“People like to put telehealth on a pedestal, but at the end of the day, it’s just healthcare.”
It’s probably not what most people expect to hear from a Chief Transformation Officer, especially one from an organization that has launched one of the most successful telemedicine programs in the country. But it’s precisely that philosophy that has driven the exponential growth of NewYork-Presbyterian has experienced over the past few years.
It’s not a belief that technology isn’t important; on the contrary, it’s the knowledge that tools like telehealth can “change the interaction between patients and physicians,” while also helping staff to broaden their skill sets by offloading some of the more menial tasks. All of this, however, doesn’t come without a solid infrastructure, a solid strategy, and a solid leadership team. Recently, healthsystemCIO spoke with CTO Peter Fleischut and CIO Daniel Barchi about how NYP is leveraging technology to improve access to care, eliminate barriers, and transform the care experience. They also discuss best practices when it comes to innovation, and how they’re addressing clinician burnout.
- Telemedicine program’s exponential growth
- From transactional to end-to-end care – “It’s a big change.”
- IT’s role in curbing burnout by “leveraging technology for more menial tasks”
- Robotic food delivery
- “It’s a continual investment in our workforce.”
- Introducing technology “in small bites”
- NYP’s diverse patient mix
- Use cases for neurology, dermatology & behavioral health: “It has already made a big difference.”
The system needs to be reorganized and reengineered to support that type of frequent contact with patients.
We do an average of about 26,000 deliveries per year across the hospital, so if we’re going to provide this level of service for our patients, we need to be thoughtful about how we support and engage our providers and employees in this transition.
That’s the key – we have to start somewhere. We have to do it in a safe way and in a high-quality way, but we have to start. We have to engage – and in some cases, retrain – our employees to meet those needs.
The ultimate goal is to try to reimagine the patient experience and provide care in a holistic way. Technology is just a piece of it; it’s just a component. Process is what drives it.
It’s a significant enhancement, and it made our staff feel a lot more empowered to be able to see the bigger picture and have a lot more autonomy.
Gamble: When did the telemedicine program at NYP really start to get off the ground?
Fleischut: We started the program in 2016, and it has grown exponentially. We went from around 1,000 telehealth visits in 2016, to around 10,000 in 2017. In 2018, we did around 120,000 visits; this year, we project it to be somewhere between 500,000 and one million visits.
Gamble: When an initiative experiences that type of growth, I imagine the challenge is in making sure it can scale properly.
Fleischut: It is. But as Daniel always says, it’s not as much about the technology; it’s much more about the people and the process. I think we took a pretty comprehensive approach to involving all the departments throughout the hospital to make this successful. We really had a thorough process for onboarding, enrollment, and thinking through the problems we’re trying to solve. We’ve really tried to take a comprehensive look at this, and focus more on taking care of patients in a new and different way, and less on the actual technology.
Gamble: So it really is a different care model. Can you talk about what was required to get this program off the ground, and what will be required to continue to expand it?
Fleischut: The first thing we had to do was to put in an infrastructure that could support 50 programs. The challenge is that those 50 programs are very transactional. You have tele-genetic counseling, you have tele-NICU visits with infants while they’re still in the hospital, and you have follow-up visits. Where we’d like to go – and where we need to go – is to think about it more from the patient perspective and take a more holistic approach.
For example, if you look at the lifecycle of an OB-GYN patient, before they even become pregnant, what are the things we can do to offer end-to-end care, including education and wellness, throughout the course of pregnancy and beyond? It’s everything from what type of education they need, what type of genetic counseling, and what type of monitoring they need in the first, second, or third trimester. After they deliver, we’ve started remotely monitoring women for hypertension and making sure they’re getting the care they need. And so you start to look at it as more of an end-to-end process for the lifecycle of an OB patient, and less of that transactional mindset.
That being said, it’s a big change. It’s a transformation of the care model. If you think about it, the average OB patient has about 14 to 16 visits where they have to come in and check their vitals. That doesn’t make sense. Maybe we send them home with a blood pressure monitor and a scale, and they can get continuous vital sign monitoring daily for the lifecycle of the pregnancy. The system needs to be reorganized and reengineered to support that type of frequent contact with patients.
Gamble: And of course, all the data needs to follow the patient. Can you talk about that aspect?
Fleischut: Care coordination is critical. The whole care team needs to be available online to coordinate and orchestrate these activities, from pharmacists to nutritionists. Some patients may choose to do this at 9 p.m. on a Tuesday or on a Saturday afternoon. And so we think it’s our opportunity to re-humanize the care we provide to our patients.
That being said, this is extremely difficult. You want to provide value for patients while not increasing clinician burnout. This is going to require a massive change in workflow, both for patients and providers. We do an average of about 26,000 deliveries per year across the hospital, so if we’re going to provide this level of service for our patients, we need to be thoughtful about how we support and engage our providers and employees in this transition.
Gamble: How do you about seeking input from users to make sure they aren’t burdened by this technology?
