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.
- “It’s a virus we’ve not seen before.”
- Virtual ED screenings to “limit exposure” to critical care docs
- Leveraging the EHR to identify potential plasma donors
- Continuously monitoring patients at home
- Telemedicine’s rise: “You don’t have to be Kaiser to do it.”
- Leadership during a crisis – “You see what’s at the core of folks.”
- Overdue recognition of healthcare workers
- Advice for CIOs: “Try to envision the future state.”
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I thought it was a little aggressive, but I would rather be a little bit more aggressive and miss, than to not reach for it.
We won’t go back to the status quo. There are just too many people doing it. It’s not isolated. It’s not, ‘only the Kaisers can do that. They’re so big.’ Everyone’s doing it to some extent.
When you see what’s happening in other parts of the world, you think, ‘these are my colleagues that I’m trying to support and set things up to allow them to see patients without being exposed.’ Going through this is motivating in and of itself.
People look at things one of two ways. It’s either, ‘I’ll tell you how this is not going to work,’ or it’s ‘We’ll figure out a way to get this done.’ It’s amazing how polarizing this is. You found yourself making mental notes.
As a CMIO, that’s where I’ve always said, ‘listen, my role is to be looking on the horizon. Tell me what your problems are so that I can look for those technical solutions and help.’
Gamble: What are some of the other high priority issues you’re dealing with – or have dealt with – in regard to Covid-19?
Oliver: The challenges have been direct challenges to this virus, because it’s a highly infectious disease. It’s a unique virus that we’ve not seen before, and so we needed to be prepared for high volumes and high quality care, while also limiting exposure to those key caregivers. Everybody is important; however, if our critical care physicians or our ED docs are all down, we’re in a world of hurt.
We’ve done a few things. We have a bunch of primary care physicians who have volunteered to do hospitalist work or urgent care work. What that means for us on the technical side is making sure they have access to whatever department they need that they don’t currently have access to, and are also able to work in the ED. That module is different than working in the ambulatory or inpatient setting, and so we got them some quick training. Fortunately we didn’t have to do that, but to have that in reserve was big.
We’ve also had virtual screenings set up for the ED physicians so that everybody who comes into the emergency department — at least at our bigger facilities — gets screened before entering. Even if it’s a broken arm, you might have COVID, so everyone gets screened. And it’s done virtually; the ED physician can be at home, quite frankly, and they could be triaging more than one facility. It’s so important to get that initial screen and say, ‘Okay, this person potentially could have COVID; I want them isolated,’ and this person with a broken arm can come in and get X-rayed. We’re trying to limit exposure and limit the use of PPEs.
A few weeks ago, the only tests we could get were taking 7 to 8 days to get returned. Imagine being in the hospital with pneumonia. You can be stable, but you’re in the hospital and we’ve got to don and remove PPE every time we come in until we get the test results. So the burn rate was incredibly high.
Obviously, it was important to get better testing and faster turnaround times, but there are things we can do. For example, if doctor’s not going to go in after that initial assessment, one nurse is going to round on a few patients and help doctors virtually. So we’ve got virtual care set up for all specialties that we just recently rolled out on the inpatient side.
Initially we focused on the ambulatory space, because they were stopped in their tracks pretty quickly when the executive orders came down. Then we focused on inpatient. We’ve had critical care and the ED set up, and now we’re opening that up more. If you’re a hospitalist, nephrologist or cardiologist, you can do virtual visits with the patient through Epic, using our Zoom platform.
The repurposing of beds is big technical piece that’s had our teams busy. ‘Okay, we’re going to have a COVID unit here. We’re going to use an ambulance bay for overflow.’ Well, what’s that going to be called? How do we get that into Epic so that whoever is taking care of them knows where they are — it’s those logistical issues. We have some great folks on our team that have been working around the clock and have done a great job getting all those beds set up. It could look the same to someone who’s walking past the room, but now it’s a Covid-19 bed, and it is tabbed differently within the EHR.
We’re doing something cool with convalescent plasma. A few of our hospitals have been working with their local blood banks to take the plasma from folks who have recovered from Covid-19 and used their antibodies to treat some severely ill folks. It’s an old technology, but one we haven’t had to use it in a while. Within our EHR, we’re building capabilities so we can identify potential donors, because they may not be in the hospital. They can get diagnosed, get treated and recover, and still be a donor for someone in the hospital. We’re trying to standardize that approach and make sure we’re not missing anybody who can contribute. That’s been a neat thing.
And there’s remote patient monitoring. That’s been a focus of mine; getting folks out of the hospital sooner, but sending them home with a monitor that’s on them continuously, and not just spot checking.
