As healthcare and technology become more complex, “it’s going to require a lot of hand-holding.”
Much has been made — and rightfully so — of the enormous strides healthcare IT has taken in the past year to improve the consumer experience and help individuals feel more connected with their health. There’s a lot to be learned from industries that offer the “seamless experience” users have come to expect.
With healthcare, however, the stakes are higher, and there are considerations that don’t arise in travel or hospitality, one of which is the digital divide, according to Patrick Woodard, MD, CMIO and VP of Clinical Systems at Renown Health. He believes health systems have an obligation to “recognize that the ones for whom we are often architecting solutions may not be the ones who benefit most from them.”
During a recent interview, Dr. Woodard talked about what IT and clinical leaders must do to ensure they’re not “standing in the way,’ while also ensuring they’re thinking “like a business.” He also discussed Renown’s experience in distributing the Covid-19 vaccine, how they were able to remain focused on strategic objectives, and how he has benefited from previous experiences.
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- The fact that Renown Health already had plans in place for telehealth and leveraging technology “to increase collaboration among staff working in different locations” provided pivotal during the early days of Covid-19.
- Renown was able to deploy telehealth because three key pieces were in place: “It worked for patients, payers and providers. Because we were able to hit all three, it worked.”
- Despite encountering some hurdles, Woodard wouldn’t change anything that was done when rolling out the vaccine. “Every decision was made with the amount of information we had at the time.”
- During a crisis, leaders must be able to tend to the urgent while also looking into the future. “It’s our job to make sure the organization continues to progress over the next several years.”
Q&A with Patrick Woodard, MD
Gamble: Let’s start with an overview of Renown Health — where you’re located, what you have in terms of hospitals, things like that.
Woodard: Absolutely. I’m the chief medical information officer and VP of clinical systems at Renown Health. We’re located in Reno, Nevada. The state of Nevada is such a geographically broad region that we’re actually are more of a regional hospital for everything north of Clark County, which is where Las Vegas is located. We operate that community, and we are grateful to be able to provide services for rural Nevadans, as well as those in the frontier who have difficulty accessing healthcare. We have two acute care hospitals, a rehab hospital and around 70 clinic sites. We also have an insurance division called Hometown Health that provides insurance services to our community here.
Gamble: I did certainly want to talk about COVID, how it has impacted your strategy and your organization. I guess, first, I would say that from your perspective, can you talk about like what happened as far as core objectives and things just having to pivot, as everyone likes to say now?
Woodard: Absolutely. We were fortunate that, over the course of a few years, we had put together a really strong roadmap for what we wanted to do organizationally in terms of our strategy. Of course, three years ago when we started that work, we didn’t know there was going to be a pandemic in the middle of it.
We did take some time last March and April to focus on some of the urgent items that we knew were necessary right now. We were planning on deploying Microsoft teams in 2020. We weren’t planning on doing it in the spring, but that’s what happened. We were going to do some work with virtual visits and telehealth in the latter part of 2020 and the early part of 2021; we did it in March and April.
In that aspect, we were really fortunate in that we had been planning to do these things to help our workers be more collaborative when they’re not in the same location. We had plans for telehealth and virtual visits, which we felt would empower clinicians to see patients regardless of where they are, and meet them where they are — we just didn’t plan to do it that soon.
In many cases, actually, we were really fortunate in that we had already done a lot of the legwork and the prep work and we just did it on a quicker timeline. That’s not to say there weren’t 80 to 100 hour weeks for most of our staff; it just meant we weren’t starting from scratch. I actually consider us to be very fortunate because we had the opportunity to plan in advance for things that we knew were coming anyway.
I think the pandemic also highlighted the need to focus more on consumerism. Because we had already started thinking that way in advance, it allowed us to take the plans we had packaged up and deploy them throughout our organization, rather than having to scramble and start from scratch and say. In that regard, we were really fortunate.
Gamble: You said plans had been in place to implement Teams — can you talk more about that?
Woodard: We had a pretty strong roadmap for where we wanted to go, both with our clinical systems and in our back office. We had Skype, but we feel Teams is a better and more collaborative platform. We had been planning to move to Teams, and so, instead of doing it in the summer or fall, we did it in the spring.
Same with kind of the telehealth stuff, we knew that we were planning to do that. We already had the demo account setup with Zoom for virtual visits. We already had the contacts. We already had it integrated in a demo environment. We just had to put it into production and make the workflow fit for our clinicians, because now they’re not in the office; they’re at home. It’s hard to see clinic patients if you’re not in the clinic, but you still need to be able to care for them.
Gamble: We know there are providers who are already doing this and some who have been resistant. From your perspective, how did it go as far as making that quick adjustment to virtual?
Woodard: I think it was actually the perfect way to deploy a product, because the demand really was across the entire spectrum. It worked for patients, payers, and providers. And because we were able to hit all three, it worked. There’s no other way to deploy something so perfectly as when the demand exists in all three of those domains.
A few things happened the payer, CMS namely said that they all have parity for teleservices. The providers now don’t want to come into the office because it may be unsafe. If they’re able to provide the same level of service in a safe way either from their home or from an office that doesn’t have people in it, providers want that. It’s the same with patients; they don’t want to come into an office if they don’t have to. They’d rather receive services at home, and so they’re asking for it as well.
Because we were able to hit that area of demand and remove the barriers from all three of those, it was actually really smooth. In two weeks, we went from having a couple of virtual visits per week to having thousands of virtual visits per week. I attribute that to the fact that no one party was saying, ‘I don’t want to do this.’ There were challenges along the lines of ‘I don’t know how to do this,’ and ‘I need to learn really quickly,’ but that’s a much more approachable barrier than ‘I don’t want to do this.’
