In most – if not all – industries, incorporating technology has led to more productivity and increased efficiency.
For healthcare, however, this has not been the case, according to Jared Antczak, Chief Digital Officer at Sanford Health. “As we’ve added more technology, it has seen less productivity,” he said. One of the biggest drivers? An emphasis on digitization over digital transformation, which started with the rush to implement electronic records. “We took existing workflows that were either on paper or on a different tool, and lifted and shifted them into a new tool without really fundamentally asking some of the hard questions.”
The good news is that there’s a tremendous opportunity to “apply digital transformation to simplify and remove some of the complexity and some of the non-value-added processes,” Antczak said. During a podcast interview with Kate Gamble, Managing Editor at healthsystemCIO, he talked about how Sanford Health is leveraging digital technologies to make care more accessible, affordable, and equitable across its sizeable footprint—and doing it in a way that answers the hard questions.
He also discussed the benefits of being in a rural environment; the advantages of having both a dedicated CIO and CDO; what a fast-food app can teach healthcare about engagement; and the time he almost became a physician.
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- On accessibility challenges: “The sacrifice of time and resources required to make that pilgrimage across really hazardous roads in the wintertime, or take time away from work [or time away from the harvest], or find childcare and reliable transformation — all of those things can really compound to create barriers.”
- On Sanford’s $350 million virtual care initiative: [It will] allow us to accelerate some of the great work that we’re already doing and double down to ensure we’re helping to provide care when, where, and how our patients want it and need it.”
- On ‘website manner’: “What does it take to connect with a patient through a camera or a digital screen and still make them feel important? What does it take to establish a relationship with them and make them feel heard and validated? Things like that go a long way toward making patients feel safe.”
- On digital transformation: “It addresses the people, the process, and the technology holistically, and it fundamentally transforms the business and the care delivery model. It doesn’t just super impose technology onto existing labor-intensive processes.”
- On having a CIO & CDO: “It allows us to focus resources and attention across the spectrum of technology to ensure that we have a balance approach, meaning that we’re focusing on not only keeping the lights on … it’s a really nice balance that allows us to kind of ensure that we’re doing the right things.”
Q&A with Sanford Health CDO Jared Antczak
Gamble: Hi Jared, thank you for taking some time to talk. Why don’t you start by just giving an overview of the organization — the size, where you’re located, things like that.
Antczak: Sanford Health is actually the largest rural health system in the United States. Our headquarters is in Sioux Falls, South Dakota. We have a geographic footprint that extends about 250,000 square miles across parts of South Dakota, North Dakota, Minnesota, and Iowa, where we serve well over a million patients through our 47 medical centers and about 2,800 employee providers. If you can envision, it’s about the size of Texas, spanning across the upper rural and Midwest. We have a fairly large and expansive geographic footprint.
But in addition to our hospital network, our integrated health delivery system, we also have a health plan which serves about 220,000 members. We have our Good Samaritan Society which has over 200 senior care locations and is the largest senior care organization in the country. We also have rural clinic locations in about 8 different countries around the globe.
Gamble: I would think having a health plan has been advantageous in terms of getting access to some of that information.
Antczak: Absolutely. Sanford was actually one of the first health provider organizations that spun out a health plan, and so, it really does allow us to have that sort of vertical integration approach to serving our consumers, our patients, and our members in a comprehensive way where we can ensure that we’re meeting their needs in the best ways possible.
Gamble: Being an organization that covers a huge amount of ground comes with challenges, I would imagine.
Antczak: Absolutely. Being a large rural health system definitely comes with a unique set of challenges but also opportunities when it comes to serving people in our communities. That was one of the compelling factors that drove me to join this organization. The commitment to providing urban care to rural America and providing services to people who otherwise wouldn’t have access to high-quality care without Sanford Health was one of the things that really interested me.