Let me put it in perspective. We’ve had a systems director for digital health since August — thank goodness we hired him. In January, we outlined an 18-month roadmap for where we hoped to be. I thought it was a little aggressive, but I would rather be a little bit more aggressive and miss, than to not reach for it. As it turned out, we got through a lot of that 18-month roadmap in six weeks. We blew it out of the water; that’s been the silver lining, I suppose. I never would have wanted it to happen this way, but we’ve advanced three years in our digital offerings with the whole organization focused on it.
Gamble: That’s amazing. I think we’re going to look back at this time in absolute amazement of what organizations were able to do.
Oliver: I agree. And I think because it’s so widespread, that’s another reason why we won’t go back to the status quo. There are just too many people doing it. It’s not isolated. It’s not, ‘only the Kaisers can do that. They’re so big.’ Everyone’s doing it to some extent.
My wife works in a private independent pediatric practice, and they had to adapt and figure out a telemedicine platform. They don’t have an IT department, but they’re doing it. You have to do it, or you won’t survive. It’s inevitable.
Gamble: Right. Had you ever been through any type of disaster experience — whether it was Ebola or a natural disaster — that gave you a sense of what it’s like to lead through a crisis?
Oliver: No. I haven’t served in the military and I didn’t have anything with Ebola. We had some disaster recovery/business continuity plans underway. We actually had a company that produced a fake video for us. There was a news report saying something like ‘Baptist Health has had a natural disaster and your whole system is down — how do you deliver care?’ We’ve been working on that for the last year or so. It’s more of a three-year process, but that has helped. I think back to residency when I did 36-hour and 48-hour shifts. You learn to push through the fatigue.
When you see what’s happening in other parts of the world, you think, ‘these are my colleagues that I’m trying to support and set things up to allow them to see patients without being exposed.’ Going through this is motivating in and of itself. I see that with our teams; they get that we’re potentially saving lives here. Maybe you say that every day in healthcare, but it has really felt like that.
And so, I haven’t been through something that prepared me for this. But one thing I’ve found very interesting is that when there is a crisis, you see what’s at the core of folks. You see that people look at things one of two ways. It’s either, ‘I’ll tell you how this is not going to work,’ or it’s ‘We’ll figure out a way to get this done.’ It’s amazing how polarizing this is. You found yourself making mental notes; I know who to reach out to when I’ve got something creative and I need a little help thinking through it. On the other hand, I know which team members would say, ‘I’ll tell you why this isn’t going to work.’ It’s been an interesting insight.
Gamble: Being a physician, I can imagine how it feels to see your colleagues on the frontlines and the work they’re doing. It must be gratifying to see that recognition of what healthcare professionals go through, even when it’s not a major situation.
Oliver: There’s always been this stereotype that doctors make a ton of money and they don’t care about people, when in reality, we’ve incurred a lot of debt to get where we are. My wife and I are both primary care physicians. And I’m not saying we’re destitute, but there are much better ways to get wealthy than to go into medicine; to see people recognize that is gratifying.
One thing that’s really frustrating is the pay cuts. I understand that current revenues are down 40 percent; it’s a big deal. You have to be viable, but it’s so disheartening to see ED physicians get a pay cut. These folks are putting their lives on the line; they always do, whether it’s another infectious disease or the rising amount of assaults in the ED. The majority of people I know went into this for the right reason, and I’m thankful that they’re getting some of the spotlight.
Gamble: The last thing I want to talk about is the relationship with CIOs. What should they be aware of, or what can they do to ease the burden for physicians?
Oliver: I would say, try to envision that future state. Because if you see that you’re providing a product or capability, or a functionality that is needed — for example, video visits — it’s amazing. The grace that is given, the excitement and the willingness to partner, they’re all in.
And I think it’s been good for both sides. The clinical folks saw that they really needed those technical folks. But there’s that real, ‘I can’t do this. I can’t call them into the office. They’re not coming in. How can you help me?’ That’s where I’ve seen the recognition — ‘I didn’t know how much work you all were doing to get us prepared. I spoke with my colleague at this organization or at this practice, and they’re stuck with a system they can’t use. But you guys have done it.’
And so, it’s both. This is a great time to see the other side; to say, ‘let’s sit down and talk about what goals you have as a clinician, as a department, so we know how to partner with you.’ We’ve always said that, but I think they’ve been a little hesitant in partnerships — maybe because they didn’t understand. As a CMIO, that’s where I’ve always said, ‘listen, my role is to be looking on the horizon. Tell me what your problems are so that I can look for those technical solutions and help.’ It’s being willing to get with clinical leaders and say, ‘How else can we partner together and make things that much greater for our patients?’