If healthcare leaders want physicians to adopt a solution, there’s a very simple question they must be prepared to answer: What’s in it for me?
In other words, how is it going to help me do my job — which, of course is to provide quality patient care — in a better, more efficient way? The answer, of course, must be more than an explanation. Physicians need to see firsthand that the technology in question can, in fact, have a positive impact.
At Inspira Health, a 3-hospital system based in Southern New Jersey, that’s precisely what Tom Pacek’s team did. Rather than spend their energy telling physicians that leveraging an app for self-scheduling could improve access and patient satisfaction, without hindering workflow, they piloted it in cooperation with the vendor, and were able to produce positive outcomes.
“You have to work with doctors,” said Pacek, who recently spoke with healthsystemCIO about how his team was able to pivot quickly when Covid hit, and the strategy they used to educate users. He also spoke about the hackathon that helped spur ideas, and what it takes to lead through a crisis.
- Inspira Health is a 3-hospital system covering a large section of Southern New Jersey.
- The biggest priority when Covid first hit? Getting physicians who had previously been hesitant to adopt telehealth — even if it meant having to offer multiple solutions.
- Inspira partnered with a start-up company to provide remote monitoring devices for chronic care patients, which helped discharge individuals earlier and free up beds for critically ill patients. “That kept us from bursting at the seams,” said Pacek.
- As part of its “hands-on approach” to educating physicians on use of telehealth tools, Inspira got creative by leveraging videos and other training methods. “It was very well-received.”
- A key factor in building adoption of the MyInspira app was in demonstrating, through pilot results, that “it was not as intrusive to their workflow as they thought it would be,” and actually helped reduce time spent in waiting rooms.
Q&A with Inspira Health CIO Tom Pacek, Part 1
Gamble: Can you provide a high-level overview of the organization — what you have in terms of hospitals? Where you’re located, things like that?
Pacek: Sure. We’re located in southern New Jersey, serving patients in five counties. We have three hospitals, 150-plus access points throughout the counties, and more than 1,300 providers. Of those, between 150 and 200 are employed, and the rest are community providers.
We have more than 200 medical residents and fellows in 13 nationally accredited programs at its hospitals in Vineland, Mullica Hill and Elmer, with another 50 coming by the end of 2023. We have around 6,200 employees at this point in time, and we cover a very large territory.
Gamble: In terms of the EHR, are all the hospitals on the same system?
Pacek: They are. We’re all using Cerner Millennium.
Gamble: And that’s been in place for a little while, right?
Pacek: Yes. We’ve been enterprise-wide since February of 2018; our owned ambulatory practices and urgent care centers are on Cerner as well as the hospitals.
Gamble: About a year and a half ago, a little wrench got thrown into things. How did Covid affect your strategy most? What did you focus on initially?
Pacek: Telehealth. We had a service that enabled us to do on-demand telehealth visits, but it was not widely adopted. Our physicians were not really adopting telehealth into their practices at the time, and so we shifted very quickly, to the point where we had to go to multiple solutions for telehealth. The vendor we were using could not add our physicians and educate them fast enough to meet the demands of our patient population. And so we wound up using multiple solutions. We still have a couple solutions, but we’re migrating to one platform by the end of the year; that was the biggest thing.
Part of telehealth is really around chronic care management of patients. We had a partnership through our innovation center, and we created a partnership with a start-up company in the chronic care management space that had their own medical devices for patients, as well as a service to monitor them. It really came in handy during Covid. When we were at full capacity and were scrambling to find beds, we were able to actually discharge some of our patients earlier. We were keeping them for 14 to 16 days, but some of them were getting better after 10 days, and so we adopted these technologies and sent them home with some bedside education for their families. There was also a virtual option; we also sent patients home with devices to monitor their continued improvement from home. That allowed us to free up beds for the more critical patients, which helped us from bursting at the seams back in March-April-May timeframe. So that was really successful. It also helped the physicians in the community to adopt these solutions and start referring more patients into that program to manage their care.
Gamble: You brought up a point about educating physicians on how to use telehealth solutions. I think that’s something a lot of organizations struggled with; how did you approach that?
Pacek: Hands-on approach. We have an education department that helps with rolling out new technologies and new systems, and we ramped up that group with a few more resources. They actually got very creative and did some short videos to get the physician’s attention, get them educated quickly, and test their understanding. It was really well-received.
We used one telehealth product from Doximity that was pretty simple to adopt. There wasn’t any integration back to the EMR, but it got the appointment done quickly. There wasn’t a lot of education on that; honestly, the physicians found it on their own and started to spread the word, and it got back to me. They were saying, ‘We’re not going to use another solution. This is working for us.’ It was good because the physicians just sent a link to the patient when it was time for them to meet, and the patient clicked on the link and they had the appointment. From my perspective, we didn’t have integration, and so we did have to find a way to get the documentation back into the system, but we were able to care for the patients much more quickly.
