Although the entire nation — and the world — has been impacted by Covid-19, it has been without standards. Different areas have been hit at different times, and in different ways. As a result, no two organizations have responded in exactly the same way.
But, as leaders have scrambled to address what they believe are the most critical needs first, while keeping an eye on how facilities will be affected down the road, there has been one common thread: an unprecedented willingness to share best practices and put the needs of the public first.
In keeping with that spirit, leaders from two of those organizations, which happen to be located on opposite coasts, described their teams’ efforts and offered advice for those in areas that haven’t yet peaked. Christopher Longhurst, MD, CIO and Associate CMO of Quality/Safety at UC San Diego Health and Rob Fields, SVP and CMO of Population Health at Mount Sinai Health System.
UCSD’s Four Buckets
At UC San Diego, a focus right out of the gate was to ensure the EHR system was being fully leveraged to help support clinical staff, whether by tracking transmission in real-time or enabling telemedicine visits. In fact, a team from the organization published a paper in JAMIA detailing “a series of EHR enhancements designed to support the rapid deployment of new policies, procedures, and protocols across a healthcare system in response to the COVID-19 pandemic.”
The goal? That their experiences will be “helpful to other health systems facing the same challenges,” the authors noted.
According to Longhurst, the strategy was divided into four primary buckets: remote working capabilities, EHR and workflow, virtual care, and analytics.
Fortunately, UCSD had rolled out Zoom prior to the pandemic. But as more teams adopted telecommuting, utilized increased exponentially, and along with it, the need to ensure users had access the right tools and hardware. “That was a big lift by our technology team,” Longhurst noted.
The second bucket involved leveraging the EHR as a platform to enable rapid responses in a standardized way for functions such as testing, screening protocols, and order sets. According to the paper, the team created order panels for inpatient, emergency department, and ambulatory settings that included a defaulted, prepopulated COVID-19 lab order, appropriate isolation orders, and options for additional laboratory testing or imaging studies.
The third area was the use of virtual tools — or “electronic PPE” — to prevent unnecessary exposure of patients and providers. Along with video visits on the ambulatory side, this also includes inpatient video visits, which are done using iPads.
Finally, UCSD utilized analytics to “get the data right, get it in real-time, and get in transparent,” said Longhhurst, both internally and externally. On the internal side, a dashboard that was initially accessible only to executives, then was made visible by 14,000 employees, while externally, the organization has posted statistics to Twitter and other outlets listing the number of patients who are seen and discharged, as well as the number of deaths.
The public response, he noted, has been overwhelmingly positive. “I can’t tell you how many messages I’ve gotten that it was helpful and reassuring. It has helped people feel less at risk and more comfortable.”
Mt. Sinai’s Dashboard Strategy
At Mount Sinai, an 8-hospital system located in New York City, a key priority early on was the distribution of resources to avoid overwhelming capacity, said Fields. This meant having to convert places like Central Park and the Javits Convention Center into pop-up hospitals, and standing up processes to get new physicians trained and credentialed so that they could provide frontline assistance.
One of the biggest challenges, however, was in being able to quickly and effective triage patients and match them with the appropriate resource, noted Fields. And so, the team created dashboards to help identify high-risk patients; something that became a dire need as healthcare professionals were asked to take on different roles.
“As individuals were figuring out how to get redeployed in this new world, they could use this tool to generate registries specific to their needs,” he said.
In designing the dashboard, Mount Sinai concentrated on five domains:
- General assessment and screening of chronic conditions such as congestive heart failure and COPD
- Medication access, which includes the long-term goal of converting patients to 90-day prescription services
- Food insecurity – Ensuring high-risk individuals have access to meals.
- Behavioral medicine – identifying those at increased risk for suicidality and reaching out to them
- Managing COVID-related symptoms – leveraging texting and other tools such as the STOP COVID NYC app to monitor symptoms and connect with providers
Although the app was already in development prior to the pandemic, as the need increased for easier methods of engaging with consumers, plans were ramped up. And, in addition to being a patient satisfier, it has also helped the organization to “utilize human resources more efficiently,” he stated. “There’s a tremendous amount of functionality. We’ve been pretty excited to get it going.”
The app, Fields noted, is a perfect example of how Covid-19 has shaken up the industry, and will continue to do so. “The need has required a much greater speed of transformation. It’s daunting, but exciting.”