the past 12 months, cyber attacks against hospitals have increased about 130%, making them the top critical infrastructure that's targeted by cybercriminals. And make no mistake, they know when they target a hospital, lives are threatened. In fact there's now even evidence that nation-states are collaborating with criminal groups.

00:03:53:24 - 00:04:04:21
John Riggi
Justin, I know Microsoft keeps a very close eye on the evolving threat landscape. Can you talk to us a bit about the trends you're watching that might affect health care organizations?

00:04:04:24 - 00:04:27:13
Justin Spelhaug
I can and John, thanks. I mean, your feedback that hospitals are only, you know, one cyberattack away from closing, especially the rural hospitals that are very stretched, is just really eye opening. And when we look at the challenge facing hospitals, but frankly, many different kinds of organizations, one of the reports that we produced is a Microsoft Digital Defense report.

00:04:27:18 - 00:04:51:13
Justin Spelhaug
Now, we use about 78 trillion security signals a day from Windows and Cloud endpoint devices to inform this report. We've got security engineers and intelligence analysts tracking about 1500 unique threat groups all around the world. And the trends I'll talk about here are relevant for every industry. But as you said, John, it's impacting health care and it's impacting rural health care in particular.

00:04:51:17 - 00:05:32:03
Justin Spelhaug
So let's talk about a couple of the trends. The first one is that we're continuing to see a massive escalating intensity on password based attacks. When we look at our Microsoft entry data, we see organizations being barraged by about 600 million identity attacks per day, and 99% of those are password based. Now, advances such as zero trust architecture, conditional access policy, MFA have helped defend against this. But we're seeing hackers work around MFA, targeting infrastructure and applications and bypassing authentication altogether.

00:05:32:03 - 00:05:59:15
Justin Spelhaug
And that's why advanced monitoring and threat detection capabilities inside of an environment are so critical. So that's the first theme. The second theme that we see is nearly a 3X increase in year-over-year human operated ransomware attacks. They're attacking health care. They're attacking rural hospitals. They're attacking nonprofit. They're attacking schools, they're attacking sensitive government infrastructure. Now, on the good news

00:05:59:15 - 00:06:27:25
Justin Spelhaug
if there is any good news anywhere in this story, is we see a significant decline year-over-year in attacks reaching the encryption stage and locking up resources. And that's because of the deployment of automated attack disruption tool. It is also endpoint protection deployment 92%, 92% of all successful ransomware attacks involve the attacker going through unmanaged device on the network.

00:06:27:27 - 00:06:50:08
Justin Spelhaug
And it's also about increased training and awareness across the employee base in every organization. But we need to keep making progress because as you know, John, you said the average recovery was about an $11 million investment when they break through. It's devastating, for a rural hospital in particular it's devastating. We're also seeing a third theme and that's the ingenuity of fraud

00:06:50:08 - 00:07:20:26
Justin Spelhaug
tactics are quickly evolving. We saw growing sophistication of investment scams, tech support scams are particularly impacting hospitals and more. At the same time, we're seeing impersonation getting more sophisticated, in fact, and detection more difficult because of the access to deepfake technologies that cybercriminals are using. And globally, the World Economic Forum reports that scammers stole over 1 trillion in U.S. dollars from the global economy in 2023.

00:07:20:26 - 00:07:54:11
Justin Spelhaug
So the massive, massive impact. Then finally, John, something that you mentioned, nation-states. We're seeing actually blurred lines between nation-state threat actors and cybercriminals. They're partnering together to advance each other's objectives and in particular monitoring and see Iran, who appears to be the most active nation-state actor targeting health care organizations specifically. Perhaps the most acute impacts and the biggest headlines have been in the health sector, certainly over the last 12 months.

00:07:54:13 - 00:08:13:15
Justin Spelhaug
And when you talk about a small rural organization or a rural hospital, John, as you just did with less resources as you just talked about to protect themselves and respond. We know why, you know, hackers are targeting these organizations and why it is such a huge challenge for us here in the United States. So big challenges all around.

00:08:13:17 - 00:08:25:04
Justin Spelhaug
Now, John, those are the challenges. Can you talk a little bit about the impacts you're seeing these cyber attacks actually have on hospitals and maybe even more importantly, the communities that they serve?