Fleischut: We have steering committees and other means of getting input from patients and providers. But we’re not trying to get it perfect right out of the gate. With remote monitoring, for example, the traditional workflow is that if a patient is discharged who has potential for being hypertensive, they’ll get a blood pressure cuff and monitor it from home. We don’t need to perfect it; let’s just start the process. We’ve found some profound benefits in doing this right off the bat by identifying women who were hypertensive and had to come back in and be admitted into the hospital. That’s the key – we have to start somewhere. We have to do it in a safe way and in a high-quality way, but we have to start. We have to engage – and in some cases, retrain – our employees to meet those needs.
Gamble: You mentioned burnout – what are some of the ways in which you’re looking to prevent that?
Barchi: We’re focused on the workforce of the future. When we talk about what we’re doing with telemedicine in OB, the ultimate goal is to try to reimagine the patient experience and provide care in a holistic way. Technology is just a piece of it; it’s just a component. Process is what drives it. At the same time, we need to make sure our physicians, our nurses, and our staff are ready to embrace this.
One of the ways that we think that technology can help is by having everybody work to the top of their license. What I mean by that is, if we can leverage technology for the more menial tasks, we can have people doing what brings more value, whether it’s a physician or nurse getting exactly the information they need to make decisions without digging through a lot of data, or something like robotic delivery of food trays to patient floors. We’ve been working nights and weekends to build the system and program the initial robots — that falls on the technology team, but it’ll be the food service team who runs them. These are people that are used to doing things like making soup, cleaning the carts, or doing other tasks in the kitchen — now they’re the ones who are deploying the robots. It’s a continual investment in our workforce to prepare them for the next set of technology that’s coming.
Gamble: Right. That’s very cool, and it speaks to what you said about working at the top of the license. Now, when it comes to something like telemedicine, is it difficult to sell because even though it will eventually lead to improved outcomes, it’s going to be challenging in the short-term?
Barchi: Our strategy has been to ‘soft-sell’ it even more by comparing it with implementing a new EMR system, which is difficult to do and means a lot of disruption. We’re introducing technology on a weekly basis is small bites, and so the workflow doesn’t change that much. We also feel it’s better to take a continually improving approach. As Pete mentioned before, not everything is perfect. When we roll it out, we don’t try to get it perfect — we’re simply putting tools into peoples’ hands, then adjusting as needed.
Going back to food delivery, when we trained our food service staff to deploy the robots, we had our technology team there in the kitchen doing it. After about 4 or 5 days, Pete had his team grab two people and say, ‘Hey, we need to show you how to do this.’ They were either cleaning the carts or making the soup 20 minutes earlier, then had 15 minutes of ‘Watch how we do this. You pick the robot. You go to the screen, pick what floor, click on this, and click on that.’ Then 15 minutes later, they moved on to another role. Some might say that’s disruptive, or that people should be sent to a class. But the way we see it, it was just a minor tweak in the workflow — pretty self-evident technology, and it really changed what they’re doing and how we’re using it.
Fleischut: There’s a lot that needs to happen — you need to make sure you don’t jam up the elevator. You need to make sure the dining hosts are picking up the meals. You need to make sure the kitchen is getting decanted of the meals. It takes a while to get into the rhythm. We handed the reigns to someone who had been working in the kitchen for 10 years doing deliveries, and they felt completely empowered. Now they’re almost in a managerial role because they’re overseeing robots and trying to make sure they’re in the right place. It’s a significant enhancement, and it made our staff feel a lot more empowered to be able to see the bigger picture and have a lot more autonomy.
Gamble: Is it really something where people have to learn by doing, and then tweak what needs to be tweaked?
Fleischut: It is. Looking at telemedicine, Daniel and I are very proud to work in an institution that prides itself on taking care of all different patient populations and ethnicities, and our payer mix is about one-third Medicare, one-third Medicaid, and one-third commercial. When it comes to technology, we need to make sure we really instill our values in doing these initiatives and rolling it out to patients.
During the past few months, we’ve undertaken a significant effort in our ambulatory care network, which is primarily Medicare/Medicaid patients. We feel it’s an ideal opportunity, because this is an area where it’s critical to ensure patients have access to these services. As we all know, it’s a challenge for everyone — even commercial — to get access to specialists. Before we started the telemedicine program, it took about 9 weeks to see a neurologist; now, there’s about a 24-hour wait. It went from 9 weeks to 24 hours, which is incredible.
In dermatology, we’ve been able to reduce wait times from 5 weeks to a few hours. Medication management is near and dear to my heart. It’s a huge issue, and we’ve cut down the time it takes for an in-person medication management visit from seven days to 24 hours.
Another area where access is challenging is behavioral health. We have an ADHD management group where the way to see someone in person went from about 3 months to 3 weeks. This has all happened within the last few months. We’re already seeing that the ability to look at a different care model that uses technology to help patients gain access to care has already made a big difference.