Digital leaders at the forefront of containing COVID-19 in the U.S. are using novel and innovative strategies to expedite care for those in need while also protecting their patients, clinicians and teams from exposure to the virus. Health IT executives from two COVID-19 hotspots – Seattle and metro New York – share lessons learned to help others around the country proactively manage patients, assist providers, conserve limited resources and avoid exceeding their healthcare system’s capacity to handle the pandemic.
Lesson 1: Learning from peers can save valuable time.
The first COVID-19 case was documented in January in Western Washington, home to Seattle and UW Medicine. The area has since witnessed the swift spread of COVID-19 and related deaths from the disease. Meanwhile, New York state has reported the highest number of COVID-19 cases in the U.S., with cases largely concentrated in the New York City region. UW Medicine’s CIO Eric Neil and CNIO Kelly Summers and Brooklyn-based Interfaith Medical Center’s Assistant Vice President of Information Security Chris Frenz encourage healthcare IT executives to take advantage of insights gained from peers at the forefront of the pandemic in the U.S. to lessen the stress that the pandemic will place on their healthcare organizations.
“Working together is critical right now as this pandemic, and all of the risks it brings, impacts all of us,” Frenz notes. “None of us are facing this in isolation and we all stand to benefit from the open exchange of ideas and best practices.”
UW Medicine moved quickly to create a resource site with COVID-19 policies and protocols for other hospitals to use when considering their own pandemic response. The AEHIS Incident Response Committee, which is chaired by Frenz, has written a concise guide listing IT considerations during a disease outbreak. The guide can be downloaded here.
Lesson 2: Remove barriers that impede innovation.
Neil and Summers have been supporting UW Medicine’s efforts to help contain and control the disease through telehealth, telecommuting, reporting and analytics, and more. By prioritizing critical projects, modifying others and mothballing routine, nonessential endeavors, they have been able to build capacity in weeks and days that previously might have taken months. “We have really sped up our change process for things that are high priority,” Summers says. “But we have also very consciously stopped doing some routine things that we normally would have been doing at this point in time.”
UW Medicine has doubled their telehealth capability in less than two weeks in the ambulatory space; created a telehealth room in the acute care setting, fast tracking a project that normally takes three to four months to 10 days; modified online and call-in processes and procedures to stratify patients appropriate for telehealth visits; established drive-through clinics to test people for COVID-19; facilitated telecommuting, including an Epic implementation project now done virtually; and created a dashboard for the health system’s leadership to monitor and anticipate issues involving supplies and equipment.
Lesson 3: Assess your staff’s needs and capabilities.
Frenz cautions that COVID-19 is likely to strain healthcare systems’ staffing as clinicians and other employees become ill, self-isolate, have family emergencies or work from home. He recommends cross-training IT and security team members to ensure one person can step in for another during temporary absences. Healthcare organizations may need to bring in temporary help to cover absences and higher demand.
UW Medicine has been able to turn projects around so quickly because it has a team available around the clock. Although the demands may not be as grueling as those that clinicians face, these teams also can experience fatigue, Summers emphasizes. “We have augmented our technology on-call schedule to make sure we are deep enough on the bench to cover for just about anything that comes up but also allow for adequate rotation of our staff,” she says. “We are running a 24/7 shop right now as well. Making sure you have a good rotation schedule, taking care of your IT team so (you) can be responsive, is super important.”
Lesson 4: Virtual care offers huge benefits but requires forethought.
Telehealth provides fast, high-quality care while eliminating physical contact that could spread the virus and conserving resources like the masks, gowns and other personal protection equipment (PPE) required for an in-person visit. Using their online and telecommunications tools, UW Medicine developed a process to screen patients, offer face-to-face telehealth consultations and determine who needs to visit a clinic or hospital and who can safely stay home. Their ambulatory telehealth program allows patients who may not have access to the internet or other key tools to have a telehealth visit at a facility.
In the acute care setting, they stood up telehealth rooms for remote consultations with pulmonologists and intensivists. Besides the safety and PPE conservation benefits, acute care telehealth eliminates commuting, which lets specialists assess more ICU patients. “It is really extending our reach and increasing our ability to treat critically ill patients,” Summers says.