Behavioral health’s edge
Behavioral health services was another area that exploded. It really benefitted from the fact that those patients are much more willing to use telehealth than any other population, and so they really took to it. We use Microsoft Teams, and they educated patients on how to use it. The very first time they had an interaction, they spent 5 or 10 minutes helping them, making sure it was set up properly on their phone, iPad, or whatever device they were using, and it went smoothly from that point forward. Physicians couldn’t take time out to education patients on how to use technology; it was hard enough to get the physicians to learn how to use it. And so Teams didn’t work as well for physicians, but for behavioral health services, it worked very successfully.
Gamble: I’m sure it’s an ongoing challenge. Physicians have limited time with patients, and so having them get used to a new platform is never easy — especially when things are as crazy as they were during the height of Covid.
Pacek: For sure. Just getting them set up in their homes to be able to do telehealth is difficult. The other realm was doing telehealth in acute care facilities, because we were running short on PPE supplies and there were just not enough physicians. The physicians were being taxed so much that it was hard for them to get in and make rounds timely, and so they were starting to resort to telehealth to call in to the bedsides. That was something we had never done before, other than a tele-ICU, which was been around for a while. The average patient on a med-surg unit had never had telehealth capability, so we had to get used to that.
Gamble: It seems like you were already headed in the direction of digital health with things like the patient portal app, but Covid helped move it along quicker.
Pacek: It did accelerate things. Health crises accelerate the adoption of technology; they really do. That’s how the EMR came into play. The government mandated EMRs, and all of a sudden, physicians started using them. They resisted them before that. I hate to say it, but sometimes it takes a negative event to create that motivation.
Gamble: I would imagine a lot of your focus has been on the MyInspira and making it as user-friendly as possible.
Pacek: Very much so. We had multiple apps to do different things in the very beginning, and quickly learned that people aren’t going to download multiple apps. It’s confusing for them as to what app to download, so we consolidate functionality on to one MyInspira app.
The first part of the app doesn’t require you to sign in. You can go in, find a physician, and request an appointment. But when you get into the personal health record, we need to protect that with security, and so you have to log in at that point. That’s what we did. It wasn’t well-adopted at first, but once the biometric features came out that it made it much easier to log in and out, the adoption rate went up considerably.
Pushing data out
And we continue to do that. It’s helped us with Covid for sure, because as people had to get tested and were waiting anxiously for the results — asking things like, can I go back to work, or do I have documentation to show my employer — they were getting anxious. We had people walking into the medical records department, looking for their results. They didn’t know if they were Covid-positive, and yet they were coming in and potentially infecting the medical records department.
And so we quickly adjusted it and made sure Covid results were getting out there, and that people were aware they could get the results through the MyInspira app. It sends them a notification that their result is ready, and they can click on it to see whether they are positive. That has really helped us avoid a lot of people coming into the hospital looking for results, or calling the access center or the physician office trying to get the results. This way, we’re able to push it out to them.
Gamble: With something like online scheduling, was there hesitancy among physicians? How did you work through that?
Pacek: That was a true collaboration with our physician offices. Because you’re right, the doctors don’t particularly want to lose control of their schedule. They know that when Mrs. Smith typically comes in, they need 10 minutes, but Mr. Jones might need 20 minutes because he’s a chatter or he’s more complex. When you do online scheduling, you have to create templates that are standardized across the whole practice; and with big practices that have 100-plus physicians, it’s even more important to standardize. You have to get agreement from the physicians on, if it’s a well visit, it’s going to be this. If it’s flu symptoms or cold symptoms, it’s going to be this. Is the PA going to be able to handle that? Is the physician going to handle that? You had to build all that into the system. We worked very closely with Kyruus on that. They gave us guidelines on how to do that. They helped us set up meetings. The marketing and the physician liaison groups met with the practices to work through that. It took us a while.
We started out with a pilot of about 25 primary care docs we were working with. We needed to get more access to patients because they weren’t coming in due to Covid. That was the other thing; they didn’t want to come into the office. They wanted to do telehealth, and so we made that available through the app working with Kyruus. We had both in-person visits and telehealth available for self-scheduling, and the patients really took to it. It worked well.
Confidence from pilots
But we needed those pilot physicians in the beginning; between August and the end of the year, we had our pilot groups up, and they saw very positive results. It was well-received. The physicians realized it worked fine in their workflow. It was not as intrusive to their workflow as they thought it would be. It actually helped the staff manage the patient flow in the office and reduce time spent in the waiting room. So they were able to encourage people to do telehealth rather than in-person visits.
It all worked out really, and our numbers have just continued to get better. More than 50 percent of appointments were scheduled online, or were new patients. That helped us from a growth capacity as well, which we need. With the hits we suffered from Covid, we needed to generate some new revenue and get patients into the system.
That has really helped us. I think we’ve had over 5,300 online bookings since August of last year through the middle of September. So the numbers have been really, really strong.