It’s funny; one of the key challenges for healthcare IT leaders during the COVID-19 pandemic is a lack of time. There simply aren’t enough hours in the day. And yet, it’s that time crunch that has forced organizations to shorten the decision-making process and make “informed, but expedited decisions,” said Stephanie Lahr, MD. “We didn’t have time for overthinking.”
As a result, the informatics and technology teams at Monument Health, a five-hospital system based in Rapid City, South Dakota, were able to operationalize extremely quickly in preparation for an influx of patients. According to Lahr, who holds both the CIO and CMIO titles, Monument went from doing almost no telehealth visits to more than 600 per day, and set up a nursing triage center within 24 hours. The keys? Having the support of leadership, and teams that are able to come together to achieve a common goal.
In a recent interview, Lahr talked about the organization’s multifaceted approach to continue to provide quality care during the pandemic, the unique challenges rural organizations face — particularly during a crisis, and how disaster preparation is similar to planning a major implementation.
- Capacity planning & staffing strategy
- Key to telehealth success: “Having everyone swimming in one direction.”
- Replacing at-the-elbow support with self-deployment
- Virtual care’s momentum — “It’s going to be very difficult to peel back.”
- 5G national deployment project
- The “overlooked opportunity” with rural health
- Parallels between go-live planning & disaster preparation
- Value of empathy: “We need to support each other and give each other some extra grace.”
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We wanted to make good decisions. We didn’t have time for overthinking, having multiple meetings, and bringing multiple different areas together. We couldn’t use our traditional decision-making processes because we just didn’t have the time.
It was very different from my normal informatics, high-touch, at-the-elbow approach to support; it was the exact opposite of that, but we were really upfront about it.
There are hidden opportunities in this for us to innovate and create and push the bounds of what we’ve done before. For the most part, this type of situation typically brings out the best in people and that’s really what we’re seeing.
It’s a little bit similar to a go-live or a major project. You have a lot of people that need to be coordinated, a lot of education that needs to happen, and a lot that is expected but unknown about what that future is going to look like.
This is one of those times when we need those calming factors. We need those connections to each other. And we need to recognize what it is we’re going through, acknowledge it, and let it be what it is. That helps us get through it.
Gamble: What have you done in terms of staffing? Have you had to ramp up to be able to accommodate more patients?
Lahr: We’re in the phases of putting together an eight or nine-phase surge capacity plan, which includes everything from the space to the technology to the other equipment needs, as well as staffing. The place we’re at now is putting together those plans so that as we enter into each of those phases, we know who and how we’re going to need to leverage people. On the inpatient side, we’re doing things with video capability that will potentially allow, for example, an ICU nurse sitting at a command center work station to be able to monitor 16 patients at one time in various ICU settings around the hospital. That ICU nurse can also communicate with a nurse who is in closer proximity, but who may be going back and forth between more widely distributed areas because the negative pressure isolation rooms are not all in one location. I think it’s common at a lot of hospitals for them to be separated into different areas of the hospitals. But we will reserve those rooms for ICU-level patients receiving aerosolized procedures, so now we have a decentralized ICU.
That’s part of our capacity planning and staffing — what are some tools we can use that might allow a physician to be able to round on 24 patients in a few hours instead of 12? One way to do that is by being able to beam in room by room as opposed to having to physically have to walk in and put on equipment.
Gamble: Let’s talk about telemedicine. It’s remarkable how quickly it’s been put into place. What were the keys to making that possible?
Lahr: There were a couple of things. One, the organization was all swimming in one direction. Everybody was in agreement that this is something we want to focus on; we’re motivated to do it. When rolling out a big project, a huge part of being able to succeed quickly is in having everyone row in the same direction. We made informed but expedited decisions.
My philosophy since we started really digging into all of this was that we wanted to make good decisions. We didn’t have time for overthinking, having multiple meetings, and bringing multiple different areas together. We couldn’t use our traditional decision-making processes because we just didn’t have the time. And so, with the support of the organization, my team was going to make the best decisions possible knowing we’ve got great clinical and technical people on the team. They said, ‘You figure this out, and whatever you think we need to do, we’ll be behind you.’
That’s how I was able to essentially say on day one, ‘Okay, here’s the criteria I need,’ and I asked my team to do some leg work on what that would look like so that we could do a comparison, and within 24 hours, go from initial search to decision and contracting. And then again, because the organization was excited and motivated to do this, the next day we were able to get it built out and have the teams say, ‘yes, we’re willing to trial it. We know it’s going to be a little rough around the edges, but we’re excited to be able to move into this space.’
And then we rapidly created what I called a self-deployment package. I shared with the organization and the rest of the leadership team very early on that if we wanted to get all the clinics and all specialties up across our 25 locations and several hundred-mile geography, we were going to need to do self-deployment.
It was very different from my normal informatics, high-touch, at-the-elbow approach to support; it was the exact opposite of that, but we were really upfront about it. We said, ‘here’s how it will work. Here’s WebEx. Here are the tip sheet and the tools. We’ll have people available for you to talk to, but in order for everyone to essentially go live at almost the same time, you guys have to own the success of this, as much as we do. And again, because everyone was so motivated to make it happen, that’s exactly what they did. We walked through a day or two of piloting to work out a few kinks. We put those tools together for people to be able to self-direct and they ran with it.