As a Chief Digital Officer, it definitely presents a unique set of challenges. People living in rural America have a lot of unique circumstances, and access to care is one of the most significant determinants of health. Two-thirds of our patients live in rural communities. As we know, people living in rural communities likely have access to fewer resources, and higher rates of poverty, food insecurity, and chronic disease — a combination that often leads to poorer health outcomes. During the pandemic, a lot of those challenges were really exacerbated, and they really took a disproportionate toll on rural America.
I would also say that the vast majority of counties served by Sanford Health across the upper rural Midwest are federally designated provider shortage areas. We just simply don’t have enough doctors to help care for some of these communities. We’re committed to removing some of the barriers that prevent people from being able to access care in really compelling ways.
There are patients in our community who have to travel 3 to 4 hours just to get to the nearest doctor’s office. As you can imagine, that sacrifice of time and resources required to make that pilgrimage across really hazardous roads in the wintertime, or take time away from work [or time away from the harvest], or find childcare and reliable transformation — all of those things can really compound to create barriers for people getting the care they need.
Gamble: When you look at it that way, it really becomes glaring how much of a need there is for digital solutions that can bring care closer to patients.
Antczak: Absolutely. We’re really excited. We’ve recently seen a renewed focus on extending our virtual care capabilities. In 2021-2022, we launched a virtual care initiative which invested $350 million in our system to ensure that the communities we serve are able to receive accessible, affordable, and equitable care. Over the last 12 months, we’ve had more than 110,000 virtual visits across Sanford Health.
Virtual care isn’t a new thing for us. We’ve been doing virtual care with consults over the last decade. We’ve calculated that has amounted to roughly 23.5 million miles saved by patients who didn’t have to travel great distances in order to see their doctor. This initiative is going to allow us to accelerate some of the great work that we’re already doing and double down to ensure we’re helping to provide care when, where, and how our patients want it and need it, and to extend services that are in short supply across our footprint.
A “blanket of anonymity” for BH patients
Going back to some of those federally designated shortage areas, one of the areas that we struggle with, just like a lot of health systems, is the shortage of behavioral health providers. Behavioral health is such a big need for patients in our communities. Being able to deliver a virtual behavioral health experience helps remove some of the fear and the stigma that comes with physically driving to a clinic and worrying about whether your neighbors see you. We’ve heard directly from patients that it gives them a blanket of anonymity where it allows them to engage in the services that they need from the comfort and convenience of their own home.
From the other perspective, our providers have indicated that there is something special in being able to see a patient in their own environment and to see their surroundings and their atmosphere. This allows them to better understand some of the circumstances they’re living with and be able to provide the right care for the right people at the right time.
Gamble: That’s great. Can you talk about what else falls under the virtual care initiative?
Antczak: Absolutely. One of those is to expand some of the great work that we’re already doing focused on virtual primary care, virtual behavioral health, and other specialties where we need to meet our patients where they’re at.
Last summer, we broke ground on a new virtual care center in Sioux Falls. It’s going to be a place where we can share best practices, train some of our providers, and teach members of our community about some of the different tools we have available.
Training on “website manner”
One of the concepts we talk a lot about in our medical schools is that medical students are trained on this concept of bedside manner, but as we move into this new digital era, sometimes we forget about website manner. What does it take to connect with a patient through a camera or a digital screen and still make them feel important? What does it take to establish a relationship with them and make them feel heard and validated? Things like that go a long way toward making patients feel safe and comfortable receiving care through some of these different digital technologies.
Rural health summit
In 2022, we hosted a summit called the Future of Rural Healthcare, during which we engaged a lot of different industry stakeholders, policymakers, and other leaders to help shape the future of care delivery in rural areas. It was the first gathering of its kind to promote topics like improving care access, reducing costs, and closing disparities of care in rural and underserved communities.