00:08:25:06 - 00:08:56:17
John Riggi
As you know, the AHA has been a very loud voice signaling what the impact is of these ransomware attacks on hospitals. Unfortunately, this isn't just about the protection and privacy of data. It's very important, but most importantly is the disruption to patient care. These attacks have caused significant disruption and delay to health care delivery when hospitals are attacked directly or through some third party attack that results in a disruptive effect.

00:08:56:24 - 00:09:31:09
John Riggi
And we all know that when there is disruption and delay to health care delivery, patient safety is placed at risk. Lives are threatened. The bottom line: these attacks are not just data theft crimes. These are threat to life crimes. And again, they're not only going after hospitals, but after our mission critical third party providers. For instance, the Change Healthcare attack: the largest, most consequential cyberattack against health care in history, compromised the health care records of 100 million patients, 100 million Americans, costing the sector $100 million a day.

00:09:31:12 - 00:09:57:23
John Riggi
And then ultimately disrupting health care delivery. But it's not just the big organizations that are attacked. And of course, when a rural hospital is attacked, there's an outsized impact to the community they serve. Because these attacks, as we have seen, are not just attacks on the hospital as an organization. It's an attack against the patients inside the hospital and against the entire community

00:09:57:23 - 00:10:26:11
John Riggi
that depends on the availability of that hospital. A couple of years ago, we had an attack on Sky Lakes Medical Center in southern Oregon. Their 90 bed hospital serve about 120,000 people across 10,000 square miles. Their next nearest hospital, 72 miles away. And when this attack occurred and encrypted their systems forcing them to shut down many of their services, it was very, very significant disruption.

00:10:26:11 - 00:10:54:01
John Riggi
And that disruption lasted about 28 days. They had to use 60,000 sheets of paper for clinical documentation. Fortunately, they did not have to pay the ransom. They had the capability to recover and restore independently. But again, significant impact to patient care delivery. And even after it hired extra staff, it took some six months to input all the paper records into the system.

00:10:54:03 - 00:11:23:00
John Riggi
So the organization spent about $10 million, a huge expense that was not covered by insurance to overcome this attack. And we have to thank Skylights Medical Center for coming forward to share best practices and lessons learned so we can all help prepare for the impact of these attacks. Unfortunately, I have many examples of how these attacks affect the patients in these rural hospitals, but also threaten the safety of the entire community.

00:11:23:03 - 00:11:45:10
John Riggi
A couple years back, I got a call from a hospital in the Pacific Northwest, and they were talking about an attack that they were experiencing, but there were two other hospitals that were also under attack. And so their natural diversion points no longer existed. And they said, John, we are very, very concerned because our next nearest emergency department is 125 miles away.

00:11:45:16 - 00:12:02:21
John Riggi
Said John, we've got a medevac parked in the parking lot, but we already are in the state. It actually snows in the winter quite a bit, and we're expecting a storm to come in. If that happens, our medevac can't fly. And if we get a stroke, heart attack or trauma patient, that patient's going to have to go ground transport if it's even safe.

00:12:02:23 - 00:12:21:20
John Riggi
And unfortunately, we don't think that patient would make it under those conditions. That's how deadly serious these attacks are. And that's why we always say and tell the federal government that these attacks - make no mistake - the bad guys know what they're doing in the hospital. They're threatening lives. These are threat to life crimes.

00:12:21:22 - 00:12:39:29
Tom Haederle
Thanks for listening to part one of this podcast. Please join us on Wednesday for part two as we continue this important conversation on cybersecurity for rural hospitals. Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcast.

00:00:01:05 - 00:00:29:17
Tom Haederle
Welcome to advancing Health. Every hospital, every day and everywhere is striving to improve its quality of patient care. As the winner of the American Hospital Association's prestigious 2024 quest for quality prize, WellSpan health serving 12 counties in Pennsylvania, is among the best at advancing health for those who depend on it. In today's podcast, we learn more about how the efficiencies WellSpan adopted during the pandemic are still in place and still paying dividends today.

00:00:29:20 - 00:00:43:05
Tom Haederle
Your host is Doctor Mindy Estes, former president and CEO of Saint Luke's Health System and former chair of the Board of trustees.

00:00:43:07 - 00:01:19:27
Mindy Estes, M.D.
I'm Dr. Mindy Estes, and today we have the privilege of speaking with Dr. Roxanna Gapstur, the president chief executive officer of WellSpan health, a position she has held since January 2019. Doctor gaster brings over 25 years of extensive health care leadership experience, having worked across various settings including practices, academic institutions and integrated health systems. Her background in strategic planning, business development and operational leadership, both at ambulatory and hospital settings, has been instrumental in her success at, well, speed.

