“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.
- “At the end of the day, it’s just healthcare.”
- Telehealth & prioritization challenges – “We continually have to reinforce the infrastructure.”
- Mobile stroke units to centralize neurologists
- Tech’s impact on physician efficiency
- NYP Ventures arm
- “Technology is a great leveler for inequality
- Innovation advice: “Start small”
We have to identify the biggest need. We have to think through the barriers and challenges to providing that.
We’re going to have to continually reinforce that infrastructure, because there’s only so much psychiatry time we have; we need to make every minute count. We need to maximize that time with the patient.
You could argue that telemedicine and things like online portal communications are changing the interaction between a patient and their physician from being a transactional, once-a-quarter or once-a-year thing, to more of an ongoing free flow of information. And that’s appropriate, because healthcare is not transactional or static.
Technology is a great leveler for inequality. If a technology can eliminate barriers of language, cost, transportation, or culture, we need to be thoughtful about adopting it.
We were fortunate enough to be able to reach out to a lot of colleagues that had an institution or a program and talk to them about what worked and what didn’t. This is where providers really need to come together.
Gamble: When you look at all the areas that can telehealth can impact — including behavioral health, where there’s a dire need — does it become difficult to prioritize and decide where to go next?
Fleischut: Yes and no. People tend to put telehealth on a pedestal. But at the end of the day, it’s just healthcare. And so it’s the same prioritization we need to use in terms of having the right number of neurologists, IV specialists, orthopedics, cardiologists, etc. I don’t want to scope creep everything, but we have to do it all. There are certain things we can’t do because of physical limitations, but we have to identify the biggest need. We have to think through the barriers and challenges to providing that; in some areas within the ambulatory care network, it’s providing services in multiple languages, and having community health workers help with the onboarding process. We need to work through the list.
With endocrinology, for example, we should be able to provide very fast follow-ups, but at the same time, we also need to space them out over time. From an end-to-end perspective, right now we’re focused on OB and heart failure.
Gamble: You talked about having a strong infrastructure in place. That’s a huge component in all of this — is it something that’s constantly being worked in terms of being able to support everything?
Fleischut: Definitely. It’s a big focus. Another example is psychiatric care. We do not have enough psychiatrists, adult or pediatric. There aren’t enough in the world to meet that need, and so we have to be really stringent with how we use that resource. And so we launched a tele-psychiatry program where we provide consults to EDs of all our hospitals. It used to take up to 24 hours to see a consult; now we can do it within an hour.
Actually, when we started it, we had two hubs: one at Weill Cornell Medical Center and the other at Columbia University Irving Medical. Those are the doctors who are doing this. The way the program is structured, there are two teams providing consults to our hospitals. By bringing them together, we can have one team in our clinical operations center, and our patients can start seeing a psychiatrist in any of the EDs. They can even start seeing patients on the inpatient floor — which they now do.
And so now, when a patient on the inpatient floor needs a psychiatry consult, we can do that by having the infrastructure in place and having it at one central location. We’re going to have to continually reinforce that infrastructure, because there’s only so much psychiatry time we have; we need to make every minute count. We need to maximize that time with the patient.
Gamble: And that’s just one area — albeit one where there is such a great demand for services.
Fleishchut: Absolutely. About two years ago, we launched our first mobile stroke treatment unit. The way it works is, a patient who is experiencing signs or symptoms of a stroke and calls 911. The CT scan is done right there in the ambulance — there’s a neurologist onboard who can treat the patient. By doing the mobile stroke treatment, you can save around 40 to 50 minutes, which equates to around 100 million brain cells. You’re getting to the patient faster. And if it’s ischemic, you’re able to break up the clot sooner.
The challenge is that it requires a specific neurologist onboard, of which there are only about 12 in the entire country. At the time we were implanting this, there were only about 10 in the country and so we put in two more mobile stroke units: one in Queens and one in Brooklyn.’ But we were able to, again, centralize the neurologists so we can cover more patients. We had patients in Queens, Brooklyn, and Manhattan who were all having a stroke at the same time, and they were treated by one specialist.