We had folks from organizations like Microsoft, the Centers of Medicare and Medicaid Services, Medtronics, Salesforce, the American Medical Association, the American Medical Group Association and many others. One of the key takeaways that I thought was really inspiring was the recognition that although being the largest rural health system in the country certainly provides some challenges, it also provides some unique advantages that enable us to innovate in partnership with our local communities. Rural communities have the ability to solve some of the most complex issues in healthcare without all of the economic overhead and bureaucratic limitations that might exist in urban setting.
Several years ago, I remember reading that the average cost to build a hospital bed was about $1.5 million. If you think about the investment it takes to build hospitals and to create this brick and mortar infrastructure, I can only imagine that has increased over the last few years, by the way, with inflation and everything else. But that adds a lot of pressure to offset those costs; sometimes that pressure comes at the expense of innovation and trying new things. We’re extremely optimistic that we can really solve some of the most daunting challenges in healthcare with digital health and can really establish a model that others can follow, starting right here in rural America.
Gamble: When you talk about the advantages, is one of those just the fact that the community is bit more tight-knit or maybe that it’s easier to get information or work with certain community organizations?
Antczak: Absolutely. I think it’s the recognition that we’re all in this together and that we’re all striving towars the same goals and that we can’t do it by ourselves. Sometimes health systems think they have to solve all of the problems themselves. When you start looking at the data in the social determinants of health, and you recognize that the actual healthcare delivery really accounts for only a small sliver of an overall person’s health and well-being, you realize there’s a whole ecosystem of needs and services and capabilities that our health system isn’t providing today, and quite frankly, can’t provide. It really is a joint effort that requires partnership and collaboration. In some of these smaller local communities, we can solicit that cooperation and those partnerships in a really meaningful and dynamic way.
Gamble: In the past, you’ve spoken about digitization versus digital transformation. Can you get into that a bit?
Antczak: Of course. One of the things that I’m really focused on as the Chief Digital Officer is ensuring that we’re not just digitizing existing things. What I mean by that is I think it’s important to note that digital transformation is not the same thing as digitization.
Digitization takes existing processes and workflows and really just performs a ‘lift and shift’ into a new tool or a new technology. I would argue that in many respects, the rush to implement EHRs over the last 10 to 15 years was primarily a digitization event. We took existing workflows that were either on paper or on a different tool, and kind of lifted and shifted them into a new tool without really fundamentally asking some of the hard questions like does this process make sense? Have we added too much complexity? Is it really a value-add to ask these questions?
Digital transformation really does that. It addresses the people, the process, and the technology holistically, and it fundamentally transforms the business and the care delivery model. It doesn’t just super impose technology onto existing labor-intensive processes, but rather, seeks to transform the who, the what and the how, in order to create greater efficiencies, improve productivity, and really enhance that care delivery experience.
It’s fascinating; healthcare is the one industry where, as we added more technology, it has actually seen less productivity as a result. With every other industry, the more technology you add, the more productivity and the more efficiencies you gain. Healthcare is the opposite. I think there’s a huge opportunity to apply digital transformation to simplify and remove some of the complexity and some of the non-value added processes that have become ingrained over time.
Transforming patient access
Gamble: Very interesting. And that goes back to what you said about education component with physicians. We have all of these new technology components; physicians need to understand how to use them in a way that fits into their workflow.
Antczak: Absolutely. I think healthcare is prime for disruption as we really embrace this concept of digital transformation with an eye toward improving engagement for our consumers and productivity for caregivers — how do we do more with less? The workforce challenge that health systems are experiencing right now is a great catalyst for rethinking how we can improve productivity and how we can rethink gaining efficiencies.
For example, we’re investing heavily in digitally transforming our patient access experience. These are the folks who sit at the front desk when you walk into a clinic; they help schedule appointments, get people registered, verify insurance, collect co-pays, validate demographic information, and get people checked in. From a patient’s perspective, nobody likes coming to the clinic and getting handed that stack of paper forms that you filled out last time and now have to fill out again. We’re looking at how do we digitally transform that experience, both for the benefit of our patients and also for the benefit of our staff.