Gamble: Where do you see it going with virtual visits — do you think they’ll still remain for at least a portion of appointments?
Woodard: That’s a good question. During the height of the pandemic, in the late spring and early summer, about 40 to 50 percent of our total visits were virtual. Since then it has dropped a bit, but I see it leveling out somewhere in the 10 to 15 percent range.
Some things you simply can’t do remotely. It would be difficult to do a really comprehensive exam for somebody who might need heart surgery, for example. For certain complaints, you need to be evaluated in person. And although virtual care was dramatically helped along by Covid, there are still some things it can’t tell you. Sometimes you need to be able to place your hands on a patient to understand the problem and get a good quality physical exam. But sometimes, it isn’t. And so I really see us settling in that 10 to 15 percent range, which is a step in the right direction.
We also need to recognize that from a consumer perspective, some patients are more inclined to want to go to a physical office, especially those who have been vaccinated. On the other hand, a 25-year-old may not want to go to an office. As a health system, our obligation is to be able to provide the same quality and the same level of service, wherever the patient may be. Whether they’re at their house, in a clinic, or in a hospital, we need to be able to meet their needs and provide high-quality care.
Gamble: At this point, I would imagine a lot of the focus is on vaccinations. Can you talk about what Renown’s experience has been?
Woodard: I’ll put it this way. There’s a cartoon that has a dog and there’s a fire in the background, and the dog is sitting there saying, ‘this is fine.’ That’s how it felt through the whole process.
We knew it was important for the community. We knew we wanted to provide this service. We knew there was a really short timeline to be able to do so, from the time the FDA gave the emergency use authorization to the time we received an actual physical vaccine.
But we knew by June that eventually we were going to roll out vaccines. And so, after we got out of the scramble of adjusting to working remotely and having virtual visits, it gave us time to think and plan around what we wanted to be able to do as things progressed. We had time on the IT side to do some of the build so that when it came time to give vaccines, we could make sure people were able to make appointments, that their data would be stored in the medical record, and that it would be sent to the state electronically. Reducing the amount of paper in the process was important, as well as making sure that if people need a record that they were vaccinated, that it existed in our EMR and wasn’t being stored somewhere else. We knew those types of elements were going to be important.
Our challenges were more around the logistics of receiving the vaccine from the state, for example, and knowing how many we were going to get, which changed continuously. But it has stabilized a lot, and I think there’s more continuity in the way that we’re able to deliver them now.
One of our challenges as we look to the future is that many patients in the community have already been to a Renown facility. We know them and we have a medical record for them. And so, as the broader community has an opportunity to get the vaccine, whether it’s at the health district, at Renown, or at one the other hospitals in the region, how do we make sure they think about us — not just as the provider who is going to help them get their vaccine, but also, how are we going to make them see Renown’s broader benefit to the community?
We’re working with the state very closely. At one point, we had given the large majority of the vaccinations in Northern Nevada, which is a credit to the thoughtfulness and the partnership between us and the state. That’s something we want to continue. But we also want to make sure we’re able to care for patients who maybe received their first dose someplace else and want to come to us for their second dose. Those are some of the difficult questions we have to be able to answer, but we don’t want to do it on the fly, and we want to be able to provide high-quality customer service at the same time.
Gamble: When you look back, is there anything you think the organization could have done differently?
Woodard: I really wouldn’t change anything, because every decision was made with the amount of information we had at the time. I don’t know if it’s necessarily fair to come back and say we would do things differently. I think we made the right decisions with the information we had. We were giving out hundreds of vaccines on day one, and eventually thousands of vaccines, which is pretty sizeable for our community. It was a little messy, but there’s no way it wouldn’t have been messy getting here, to be completely honest.
Gamble: So there’s a lot going on there. What are some of the other objectives you’re working on? Because as we know, everything doesn’t just stop for Covid.
Woodard: I’m proud to say that almost nothing stopped because of Covid. There were delays, and we did have to shift some things a little bit. But I would say the big priority for me and my team, more broadly, is that we’re focused on what’s in front of us, but we can’t stop driving the car.
For example, if you spill a drink in your car and you’re on a highway, you don’t just stop in the middle of the highway to clean it up. You deal with that while you continue on your journey.
And we know the journey we want to take. We know there’s still work we need to do to make sure that we can become more consumer-focused and make sure that we’re delivering high-quality care. And if we stop working on all of that and just focus on Covid, then we’ve lost a year or potentially even more.
Our biggest objective is making sure we’re not overwhelming the teams with Covid work in addition to our strategic work, but also making sure that the strategic work doesn’t just take a break. To that end, I think part of our role as IT leaders is to continue to look out a year or two and see where we want to be.
Stepping back to the vaccine conversation, I think there’s a reasonable chance, and more data suggesting, that Covid vaccinations may become an annual event. If we’re designing a strategy for how we deliver vaccines now, we need to think about how we would do it annually so that we don’t have to rework it in the summer when it’s time to think about annual vaccinations.
The same goes with our strategic work. If we know we want to upgrade our lab information system, that’s a multi-year project in itself; it deserves to have some thoughtfulness in advance so that we’re not in a situation where we thought we wanted to do it, but nothing is done. And so as leaders, I think it’s our job to support the teams as best we can and make sure that have the bandwidth to do the critical things right in front of them for Covid, but also think about how we can make sure the organization continues to progress over the next several years.