00:01:20:00 - 00:01:36:03
Mindy Estes, M.D.
So let's just dive right in. To begin, can you provide our listeners with an overview of WellSpan health and its mission? Understanding the foundation of the health system gives context to the strategic discussions we'll be talking about today.

00:01:36:06 - 00:02:04:24
Roxanna Gapstur, Ph.D., R.N.
Yes, absolutely. WellSpan health is an integrated care delivery system in central Pennsylvania. We serve 12 counties and about a million and a half people have nine hospitals, 23,000 team members and about 2500 providers in our system. We are the largest provider of behavioral health in our region, and we also have a clinically integrated network which provides a basis for our value based care strategy.

00:02:04:26 - 00:02:07:27
Mindy Estes, M.D.
So your geographic footprint is quite large.

00:02:07:29 - 00:02:16:00
Roxanna Gapstur, Ph.D., R.N.
It's about 12 counties now in the center of the state. Yeah. We've been growing and serving more patients each and every year.

00:02:16:05 - 00:02:44:12
Mindy Estes, M.D.
Were you in WellSpan in 2019? And soon after a small event happened, the world was confronted with the Covid 19 pandemic. And despite these challenges, WellSpan was noted for maintaining high quality care and extensive community support. Could you share 3 or 4 critical factors that enabled your leadership team to be successful during this period, and what you've taken from it since?

00:02:44:14 - 00:03:11:23
Roxanna Gapstur, Ph.D., R.N.
Yeah, absolutely. One of our values here at WellSpan is working as one. And I think this was a moment for us to really live that value. And throughout the pandemic, we were able to rapidly adapt to changes. We practiced agility, and we practiced one of our other values to find a better way. We have a significant focus in a pretty big community health team that works across central Pennsylvania.

00:03:11:25 - 00:03:40:22
Roxanna Gapstur, Ph.D., R.N.
And little did we know that the pandemic was going to highlight some of the challenges. And that team really helped us respond quickly to some of those challenges. We focused significantly on the well-being of our team. Again, I think we all found at the beginning of the pandemic, perhaps this wouldn't last a long time. But as the pandemic went on, we needed to make sure that our team was taking care of and being one of the largest providers of behavioral health services.

00:03:40:22 - 00:04:03:24
Roxanna Gapstur, Ph.D., R.N.
We had pretty significant internal resources that we were able to bring to that issue. And then finally, we really empowered our teams to think differently. And at one point during the pandemic, even had developed our own N95 mask. So I think those were were some of the pieces that were most important because we unleashed the innovation within our own teams.

00:04:03:27 - 00:04:21:26
Roxanna Gapstur, Ph.D., R.N.
We were able to move pretty quickly on things like the outdoor testing, things like out-of-pocket costs. We were one of the first in the nation to say that we would provide things without charge. Really proud of the team for embracing agility and making sure that the well-being of our teams were front and center.

00:04:21:28 - 00:04:49:18
Mindy Estes, M.D.
You know, I want to pick up on something that you said, most of us in health care study things, and we study things for a long time, and then we pilot things, and sometimes we're pilot things. And I think the Covid crisis, if you think about making lemonade out of lemons, really told us that we could be agile, that we could make decisions quickly and in TAC one way or the other if we needed to.

00:04:49:21 - 00:04:55:13
Mindy Estes, M.D.
And the question I have for you, have you been able to maintain that agility?

00:04:55:15 - 00:05:23:13
Roxanna Gapstur, Ph.D., R.N.
We have actually, so was one of the things that we said to ourselves during our after action reviews that what were some of the silver linings of Covid, and how might we continue to capitalize on those? And one of those was being agile and making decisions quickly. I think because we are locally governed and one of the only health systems in our area that is locally governed, it helps us make decisions quickly because our headquarters are here and our family, friends and neighbors are here.

00:05:23:13 - 00:05:40:27
Roxanna Gapstur, Ph.D., R.N.
And so that is something we've been able to maintain. One of the things that I did with my team during Covid was we split into two teams. We had one team really focused on our long term strategy and another team that just focused on operations and taking care of patients each and every day. We've used that as well.

00:05:40:28 - 00:05:49:02
Roxanna Gapstur, Ph.D., R.N.
Since the pandemic ended, it was a great way for us to still make progress on some things, even though, you know, we had a lot on our plates.