Now, we’re able to provide a higher level of care by having a neurologist and a vascular neurologist from Weill Cornell or Columbia who can care for patients in the ambulance. That’s where we can continually evolve the infrastructure so that maybe there will be a time and a day where one neurologist can cover all 10 hospitals, plus the mobile stroke units.
Gamble: When we talk about all the potential technologies like telehealth offer, obviously it plays a key role in transforming care. But there’s also the fear some still have that, as these tools become more pervasive, it will take away from the face-to-face interaction between providers and patients. Have you run into that?
Barchi: Not really. I think the bigger issue is with physician efficiency, and all the things they’re being asked to do. In the physician’s mind, technology is getting in the way because of documentation needs — not because telemedicine or other things are disempowering them. In fact, you could argue that telemedicine and things like online portal communications are changing the interaction between a patient and their physician from being a transactional, once-a-quarter or once-a-year thing, to more of an ongoing free flow of information. And that’s appropriate, because health is transactional or static. What Peter and I are trying to do is adopt tools to make physicians and other clinicians more efficient; we see telemedicine, and some other tools, as ways to improve communications.
Gamble: Right. Is there anything else NewYork-Presbyterian is looking at when it comes to transforming care through technology?
Barchi: This is something we’re working on. We can’t get into too much detail, but we’re working with small companies that are leveraging artificial intelligence to help physicians document quickly and efficiently in a way that they never have before, and to try to address the issue of time spent with the EMR. Because honestly, we don’t see the documentation, billing, and coding requirements of the EMR changing. And so it’s a questions of how we can make that portion of the work more efficient.
Gamble: Very exciting. We’ll definitely have to touch base in the future. Has NewYork-Presbyterian worked with small companies before, particularly in the innovation space?
Barchi: Like many other health systems, we’ve created a small ventures arm a few years ago which reports up to Peter and our transformation team. It’s a way to work with the private equity venture capital community to identify small and emerging companies and technology, and then collaborate with them in the early stage of their lifecycle to see how the ideas and tools they’re bringing to the stage might be used in a large academic medical center.
Gamble: Very interesting. That’s definitely a trend we’re seeing as far as having a venture arm. I would guess the challenge is in being able to filter through what you’re seeing and identify what types of things can realistically be done.
Barchi: That’s true. But at the same time, we’re not being passive about this. We recognize that to best serve our patients, including those who are underserved, as Pete mentioned earlier, technology is a great leveler for inequality. If a technology can eliminate barriers of language, cost, transportation, or culture, we need to be thoughtful about adopting it.
In order to do that; to ensure we’re being active and not passive, we created the NYP Ventures Group. We’re investing in small technologies. We’re working with them, and then a few times a year, members of our senior leadership team travel to Northern California in Silicon Valley to meet with private equity firms and small companies to evaluate what’s happening. We even established a small office on Sand Hill Road as an outpost for NewYork-Presbyterian to have a foot in the door with emerging technologies.
Gamble: That’s very cool. It must be fascinating to hear some of these ideas. The last thing I want to ask is whether you have any guidance on how smaller organizations can get into the telehealth space, particularly when they’re working with fewer resources.
Barchi: I’ll say first that this didn’t start as a 50-plus modality program with millions of dollars of investment. Peter and his team started small. They had some really good ideas, but they started small. One example is NYP OnDemand. They created this emergency medicine care model three years ago, starting with just 10 patients, and it’s become a very successful initiative. And so my advice is to seek out opportunities, start small, see what works, and keep growing.
Fleischut: I agree. I would also say don’t reinvent the wheel. We were fortunate enough to be able to reach out to a lot of colleagues that had an institution or a program and talk to them about what worked and what didn’t. This is where providers really need to come together to understand what are the best practices, and how to get things implemented. We’ve hosted about 60 health systems to help share best practices. We’ve been open and transparent as we’ve tried to help other organizations while learning from them as well.
Gamble: That’s great. Well, I think that about wraps it up for now. I want to thank you both so much for your time, and I’d definitely like to catch up again down the road. Your organization is doing some fascinating work, and I think our audience will enjoy hearing about it.
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