Gamble: From a leader’s perspective, I’m sure it’s great to see that willingness to own it and be willing to try something that is going to have probably hiccups at first, but has a tremendous upside.
Lahr: This situation is so challenging and unbelievable in so many ways. But there really are some opportunities hidden in this for us to innovate and create and push the bounds of what we’ve done before. What I find is that for the most part, this type of situation typically brings out the best in people and that’s really what we’re seeing. People understand that this is something we’re going to need to conquer as a team. And when I say team, that’s the whole community — the whole healthcare organization. This is a team effort, and so it’s really inspiring and gratifying in a lot of ways to be working in the middle of this situation, because there are a lot of amazing things happening.
Gamble: Definitely. And I know it’s hard to predict what’s going to happen, but do you think this will help the movement toward virtual care?
Lahr: I think it has to. For good reason, there have been limitations in place. We’re going to have a lot of data in a handful of months to help us look back and determine whether the concerns that created some of those limitations were valid. From what I’ve seen from a quality perspective, we’ll have some data that we’ll be able to look at to determine if there were changes in the outcomes of these patients. It’ll be difficult, because there are a number of other confounding variables in the middle of a pandemic as to why a patient may do better or worse than they do normally. But I think we’ll have some opportunity to review that. We’ll certainly be able to monitor things like patient experience, number of visits, ease of use, and those types of things.
I think that’s going to speak greatly to the success of this. What I’m seeing is that patients really, really like it. The providers do too, but I think that’s always been the question: do patients really want this? Are they going to use this? We’re seeing that they really do like it and they think it’s a high-quality experience. From a consumer perspective, hopefully that will drive the payers to say, this is something our consumers — the people who are paying for the services we provide — really want this access. And so I think it’s going to be very difficult to peel it back once people have become somewhat accustomed to this. I won’t say it’s impossible, because it definitely can be done, but I it’s going to be difficult, and I think we’re going to have a lot of information available to help show that this can be very successful. And it may show us some areas where it is less ideally suited, and we can make adjustments.
Gamble: Right. There are a lot of upsides, especially for those in rural areas, but connectivity has been a challenge.
Lahr: Yes. Even before all of this happened, I’ve been involved in a few different initiatives. I’m doing some work with a couple of different groups, particularly with CHIME on what we call the 5G national deployment project. What is that going to look like over time? What are the drivers? Where should it go and when? My gut feeling is that for rural areas, it may have been an overlooked opportunity — it may be even more necessary there than in heavily populated areas because of limitations with connectivity. We have patients living in areas where only satellite and dial-up are available. You can’t do a high-quality video visit over dial-up, and so having expansive 5G could really be valuable. In the meantime, we’ll do phone visits. That’s good too.
Gamble: Right. So, the last area I wanted to talk about is leading through uncertain times. Is this something you’ve experienced, whether it was going through something like a natural disaster or anything where you could apply some of those lessons?
Lahr: It’s interesting you say that. I don’t know if this is a fair comparison, but from a technology perspective, it’s a little bit similar to a go-live or a major project. You have a lot of people that need to be coordinated, a lot of education that needs to happen, and a lot that is expected but unknown about what that future is going to look like. And as you get closer to that go-live, peoples’ anxiety levels go up, the level of need for information goes up, and the need for good communication goes up.
I actually had this conversation with my team. We did our Epic go-live two and a half years ago, and so I said, ‘do you remember when we were about 8 or 10 days before our go-live? A lot of great work had happened in preparation, but we were seeing this rising level of anxiety and a sense of uncertainly as to whether we had really done everything we needed to do. Were we going to be ready? Were all the right people included?
Some people didn’t feel as though they had all the communication they needed. Things were changing rapidly; everyone had to be informed. And yet, communication tools being what they are and human behavior being what it is, communication remains a challenge. That time period right before we went live is very similar to where we are right now. For those in New York and Seattle and places where things have already really taken off, it’s a completely different kind of situation. We’re in that pre-go-live stage right now, and there are challenges in that as well, because people have enough time to think about what may be coming and are we or are we not adequately prepared. That creates anxiety and questions and increases the need for communication. But they also think, ‘well, it’s not here yet, so we probably still have time and maybe we should make more changes.’
I’ve tried to counsel my teams on the need to fundamentally acknowledge that people are experiencing anxiety, and we need to support each other and give each other some grace. We need to work on communication. For my own teams, we now do Facebook live every week; I do about an hour-long session every Friday giving updates to my team where they can submit questions. Some of them are a little bit clinical. Where are we in the community? What type of work is our team doing? We play games on Facebook or other means of social media where we gather people today. On Thursday we have movie nights where we pick a movie and we all watch it at the same time, and post to our private Facebook group.
Based on what I learned from my physician training about human behavior in times of stress and emergency, this is one of those times when we need those calming factors. We need those connections to each other. And we need to recognize what it is we’re going through, acknowledge it, and let it be what it is. That helps us get through it.
Gamble: Actually, the comparison does make sense. There’s nothing you can really compare this to, but there are similar feelings.
Lahr: Right. And I don’t want to oversimplify that a pandemic is like an Epic go-live. That’s not what I’m saying. But some of the emotions that go into the ramp up and that culminating moment and high-pressure situation are similar.
Gamble: Agreed. Well, I would love to talk more with you, but I think that I should let you go considering everything you have going on. Thank you so much, and I definitely hope we can catch up again in the future.
Lahr: Absolutely. Always good to talk to you.