There’s a different mentality during an emergency situation, particularly in healthcare. Individuals are expected to go above and beyond to ensure patients are cared for, whether it’s those who are providing the care or those working behind the scenes. For organizations with the right pieces in place, it can be an opportunity to shine.
But when an emergency lasts for months on end, it can become too much for any team to handle, which is exactly what’s happening with the Covid-19 pandemic.
In a time of emergency, everybody feels like they need to run a sprint every day,” said John Halamka, MD, President, Mayo Clinic Platform. “But you can’t sprint for a year.” During a recent HIT Policy Update, he discussed the key challenges healthcare IT leaders have been grappling with since Covid first hit, the solutions that can help ease the burden, and what he believes is the best path forward.
The first step is acknowledging the “roller coaster ride” that the entire industry has been on since March, said Halamka, who admitted to feeling a “strange mix of emotions” approaching the end of 2020. “On the one hand, we are seeing great science producing levels of cures and potential vaccine candidates at an accelerated rate that far exceeds anything in human history. But at the same time, we’re seeing a pandemic surge that exceeds anything we’ve experienced before.” As many areas endure spikes in Covid cases, “We’re seeing hospital capacity stretched to its limits. We’re seeing burnout of our caregivers, and we’re seeing supply chain challenges.”
There is, however, a silver lining: a willingness to put aside competitive differences and work together to develop solutions, said Halamka, who co-leads the Covid-19 Healthcare Coalition along with Dr. Jay Schnitzer of MITRE. “We’re seeing a truly bipartisan effort where academic, industry, and government stakeholders are coming together for the benefit of all.”
If progress is to be made, that effort must continue. To date, there have been more than 12.5 million confirmed cases in the U.S. since the pandemic began, and at least 258,600 deaths (NY Times).
The challenge, of course, is that there are so many questions when it comes to managing Covid, and very few answers. To that end, Halamka broke it down into six key areas: isolation, testing, contact tracing, pre-vaccine return to work, post-vaccine return to work, and the new normal.
- Isolation. One of the key concerns is ensuring an adequate supply of PPE — where are the masks and ventilators, and how can we get them into the right hands. “When hospitals exceed capacity, PPE becomes scarce,” he said. And the ability to monitor supply and demand, and distribute supplies equitably, becomes critical. Through its website, the coalition offers a decision-makers dashboard that provides updated infection and death rates, along with best practices, for every county in the United States.
- Testing. A number of viral and antibody tests are available; what’s not always clear is which test should be administered, and what are the next steps based on the result. “That’s why we need additional tools,” said Halamka, who discussed some of the solutions in development, including apps that can interpret laboratory tests. “If a computer can look at a lateral flow like lateral flow assay and determine by looking at the color and using an algorithm whether it’s a positive or negative test, and record that as part of the workflow, that’s going to be important.” He expects a great deal of energy to be put toward expanding testing capabilities.
- Contact tracing. In its traditional form, contact tracing isn’t scalable — “especially when you look at the current surge, with the curve almost exceeding the capacity for public health to do tracing and recommend isolation,” said Halamka. A more practical solution is Google/Apple Exposure Notification (GAEN), a privacy-preserving protocol that doesn’t utilize GPS, which has been found to have accuracy limitations. Instead, GAEN can detect when the user has been in the proximity of an individual who has tested positive for Covid (based on the location of phones), and sends out an alert to notify him or her of a possible exposure. “It’s a really intriguing idea,” he noted. “I highly recommend it because it reports nothing but Bluetooth tokens of phones around you.”
- Pre-vaccine. The good news? This is an area that’s quickly evolving. The not-so-good? Although tests have shown that use of convalescent plasma is safe, determining efficacy isn’t quite so simple. What that means is before individuals can be randomized to placebo, “We need to gather real-world evidence to make sure it’s safe and efficacious,” Halamka said, which becomes more difficult when things are moving so quickly. And although he’s encouraged by the fact that organizations are working together through coalitions to “gather anonymized data in nontraditional ways to start to understand more about response to medications or severity of disease,” he believes progress hinges on better clinical coordination. “There are dozens of trials for the same medication and different sites that are having trouble enrolling enough patients because there are just too many.”
- Post-vaccine. Once a vaccine does become available, there will still be challenges — many of them, said Halamka. “How do we know who should get which vaccine, and how are we going to distribute them? We’ll need a national standard for the administration of vaccines, and proof of completion of the multiple doses, if needed.” More collaboration is happening in this area, with clinicians and representatives from Google, Microsoft, and Apple meeting to develop a national standard for proof of vaccine and obtain consensus on things like implementation guides. The idea, he said, is to ensure individuals get the right vaccine, that it’s administered appropriately, and it’s part of the workflow.
- New Normal. If only about 30 to 40 percent of people are willing to get a vaccine, how are we going to get through the pandemic? The answer, said Halamka, is by increasing awareness and building trust, whether it’s through PSAs featuring celebrities like Dwayne Johnson, ad campaigns, or even conversations. “If we’re going to get this vaccine administered and contact tracing widely implemented, and a universal standard for lab and vaccine proof, community engagement is really key,” he added.
A key part of that ‘new normal’ is in understanding that consumer expectations have changed during the past several months; virtual care has proven to be effective and safe, and in many instances, has become the preferred method of interaction. This new model of care delivery, Halamka noted, amplifies the need for policy changes supporting reimbursement.
It also highlights the importance of equity. “As we develop these technologies, it’s important that we think about disparities of care and make sure we’re delivering these solutions to those who need them most, and not based on technological literacy or access to broadband, income, education, race, or other factors,” he said. As a result, Halamka plans to focus heavily during the next few months on leveraging data analytics to understand disparities and forge a better path forward.
Finally, he urged leaders to take care of themselves, as well as their teams. And that means communicating often, while also encouraging them to maintain a healthy work-life balance. “It’s going to take a lot of energy to get us through these next couple of months,” he noted. “We need to band together” and demonstrate empathy and kindness. “The level of responsibility we all feel to get through this is high, and unless we are caring for each other and ourselves, we are going to burn out.”
To view the archive of this webinar — HIT Policy Update: Covid Edition — please click here.