00:05:49:05 - 00:06:06:24
Mindy Estes, M.D.
Well, you make an important point. The work of health care and the future of health care and what what we as organizations were going to do once the immediacy of the pandemic was over, it was tempting to put that on the back shelf and get back to it. But, you know, once you let it go, it's very difficult to restart.

00:06:06:25 - 00:06:28:21
Mindy Estes, M.D.
One of the things I was impressed by that I think goes into this long term thought, is that you had low nursing staff turnover during the pandemic. What strategies did you implement to have such a successful retention of nursing staff during, admittedly, an incredibly stressful and unknown time?

00:06:28:24 - 00:06:51:04
Roxanna Gapstur, Ph.D., R.N.
Yeah, that's a great question. I think one of the biggest areas was just the focus on the well-being of the team. We had a lot of peer to peer support going on, as well as our psychologists and psychiatrists across the system, working with our frontline care teams every single day. So we had real time coaching and support on all of our units.

00:06:51:07 - 00:07:12:26
Roxanna Gapstur, Ph.D., R.N.
We also did a lot of state interviews and a lot of work on understanding what people needed now because as you know, you know, things evolve during Covid and lots of changes happened over those 2 or 3 years. I would say a benefit to us is that generally, our region tends to lag a little bit on things that occur.

00:07:12:26 - 00:07:31:27
Roxanna Gapstur, Ph.D., R.N.
So we saw surges in new Jersey and New York prior to central Pennsylvania getting those same surges. And so we were working to try and learn from our colleagues and maybe what was coming. Our way, and how we could do a better job with our teams and with our nurses. So those were some of the things we did.

00:07:31:29 - 00:07:40:13
Roxanna Gapstur, Ph.D., R.N.
I think later when you ask about innovation, if you do, I can talk a little bit about some of the innovations we've done in nursing that I think also made a difference.

00:07:40:15 - 00:07:46:00
Mindy Estes, M.D.
Well, how about we just speak a little bit about innovation right now, particularly in nursing?

00:07:46:02 - 00:08:11:23
Roxanna Gapstur, Ph.D., R.N.
Well, certainly virtual nursing is something that we have rolled out across our system, which has made a really big difference in the satisfaction of our nurses, both in the time they spend and documentation. But the amount of time they're able to spend with their patients. So that's one area. We've also have tiered huddles in our system. So each day, seven days a week actually we start with tiered huddles around seven in the morning.

00:08:11:23 - 00:08:33:23
Roxanna Gapstur, Ph.D., R.N.
And those go until nine. At 9:00 is my huddle. So every day I know by 9:00 exactly what's happening in the system, and we're able to solve problems at the right level. So we have sort of tiers one through six. A lot of things are still at tier three and below or tier four and below, but those things that can't be are elevated to the senior leaders.

00:08:33:23 - 00:08:50:24
Roxanna Gapstur, Ph.D., R.N.
And we put a team on it right then and there. So I would say compared to when I first arrived at WellSpan, that we solve our problems more in real time. We're more situationally aware and we're able to prevent problems from happening because we have that focus.

00:08:50:26 - 00:09:21:03
Mindy Estes, M.D.
Well in solving problems where they're best solved. You know, is helpful for everyone. And you go away from that huddle knowing what you need to do and how you need to go forward. I think a lot of people perceive central Pennsylvania yet as a relatively homogeneous area, but WellSpan serves a diverse community. Can you discuss how you engage these diverse groups and provide resources while respecting their cultures and their autonomy?

00:09:21:05 - 00:09:53:15
Roxanna Gapstur, Ph.D., R.N.
Yeah, absolutely. I think a lot of Not-for-profit health systems feel very connected to their community and have different strategies. And certainly in my other roles in other states, even, I felt that connection. WellSpan has maybe a deeper connection than any I've ever experienced. And we have different ways of showing that. So each of our counties and our regions has a healthy county coalition, and WellSpan actually leads most of those coalitions.

00:09:53:18 - 00:10:23:18
Roxanna Gapstur, Ph.D., R.N.
But we don't try to do the work of the experts in our nonprofit organizations. Rather, we might be a convener, we might be a partner, we might be a funder. In some instances, we're working together alongside and with and the population across central Pennsylvania, as you mentioned, are more diverse. And I realized when I first arrived here, certainly the plan community is one of our largest stakeholders, and we serve a significant number of people from that population.

