Podcast Interview with CMIO Brett Oliver, Part 1: “It’s Been an Overnight Culture Change.”

There’s an interesting dynamic that happens when an organization faces a crisis. The compounding factors of stress, fear, and exhaustion can cut right to the core, and individuals are separated into two groups: naysayers and believers. And it’s the believers — the ones who focus on how to get things done, rather than why they aren’t getting done — who lift up everyone around them, according to Brett Oliver, MD, CMIO at Baptist Health.

Recently, Oliver spoke with healthsystemCIO about how his team is dealing with the myriad challenges of Covid-19, from connectivity to infrastructure concerns, and the enormous culture change he has seen when it comes to rolling out solutions. He also talks about why it’s important to have an aggressive digital health strategy, where Baptist Health has succeeded and struggled in fighting the pandemic, and the unique opportunity it presents for clinicians and IT to partner more effectively.

Part 1

• Disaster preparedness challenges – “It impacts morale.”
• Rapid growth in virtual visits – “It’s tested the limits of our capabilities.”
• Pride in having “everyone pulling in the same direction.”
• Addressing hesitation with quick rollouts
• “We have to do this.”
• The “overnight culture change” for both IT and clinicians
• Positive feedback from patients
• Connectivity concerns in rural areas – “There are still issues.”

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Bold Statements

It’s a real challenge to prepare for the disaster that could be coming to your area, and at the same time start game planning — what does this have to look like on the other side so we can be viable moving forward?

It’s giving them the comfort level to say, ‘no one’s coming after you. I’ll take the heat if something goes wrong, but it’s okay to let this go right now. I know you haven’t done this level of testing or gotten this feedback, but we’ve got to go forward.’

I still think we can do a better job with interfaces to the patients. Epic’s portal, MyChart, is excellent, but there are still things that make it a little clunky, and so continuing to improve will be a good thing.

If your scale is 10 or 15 video visits a day, you tend to forget that it can’t be done well in some areas. Well, when you scale up and now a third of your visits are virtual, all of a sudden that becomes important. We can’t provide that care.

Gamble:  When you did a webinar with us recently, you talked about being in a holding pattern, waiting for Covid-19 to hit. What are some of the challenges there, and how does it impact your ability to plan?

Oliver:  It certainly impacts morale for one, because you’re working on adrenaline. It’s like pulling an all-nighter, whether you’re working in an ER or you’re a student; if you hit a lull or stop, that’s dangerous.

It’s also economically challenging. Our revenues are down tremendously. It’s hard for a lot of the country to recognize this. They think, ‘healthcare is fine; they’re getting slammed. Yes, it’s happening in certain parts of the country, but it’s happening in the ER, and as hospital finance folks know, your medical beds don’t pay the bills. It’s your surgeries, outpatient procedures, and radiology, all of which essentially stopped. And so it’s a real challenge to prepare for the disaster that could be coming to your area, and at the same time start game planning — what does this have to look like on the other side so we can be viable moving forward?

 

Gamble:  That’s a good point. What are you doing in terms of virtual visits?

Oliver:  That’s been crazy. I hesitate to use the word ‘fun,’ but there’s definitely been some joy in being able to expand this so quickly and clear some of the hurdles. We’ve been working on this for a couple of years.

To give you some perspective, prior to COVID, we had urgent care video visits enabled for our system. The first year, we allowed our staff to utilize them at a discounted rate. On a busy day, we were running about 15 or 20. And we had essentially one provider doing it, which always made me nervous to think, ‘what happens if she gets sick?’ I’d hear, ‘we’re working on it, but the demand hasn’t been there.’ By the third week of having video visits available for any ambulatory provider in any specialty, including urgent care, primary care, cardiology, and endocrinology, we were up to around 2,200 or 2,300 visits per day.

It has tested the limits of our capabilities, but really, it’s been amazing to hear people say, ‘My patients really like this. This was helpful.’ Honestly, I don’t know that there’s any way to claw that back. I think some of the hurdles that have been knocked down, like telephone visits counting for video, etc., will get pulled back. But it’s really been fun to see some of my more Luddite colleagues — who have said in the past that it will never work and is a terrible way to care for patients — now say, ‘You know what? That wasn’t so bad.’ These are some of the things we’re learning.

 

Gamble:  So you really had to ramp up quickly. How were you able to do that?

Oliver:  I really think this would have been a six to nine-month project in terms of the pace with which we normally would go, and how we vet things out. Problems have arose that we wouldn’t have had if we would have had the time to vet.

For instance, we were working with Vidyo on a deep integration with our EHR (Epic), and we didn’t realize all the different limitations to the different websites, whether you’re using Internet Explorer or Firefox or Chrome. There are limitations, and we had to learn that on the fly. Our team that does training and support team for our ambulatory providers reports to me, and they’ve been extremely busy. It’s been, ‘okay, we got an update. Here’s the latest.’

