Perhaps the most common thread for health IT leaders during the past few months has been the spike in telehealth adoption. Organizations had to quickly expand — or in some cases, build out — their offerings to ensure care continuity. But there were a select few who already had the infrastructure in place; one of those was NewYork-Presbyterian, an academic health system located right in the heart of the Big Apple.
The fact that NYP’s OnDemand platform was already being utilized on a large scale came in handy, particularly during the early days of Covid. Some might even say the organization was lucky. Luck, however, had nothing to do with it. Instead, it was leadership’s dedication in pushing the initiative forward — without pushing it on physicians — and ensuring the right pieces were in place, that led to what has been a tremendous success story, according to Daniel Barchi.
Recently, healthsystemCIO spoke with Barchi about how Covid affected his team’s strategy (particularly in terms of its Epic implementation), why transitioning to remote work turned out to be a positive, and how disaster planning is forever changed.
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- NewYork-Presbyterian’s success with telemedicine didn’t happen overnight; the organization began laying the groundwork back in 2015.
- One of the keys to success with any initiative? Don’t lead with technology; aim to deliver technology in a way that helps providers deliver care more effectively.
- The more thoughtful organizations are about how they invest their resources, the less likely IT teams will have to delay projects in the event of a situation like a pandemic.
- Since the worst of the surge, NYP IT leadership has been working to refine its risk management practices to be able to apply lessons learned when preparing for future events.
Q&A with Daniel Barchi, Part 2 (Click here to view Part 1)
Gamble: One topic that’s been prevalent through all of this is telemedicine. From our previous conversations, I know NewYork-Presbyterian has been at the forefront. Can you talk about how having an infrastructure in place has made an impact?
Barchi: It’s hard to ramp up quickly if you have no experience. The work that we did from 2015 to 2019 really laid the groundwork for our ability to ramp up telemedicine. New York-Presbyterian was already a national leader in telemedicine through NYP OnDemand, Virtual Urgent Care, our mobile stroke units, and all the other programs we have. We were doing several hundred remote patient visits every week back in January and February of this year.
Then when Covid hit and there was no easy, safe way to see a physician, our physicians stepped up and rapidly increased the ability to do remote visits. We went from several hundred visits a week to more than 24,000 visits a week in March. And as the ability to do in-person visits has returned, the amount of telemedicine visits has dropped, but it still represents up to 30 percent of all visits, and probably will going forward.
Because there are many visits in which it’s safe and efficient for physicians to see patients remotely, and it’s also convenient. And so what we’re seeing now is that telemedicine isn’t an ‘either or’ tool, it’s an ‘and’ tool where, in many cases, it makes the most sense for visit to be done virtually. But in other cases, it makes the most sense for patients to see physicians in their practice office.
Gamble: As you eluded to, NewYork-Presbyterian has been laying the groundwork for telemedicine for a while. Did it feel like you were beating the drum trying to gain buy-in, or was there a lot of interest from users?
Barchi: Our primary goal at New York-Presbyterian is to deliver outstanding patient care. We never want to lead with technology; we want technology to support physicians in however they want to deliver that care. And so we made it available and we certainly shared the benefits, but we never pushed it as a solution. It was embraced by physicians who felt like it would be additive to their practice. We’ve taken that approach all along, and we’ve had a large uptick in use as we’ve offered each of the additional services over the past several years. During the past few months, it was the physicians again to who wanted it for their patients, and the patients embraced it.
Gamble: What would you say are your biggest priorities right now?
Barchi: Our key priority, first and foremost, continues to be the safety and delivery of care for our patients; that will remain a focus. We’ll continue to develop telemedicine tools and processes, and we’re also focused on analytics and how data will help deliver outstanding care. We continue to use robotic process automation and artificial intelligence where it’s warranted, and we’re focused on continued integrated care using technology across our entire system.
Gamble: Were there certain initiatives that had to be placed on the backburner or is that something the organization was able to avoid?
Barchi: We’ve avoided it mostly because we have always been thoughtful in the way that we ramp up our services. We don’t like to pilot things. We’ve developed them in a way that has allowed us to launch them and use them. It was never a question of saying, ‘This pilot isn’t going well. Let’s back off on it.’ Most things we’ve launched are being actively used with a positive ROI and so, it was just continuing to let them flourish. But maybe giving them less attention because they were already launched.
Gamble: I would think that speaks to having good processes in place; it shows that the organization isn’t putting time and resources into the project that aren’t important and can’t be delayed.
Barchi: That’s a good point. We’re thoughtful about the investment of resources; those in which we invest our time and resources in are the ones that we think will really move the dial on patient care.
Gamble: Let’s talk about leading through difficult situations. You’ve spoken at CHIME about your experience in the Navy and how that helped shape you as a leader. Were you able to draw from that experience to lead during Covid?
Barchi: There were so many healthcare leaders who stepped up and drew from their experiences, whether they were clinicians who worked in critical care situations or administrators who’ve been through challenges in the past. Even smaller events like hurricanes, snow storms and mass casualty drills all contributed to that experience. But normally, those events are over within a matter of days. It was that initial experience that allowed us to ramp up, and it was the partnership and collaboration of the senior leaders of New York-Presbyterian and Weill Cornell Medicine and Columbia Doctors that kept us sustained throughout.
Let me share one insight. Our CEO and Chief Operating Officer did a video broadcast to our 47,000 employees every day for well over three months. It was that level of communication from the top and being transparent about what was going well, what was a challenge, and how we were spending our time and resources and keeping everybody informed, that was a real hallmark of leadership through all of this.
Gamble: I can imagine that was really appreciated because of the uncertainty everybody experienced.
Barchi: Sure. Her updates were must-see TV daily.
Gamble: Looking back at the experience, is there anything you would have done differently or anything you would’ve changed?
Barchi: No. I’m proud that if the major initial surge happened to be anywhere, it was in New York, and that New York-Presbyterian and the city’s other hospitals stepped up and worked through this together. We were able to share insights about what to expect, so that I feel like even though we went through the worst of it initially, we were able to share enough clinical and operational information with our partners across the country so that they were able to prepare and respond when Covid surged in their areas.
Gamble: In an area like New York, which is very competitive, there seemed to be a willingness across the board to put that aside and collaborate.
Barchi: That’s exactly what happened. We partnered with hospitals across the city and shared resources and information in a way that looked out for our patients first; I think we should be proud of that.
Gamble: In terms of business continuity planning, is that something that you have addressed or you think will be addressed just as far as what to do or how to react if something like this happens again?
Barchi: We already had a pretty robust and mature risk management process. But since the worst of the surge we’ve been working with our governance committee to refine our risk management practices, based on what we’ve learned, to prepare not necessary for the exact same event, but to be able to apply lessons learned to different things that might happen in the future. So it’s been a great learning experience, even though it’s been a challenge.
Gamble: From an outsider’s perspective, it has been great to see such resilience. Being in New Jersey, I knew how badly things looked in March. I’m sure it’s really satisfying to be able to look back at what the health systems in the city were able to accomplish.
Barchi: It really is. There was a recent article in the New York Times about how we’ve kept the numbers low. Everyone is feeling like, ‘I’m glad we did it — how do we continue to do so?’ That’s where we need to keep our focus.
Gamble: Absolutely. Well, I want to thank you so much for your time. We really appreciate it.
Barchi: Of course. I always enjoy speaking with you and I enjoy your work. Thank you for reaching out.