00:10:23:24 - 00:10:52:27
Roxanna Gapstur, Ph.D., R.N.
We have special cultural liaison individuals who work with our planning community. It's really important to have those relationships, and we've done that for more than 20 years. We also have special bundle payment programs and other types of programs that fit culturally for that particular action. And I will say during Covid that Covid was difficult for that population because of the amount of family interaction they prefer to have in their health care experiences.

00:10:52:29 - 00:11:24:06
Mindy Estes, M.D.
I want to skip to the notion of gun violence in workplace violence, workplace safety, community safety. You know, gun violence is a growing concern for all of us. And you've really taken an active role in addressing this issue in New York, Pennsylvania. And I really and I know our listeners would be interested in having you elaborate on when your efforts to reduce gun violence, the partners involved, the progress made thus far.

00:11:24:12 - 00:11:34:19
Mindy Estes, M.D.
And my sense is that this is one of these issues, that the minute you take your foot off the gas, it comes back. So talk a little bit about what you've been doing.

00:11:34:22 - 00:12:01:00
Roxanna Gapstur, Ph.D., R.N.
Well, I, I can't say enough about what the teams have done in this region on gun violence. It's an issue across all of our communities, but I would say probably more acute in New York County. And that's where we've done a significant amount of the work over the past three years. Probably the biggest piece of this has been understanding both our role and then what the role of others might be in helping prevent gun violence.

00:12:01:02 - 00:12:28:26
Roxanna Gapstur, Ph.D., R.N.
I did feel when I first came to WellSpan that there was more we could be doing as a health system in prevention, but also that we can't do it all. And so we needed the right partners. I will say that that strong partners right now have been our local police departments, certainly our judges. We have a really robust treatment court here that works very hard to prevent incarceration and to get people to the right kinds of treatment.

00:12:28:28 - 00:12:52:01
Roxanna Gapstur, Ph.D., R.N.
And we also have, in the last two years, a credible messenger program. This program first started on a grant and was a business partnership agreement between one of our local nonprofits and our WellSpan York Hospital, which is a level one trauma center. And the credible messengers are highly engaged individuals who support victims and families who enter York Hospital because of gun violence.

00:12:52:04 - 00:13:20:01
Roxanna Gapstur, Ph.D., R.N.
They work to solve some of the deeper causes of violence in the community. And so they're they're very connected outside of the hospital setting. And so far in the last three years, we've seen a 43% reduction in gunshot wound patients at our hospital and a 71% reduction in homicides in our community, which is just gives you goose bumps to think about because it's such a problem for some of the younger individuals in our community.

00:13:20:02 - 00:13:30:12
Roxanna Gapstur, Ph.D., R.N.
So I would say the credible messenger program in these partnerships with local non-profits have been the most impactful in addressing really root causes of gun violence.

00:13:30:14 - 00:13:33:16
Mindy Estes, M.D.
Question or the credible messengers? Volunteers.

00:13:33:18 - 00:13:56:02
Roxanna Gapstur, Ph.D., R.N.
Not the credible messengers, are paid on the grants that we received with the not for profit. But it has been so impactful that we've continued that payment, you know, after the grant. And so all of us in New York County are very invested in that program, both emotionally and financially, because we've seen such great results with it.

00:13:56:04 - 00:14:16:27
Mindy Estes, M.D.
Well, the success rate has it's really been extraordinary in the numbers of live saved in families saved, you know, has to be a positive for the entire community. I want to look ahead. And when we look ahead, what do you see as your biggest goal for WellSpan health and what challenges do you anticipate in achieving it?

00:14:16:29 - 00:14:39:27
Roxanna Gapstur, Ph.D., R.N.
Boy, that's a great question. I would say innovation is probably one of our biggest priorities. We really believe that the health care system, as great a job as we do in many things, needs some transformation and needs to meet the needs of the future. So we've worked really hard to think about people, process, and technology differently than we did in the past.

00:14:39:27 - 00:15:09:22
Roxanna Gapstur, Ph.D., R.N.
And we've spent the last two years setting up for our next strategic plan, which is WellSpan 2030. An innovation and transformation will continue to be a big part of learning how we can use people, process and technology differently together. And, you know, I think all of us were a little taken by surprise a couple of years ago with the, generative AI changes, the Pandora's box that can kind of open as we think about how we might have safer care, more efficient care, etc..