And I have to say, there has been a lot of grace to go around. Whereas in the past, things like that would have evoked ire from a provider or manager, now it’s more like, ‘hey, just a heads up, this isn’t working either. You might want to add that to the tip sheet.’ It’s been a pleasure to see everybody pulling in the same direction. We’ve tried to do the best we can on the frontend to not roll out something that isn’t ready. But I’ve had to do some convincing with some of our non-clinically facing folks, like our infrastructure teams — they’re not used to rolling something out if it hasn’t been tested 10 times and turned around. They don’t want to put something in front of a provider until it’s ready to go. I’ve had to say, ‘we have to do this. They’d rather have something go wrong 1 out of 10 times and be able to see 9 of those 10 patients than not see any at all. It’s been interesting to watch that culture change.

 

Gamble:  I’m sure that’s a really interesting conversation.

Oliver:  It is. It’s giving them the comfort level to say, ‘no one’s coming after you. I’ll take the heat if something goes wrong, but it’s okay to let this go right now. I know you haven’t done this level of testing or gotten this feedback, but we’ve got to go forward.’ And you can see, it’s worked for 2,200-plus visits per day. It just blows me away. Maybe those numbers won’t stick, but I think they’re here to stay, at least at some level. But it’s been an overnight culture change.

 

Gamble:  What about patients? Has there been any feedback?

Oliver:  We haven’t seen the reporting on any official survey, but at least anecdotally, we know that patients have appreciated it, especially the ability to see their own provider. A lot of the payers have an urgent care outlet, whether that’s staffed by Amwell or someone else, that they would offer. But you’re not seeing your doctor, and there’s a little bit of hesitation as to whether it’s provided by the insurance company or the state government. And like I said, being able to see your own doctor virtually has been a real benefit.

 

Gamble:  Sure. And since you have a lot of patients in rural areas, I imagine this has really been a game-changer.

Oliver:  Absolutely, particularly with some of the things that we’ve always known we could do virtually. But that’s how we were compensated. We didn’t get compensated if we didn’t see you.

Our endocrinologists were thrilled. They immediately said, ‘This is going to be great. We can adjust insulin.’ They don’t have to examine a patient to have a conversation about their diet and insulin dose. So this has been right in their wheelhouse. Cardiologists and primary care have also really responded well.

And when you think about it, this virus isn’t likely going away overnight; some of our elderly folks are going to be frightened to come in to any office or hospital area. This way, they can continue to get care. I think they’ll demand it.

 

Gamble:  You mentioned that there were some challenges with the Vidyo integration. What did you have to do there?

Oliver:  A lot of it was education because there were some limitations. If you say, ‘I can’t do this on an Android device,’ I can’t do anything about that. I can’t buy you an iPhone.  You have to figure that out on your own. We still have some connectivity and infrastructure problems in Kentucky and southern Indiana, where we’re doing some remote patient monitoring with a device from a company called Current Health. It either can plug directly into your home Wi-Fi — or if you don’t have Wi-Fi capabilities, it uses a cellular network in your area to create a Wi-Fi network.

We had a pilot with them prior to COVID. When we first rolled that out in parts of southern Indiana, the home care nurses were coming back saying, ‘it’s not working. We can’t get a signal.’ So the vendors said, ‘We’ll come out and get it fixed for you.’ And they came out and said, ‘You don’t have a cell signal here.’ That’s what we were trying to tell them.

So yes, it’s still an issue, and it’s not one that Baptist or any individual organization can solve. I’m on our state telehealth board, and at that level, we continue to talk about the need for advancements in infrastructure.

There are also still some technical challenges. The thinking has been that elderly folks aren’t going to get this, but the data show that that’s wrong. Of course, there are some folks who still use a flip phone or don’t trust technology; that’s always going to exist. But I don’t think it’s quite the large gap that some perceive it to be. Our data belies that. We find that they use it well; I get messages all the time from elderly patients through MyChart in our EHR.

It will be interesting to see if some of the interstate licensing pieces get pulled back a little bit. I still think we can do a better job with interfaces to the patients. Epic’s portal, MyChart, is excellent, but there are still things that make it a little clunky, and so continuing to improve will be a good thing.

 

Gamble:  You mentioned connectivity issues; maybe things like that will be brought to light once people have had the chance to catch their breath. I think there’s still a lack of awareness of what people in rural areas are dealing with.

Oliver:  That’s a great point. I think you’re right. If your scale is 10 or 15 video visits a day, you tend to forget that it can’t be done well in some areas. Well, when you scale up and now a third of your visits are virtual, all of a sudden that becomes important. We can’t provide that care.

Surgeons are clamoring for this right now for post-op visits. They have to see patients; they have to check their wounds and make sure they’re okay, but they hate the fact that patients have to drive an hour and a half for surgeons to spend 30 seconds with them. It’s a global charge. There’s no billing piece to work out, and so they’re really excited about that.

Part 2