Because the reality is, we just don’t have enough staff right now to do some of that work — that manual data entry. We’re deploying a new digital registration experience that allows our consumers to essentially engage and complete their digital registration from the comfort and convenience of their own home, with their own device, at a time of their choosing so they don’t have to sit in the waiting room and fill out paper forms.
The forms are pre-populated with the information we already have about them. They just need to verify and validate what’s already there. They’re able to make co-payments and verify their demographic information, and when they come to the front desk, it’s a 5-second conversation to say ‘what’s your name? I see you’ve already checked in online. Have a seat.’
Creating a “much more pleasant experience”
It’s a much more pleasant experience for our consumers and it allows our caregivers to move from data entry to data validation, and work at a higher level. Since we’ve launched this new experience, we’ve seen patient engagement go from less than 3 percent with our legacy tool, to more than 50 percent our patients are engaging just naturally and organically, because we made it easy, intuitive, and valuable. We’ve removed friction from peoples’ lives.
Sometimes there’s a misconception that if you do something that’s good for the patient, it comes at the expense of the provider or clinician, and vice versa. But I think there are plenty of opportunities for win-wins across the board, where what’s good for the patient is also good for the organization and the providers.
The CIO-CDO relationship
Gamble: That makes so much sense. So, can you talk about your relationship with Brad Reimer, the CIO at Sanford? I’m sure it differs by organization, but how do your roles complement each other?
Antczak: That’s a really good question. If you were to ask a group of 10 people to define ‘digital,’ you’ll probably get 12 different answers. It’s different in every organization. I like how we’ve approached it at Sanford Health — we have a chief information officer and a chief digital officer.
The way that we’ve defined his role versus my role is, across that technology spectrum, the CIO focuses on the back-end technologies, all of the databases, the infrastructure, the interfaces, and the architecture. The Chief Digital Officer focuses on the front-end technology, the user experience, the product management, development, and applications — the things that human beings actually interact with and engage with from a technology standpoint.
When organizations try to bundle it all together under the same person, you typically see an over-indexing on one end of the technology spectrum, sometimes at the expense of the other. By having both of us, we’re very complimentary. We collaborate and work together and we have to have alignment in terms of our priorities and our focus.
Ensuring a “balanced approach”
It allows us to focus resources and attention across the spectrum of technology to ensure that we have a balance approach, meaning that we’re focusing on not only keeping the lights on and running the business and meeting operations’ needs. At the same time, it ensures we’re thinking about what’s next, evaluating emerging technologies, anticipating what’s coming around the corner, and assessing what makes sense as we seek to transform ourselves.
It’s a really nice balance that allows us to kind of ensure that we’re doing the right things. I would say the CIO’s focus is around things like scalability, security, reliability of the infrastructure. My focus is around usability and engagement and experience to ensure that it’s something that we’ll actually find valuable — something that meets people where they are.
Being Sanford’s First CDO
Gamble: So, you’ve been with the organization for a little over a year?
Antczak: That’s right. I joined Sanford Health more than a year ago as the inaugural Chief Digital Officer. It’s the first time this role has existed in the history of the organization. I think part of it was because of the recognition that in order to ensure we’re focusing our resources on the right things and that we’re providing that balance, we really wanted to have both a Chief Information Officer and a Chief Digital Officer. Again, that’s something that I really appreciated.
But prior to this role with Sanford Health, I’ve been in the healthcare industry for over a decade at a variety of different provider organizations and payer organizations focusing on patient experience, the member experience, the caregiver experience, and the clinician experience. I’ve seen a little bit across that landscape.
Every organization is structured a little bit differently when it comes to digitalizing, as you mentioned before. Some are a little bit more advanced and more mature in certain areas and further behind others, but I can appreciate that every healthcare organization is on a similar journey. Everybody is trying to figure it out.
Pursuing med school
Gamble: Before coming to Sanford, you had held some roles in the digital space, right?