00:15:09:27 - 00:15:38:05
Roxanna Gapstur, Ph.D., R.N.
And I would probably call out to that we've been heavily involved in. One is using artificial intelligence to improve the speed and accuracy of our radiology exams. WellSpan has deployed over 14 different applications for the last five years in radiology. I think we're leading the pack, and in terms of how we've deployed and how engaged our radiologists are with artificial intelligence.

00:15:38:07 - 00:16:06:11
Roxanna Gapstur, Ph.D., R.N.
And as you know, Mindy, artificial intelligence requires a lot of work and effort and process in order to make it the most useful for care teams. Our teams have done that work, and we've seen 81% faster traditional review of our exams with our radiologists using using AI. And our physicians who read scans are 98% engaged with the applications.

00:16:06:13 - 00:16:30:25
Mindy Estes, M.D.
That's very exciting. And I think you've you've enabled your radiologists to be part of the process because, you know, I think ultimately will help us make smarter decisions, faster decisions, but does not replace the physician. I think once we understand how to use that, and we're still learning and the technology is evolving, you know, we'll see more and more of it.

00:16:30:27 - 00:16:46:29
Mindy Estes, M.D.
We are just about out of time, believe it or not. And I want to thank you for sharing your insights. Your leadership at WellSpan health clearly demonstrates how engagement can drive meaningful change and sustainable change.

00:16:47:02 - 00:16:55:11
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.

00:00:00:20 - 00:00:33:17
Tom Haederle
Welcome to Advancing Health. South Dakota-based Sanford Health is America's largest rural health care system. But even with its hundreds of locations, some patients still face voyages of hundreds of miles to access the care they need. In today's podcast, recorded at one of the world's largest digital health conferences, we hear how Sanford is innovating with both telehealth and artificial intelligence - AI - to shrink those vast distances and deliver quality medical care to all who need it, regardless of where they are.

00:00:33:19 - 00:01:00:21
Chris DeRienzo, M.D.
Hi again everyone, this is Dr. Chris DeRienzo, AHA’s chief physician executive and I am super excited to be here on the sidelines of one of the world's largest digital health conferences with Dr. Dave Newman. Dave and I have known each other for a while now. He is an endocrinologist up at Sanford Health in the Dakotas, and he is the chief medical officer of virtual care for a health system that knows a little bit something about how to serve rural and frontier populations.

00:01:00:24 - 00:01:11:20
Chris DeRienzo, M.D.
And you can hear in the background, we are on the sidelines of this, this large conference, and both of us happen to be talking innovation. We got you to agree to jump on the podcast with us and talk a little bit more about it.

00:01:11:20 - 00:01:12:26
Dave Newman, M.D.
Yeah, thanks for having me, I appreciate it.

00:01:13:03 - 00:01:27:22
Chris DeRienzo, M.D.
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.

00:01:27:25 - 00:01:47:25
Dave Newman, M.D.
Yeah. So at Sanford Health, we're the nation's largest rural health care system. We range all the way from Wyoming to Michigan. We have lots of hospitals. We have got big hospitals. You got small hospitals, we've got critical access hospitals. You'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.

00:01:47:28 - 00:01:53:03
Dave Newman, M.D.
We realize that we have to jump to innovative care models to survive because our patients really need it.

00:01:53:03 - 00:02:11:09
Chris DeRienzo, M.D.
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.

00:02:11:10 - 00:02:24:00
Chris DeRienzo, M.D.
Talk to us about that. And then you will 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.

00:02:24:03 - 00:02:45:21
Dave Newman, M.D.
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. 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.

00:02:45:23 - 00:02:46:25
Chris DeRienzo, M.D.
Whoa.

00:02:46:27 - 00:02:49:16
Dave Newman, M.D.
And oftentimes it's for a 15 minute appointment.

00:02:49:19 - 00:02:50:10
Chris DeRienzo, M.D.
Oh my goodness.

00:02:50:10 - 00:03:10:22
Dave Newman, M.D.
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 is 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, to missed time away from their loved ones, to do something that can be easily done virtually.

00:03:10:24 - 00:03:25:27
Chris DeRienzo, M.D.
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 remind our listeners what an andrologist is in just a moment. Yeah, yeah. You know, I mean, I would drive 400 miles and spend the night just so I don't, I don't miss that.

00:03:25:28 - 00:03:28:24
Chris DeRienzo, M.D.
That can be such a key conversation in in a family's life.