Besides the technical considerations, healthcare organizations need to ensure clinicians have the necessary training and hospital privileges, they add. “If we knew two months ago what we know now, what would we tell other hospitals?” Neil asks. “It is the rapid training of our providers, getting them credentialed so everyone can provide those telehealth visits.” UW Medicine’s IT training process includes explaining responsibilities as a telehealth physician, how to establish rapport with patients and their families, and how to interact with and use the tools.
Other telehealth tips:
- Be prepared to revise patient portals, communication tools and other technologies to control patient flow. “I think all healthcare systems are hard at work to allow patients to make their own appointments and ease the access of care,” Neil notes. “Now all of a sudden we need to do screening. We don’t want everybody making an appointment and walking into a clinic or an emergency room or whatever the setting of care is and potentially getting others sick when there is no need for it.”
- Have a plan to communicate that change, recognizing that different populations respond to different methods of communication.
- Think in advance what equipment will be needed to allow quick setup.
- “Be prepared to extend your IT network to areas you would have never anticipated,” Neil advises. “For example, we would have never anticipated putting a testing clinic inside of our parking garage so people could do drive-through testing.” They now are creating what they call networking in a box, “so that no matter where they need to extend the network, we have a solution right out of the box ready to go to decrease the lead time.”
Lesson 5: Anticipate leadership’s need to monitor supply chains.
Hospital leadership will need real-time data to monitor and manage supply chains, especially as demand increases. Neil’s team brainstormed the likely questions C-suite executives would ask to build a responsive, easy-to-use dashboard that can track usage rates, the status of incoming supplies, identify bottlenecks in the testing process or supply chain, and help leaders predict and address problems before they reach a crisis stage.
Lesson 6: Think broadly about telecommuting.
With the emphasis on social distancing, more administrative staff and clinicians may begin telecommuting rather than work on the premises. The IT team should ensure that all devices are properly protected, users are educated on cybersecurity best practices and familiar with teleconferencing technologies, among other tools.
Lesson 7: Keep security top of mind.
The urgency of COVID-19 creates security challenges for healthcare organizations. “While healthcare organizations need to act swiftly, they also need to be sure they aren’t compromising the safety and privacy of their patients,” Frenz cautions. “One of the things that concerns me on the information security front is that all of the confusion and staff outages that a surge in COVID-19 cases will cause creates an ideal situation for a cyberattack to occur. Reduced information security staff due to illness, a surge in patients and temporary workers, and the greater attack surface created by the increase in allowed remote connectivity creates the ideal situation for a cyberattack to occur and to occur undetected.”
He recommends IT departments test backup and disaster recovery plans, test business continuity plans, consider how they will handle the security risk of temporary employees and be vigilant for cyber threats. Healthcare organizations that have not yet journeyed into telehealth and remote access initiatives, or have just started, should perform a thorough risk assessment before launching such programs quickly in response to COVID-19, he suggests. “Hospitals need to be mindful that patient safety needs to be at the forefront of their thinking and that cybersecurity is a key component of patient safety in a modern hospital,” Frenz says.
Lesson 8: Early preparation will help even out distribution when a surge occurs.
The rising number of confirmed cases raises concerns that the healthcare system may reach a tipping point, with demand exceeding capacity to treat COVID-19 patients and others in need of care. Hospitals and health systems that proactively prepare for a possible surge in COVID-19 cases would be better able to absorb the influx of patients locally and ease the pressure put on nearby institutions. Put another way, each hospital that has to transfer patients to a nearby medical campus or county trauma center because of overcapacity is like a domino falling on its neighbor. The more that remain stable, the more patients will receive care and have better outcomes; the more that topple, the more likely their neighbor will follow, culminating in less care and worse outcomes.
“The stronger the health system is across the country, the better it is for all of us,” Neil says. “It doesn’t put all the pressure on the big health systems.”
Candace Stuart is the director of communications at the College of Healthcare Information Management Executives.
Part 2 Coming Soon…
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