Antczak: I was. I’ve been in a variety of digital and technology-oriented roles throughout my career. Interestingly enough, I actually started my career with the intention of becoming a doctor. Way back when, I took the MCAT and went through the application process and I ended up taking what was going to be a temporary job with a health system that was in the process of implementing an EHR for the first time. Between graduating with my bachelor’s degree and matriculating into med school, I worked for this health system. I saw firsthand through my own experience how technology often inhibited the patient-provider relationship rather than help to facilitate it.
I saw that the sacred moment between patient and provider was often disrupted by the technologies of the day, and as a result of that realization, I actually turned down an opportunity to go to med school so that I could focus on that problem. That set me on this path and has really been the driving force behind my career ever since.
Healthcare’s lag with digital sophistication
Gamble: It’s probably hard to picture what would’ve happened if things had gone another way.
Antczak: It would have been very different. I really love the career path I’m on. One thing that excites me and gets me out of bed every morning is recognizing that the healthcare digital experience, I think it’s fairly safe to say, generally lags behind a lot of other industries when it comes to digital sophistication.
I use ‘consumer’ instead of ‘patient’ intentionally. I know that’s somewhat of a provocative notion in healthcare, but as we make that shift from sick care to healthcare, there’s a reason why I think we need to shift our focus from patient to consumer.
Consumers, not patients
The root meaning of the word patient means to suffer or to bear. If you think about that, we’re thinking about people when they’re suffering or bearing an illness. If we start shifting the focus from sick care to healthcare rather than reactively treating people only when they’re ill, how might we proactively prevent illness and promote health and well-being? Focusing on consumers rather than patients allows us to consider what people really need, upstream and downstream from that traditional visit or encounter experience and to become more relevant and valuable in people’s lives.
The other reason why I like ‘consumer’ is because, as an integrated health system, we also have residents in our long-term care facilities. We also have members in our health plan. We have customers through some of our other entities. We really want to think about people more holistically, not just as our patients. I think it’s safe to say that our consumers are the same people who use other digital experiences like Netflix for entertainment or Amazon for shopping or Delta for traveling. They have the same expectations for an easy intuitive and seamless experience in healthcare.
I have younger children. One of their favorite places to eat is Chick-fil-A. One of the reasons why it’s one of my favorite places is because of their digital experience. We typically get the same food each time we go, but the app remembers my order history. It lets me create the same order with one tap. It knows which card I prefer to pay with. It knows the color of my car when I arrive. It randomly sends me prompts and nudges and rewards and free food throughout the week so that they stay top of mind the next time we decide to eat out. If you compare that to your typical healthcare experience, and maybe the only time you hear from your health system proactively is when it’s time to pay a bill.
I’m slightly embarrassed to say that I think Chick-fil-A knows me better than my doctor. There’s such a huge opportunity to meet our patients where they are; meet our customers where they are, and to transform that experience in a much more meaningful way.
Digital equity as a social determinant
Gamble: Well said. Now I’m hungry for Chick-fil-A. But anyway, it seems like you’ve really embraced rural care. It’s so important because so much of this country is rural and being able to share experiences is so important.
Antczak: Absolutely. We talked about social determinants, and digital equity being a social determinant. When you think about digital equity and internet access, you need to ask: do people have internet access through a device, through broadband connectivity or through a cellular signal strong enough to access the internet? Do they have device availability? Do they have mobile phones? Do they have tablets? Do they have computers with cameras? What does their digital literacy look like? Are they comfortable and confident being able to download, register, and navigate through a digital experience?
Those are all things we’re thinking about and evaluating anytime we seek to understand our consumers and their needs. Because having the slickest mobile app out there does no good for somebody who doesn’t have a device or doesn’t have connectivity or doesn’t know where to look to download it. We need to meet our patients where they are; sometimes that means it’s a combination of both online and offline experiences, depending on who they are and what they’re needs and preferences are.