00:03:29:01 - 00:03:36:20
Dave Newman, M.D.
Right. Absolutely. Yeah. So andrology is sex hormone. So it's a lot of, if your testosterone is low or if you're having troubles, reproducing. Yeah.

00:03:36:20 - 00:04:00:26
Chris DeRienzo, M.D.
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.

00:04:00:27 - 00:04:17:11
Dave Newman, M.D.
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 and 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.

00:04:17:15 - 00:04:26:19
Dave Newman, M.D.
So, for example, pediatric infectious disease. If a patient needs a pediatric infectious disease consult, they often had to be transferred to Fargo or Sioux Falls for the higher level of care.

00:04:26:20 - 00:04:27:11
Chris DeRienzo, M.D.
Wow.

00:04:27:13 - 00:04:56:06
Dave Newman, M.D.
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 disease doctors into their hospitals. We can keep the patients there. Sometimes you can just see how relieved the patients are knowing that they're not going to be transferred, and knowing that they still get the same high quality specialty care in their hometown hospital.

00:04:56:11 - 00:05:21:13
Chris DeRienzo, M.D.
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 that you all took me there is that it made national news. The virtual care setup that you had in Dickinson was such that patients who had, pediatric patients actually, who had, you know, chronic conditions that were requiring them to drive a 1100 miles roundtrip to see subspecialists, you could now set them up in that building

00:05:21:13 - 00:05:33:27
Chris DeRienzo, M.D.
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. You've got to be very intentional about designing a system to work like that. How do you do it?

00:05:33:29 - 00:05:50:02
Dave Newman, M.D.
Yeah. So a lot of it is, is what the patient wants, and from provider buy-in. And 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, it's the easy button for the patient. So if they're not tech savvy they can go to the clinic.

00:05:50:04 - 00:06:07:17
Dave Newman, M.D.
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. Yeah. If they need blood test, they're there. And it is their trusted provider.

00:06:07:19 - 00:06:12:18
Dave Newman, M.D.
Those labs are going to go straight to their in-basket and they're going to have follow up there. So it's defragmented care.

00:06:12:18 - 00:06:32:09
Chris DeRienzo, M.D.
I love this example because that medicine is always a spectrum. I'm a neonatologist, you're an endocrinologist. You know I see babies at the super, you know, critical hyper-acute end of the spectrum and you know, out in follow up care. And telemedicine is no different, right? There are telemedicine visits you can do in a patient's home with the technology that just exists on their phone.

00:06:32:09 - 00:06:50:15
Chris DeRienzo, M.D.
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, you know, 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 of an innovation.

00:06:50:21 - 00:07:04:11
Chris DeRienzo, M.D.
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?

00:07:04:14 - 00:07:22:25
Dave Newman, M.D.
Yes. 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 in their belt that talks to a sensor, which is a sticker on your skin that continuously checks your blood glucose.

00:07:22:27 - 00:07:39:06
Dave Newman, M.D.
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. Wow. 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 download it.

00:07:39:06 - 00:07:55:06
Dave Newman, M.D.
Okay. 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 their work virtually. So for a condition like type 1 diabetes, it is like a part time job.

00:07:55:13 - 00:07:56:02
Chris DeRienzo, M.D.
Yeah.

00:07:56:03 - 00:08:15:00
Dave Newman, M.D.
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. Once a year. Yeah. So it's partnering with the technology. We firmly believe that artificial intelligence is going to be a tool that we use. It's not going to replace doctors, but it's going to be absolutely kind of the stethoscope of 2025.

00:08:15:02 - 00:08:36:27
Chris DeRienzo, M.D.
I mean, for those, you know, listening to the podcast, that's the type of diabetes that you're typically are diagnosed with when you're young. And for generations that meant, you know, throughout childhood and your adolescent years, your blood sugars were way off. And so that that changed the trajectory of sort of the health band that you could live in for the rest of your life.

00:08:36:29 - 00:08:47:13
Chris DeRienzo, M.D.
Getting to press this easy button for patients with type 1 diabetes who are much younger, I mean, help me understand, you're talking about generational shifts in health outcomes.

00:08:47:13 - 00:09:03:26
Dave Newman, M.D.
Absolutely. So these patients are now not dying from their diabetes. It is giving them their life back, that they're no longer in the road for appointments, that they're able to go on cruises, they're able to go to on family trips, they're able to do those things, and they're able to be normal kids and normal adults. You use the term easy button.

00:09:03:26 - 00:09:18:27
Dave Newman, M.D.
So we are fully committed to not just our patients but our providers, leveraging technology to make things easier. Yeah. That if the solution is to add something more to our patients or my providers, I'm not interested in it. I'm interested in taking things away. I'm interested in making life simpler.

00:09:19:03 - 00:09:40:24
Chris DeRienzo, M.D.
And it doesn't have to be in cities with 8 million people. You're making life simpler for patients who get to stay where they want to live with their families for more of the time now. I don't think we think about this burden enough in health care. But we have patients who  - it's days, it's weeks. It's months of their life, you know, to be able to access our services.

00:09:40:24 - 00:10:01:26
Chris DeRienzo, M.D.
And we are we are experts in lots of different things. You're almost turning that around, by being able to project care into people's homes using technology. But let's talk about the providers for a minute, because I've been there right with you as a CMO of a health system before joining AHA. You don't want every new innovation to workflow to be an addition.

00:10:01:28 - 00:10:14:27
Chris DeRienzo, M.D.
And I, frankly, is one of the technological revolutions I'm seeing that actually is beginning to deliver a little bit on what you said, which is we can actually take some things away that have been layered on. Got any examples of those?

00:10:14:27 - 00:10:32:06
Dave Newman, M.D.
Oh yeah. So the best example is one that's really hot right now is ambient listening. Yeah. So we rolled this out recently and I cannot believe how well it works. So for the listeners, this is an AI program that the provider, during your clinic visit with them will turn on their phone and it'll listen to you and it will write their note for them.

00:10:32:09 - 00:10:53:09
Dave Newman, M.D.
One of my buddies is a pediatric oncologist. Really a good guy, he was really bad at writing his notes. So he was always on the naughty list, is what he called it. So he was getting messages from the CMO saying, you need to close your charts. And he did this for 12 years. We opened ambient listening to him, and he texted me the other day and he said, Dave, I didn't miss my daughter's recital.

00:10:53:12 - 00:10:57:01
Dave Newman, M.D.
I'm not on the naughty list. Like, this is giving me my life back.

00:10:57:01 - 00:11:20:00
Chris DeRienzo, M.D.
A little bit depressing, frankly. The baseline it's just an expectation that, yeah, I'm going to miss the recital. That's what you and I, that's the that's the culture that we've grew up. It doesn't have to be that way anymore. And I'm hearing the same things. I've now heard from multiple systems in multiple states on multiple different platforms that, on average, ambient listening seems to be decreasing in EMR time by double digits.

00:11:20:01 - 00:11:21:26
Chris DeRienzo, M.D.
Some sort of high double digits.

00:11:21:26 - 00:11:22:13
Dave Newman, M.D.
Absolutely.

00:11:22:13 - 00:11:28:06
Chris DeRienzo, M.D.
And that time is being returned to us to do the things that the human part of health care.

00:11:28:06 - 00:11:46:10
Dave Newman, M.D.
Yeah. So it was interesting. I was talking with a patient the other day, who was in a clinic visit with one of their providers that was using this. And they had a real conversation. Because now being a provider, it's harder. You're always ordering things on a computer. You're looking at labs, you're trying to type your note as you go, and it's lost the human element.

00:11:46:10 - 00:11:49:05
Dave Newman, M.D.
Ambient listening has given that human element a chance.

00:11:49:07 - 00:12:07:26
Chris DeRienzo, M.D.
I mean, we shifted to electronic technologies for all of the right reasons, you know, and it certainly led to some positive outcomes, for sure. But you're exactly right. Health care is and always has been and always will be a uniquely human experience. And we need to keep threading that thread of humanity through the needle of technology.

00:12:07:26 - 00:12:31:01
Chris DeRienzo, M.D.
If we're going to be able to experience the stuff that brings us joy as doctors, right? Getting to spend time with our patients, getting home and getting to our kids recitals. You know, as long as we've got folks like you, Dave, out there, leading the innovation, I tell you what, I am incredibly optimistic, about the current generation of trainees walking into a practice of medicine and of nursing, respiratory therapy and lab techs and all of the professions.

00:12:31:04 - 00:12:36:16
Chris DeRienzo, M.D.
That is only going to keep getting better. Thank you so much for joining the podcast. It's been a total privilege.

00:12:36:21 - 00:12:38:03
Dave Newman, M.D.
Thank you, Chris.

00:12:38:05 - 00:12:46:16
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.