For someone who has been in health IT leadership roles since the 1990s, as Mike Minear has, it takes much more than a shiny toy to impress them. “I don’t get excited about whiz-bang technology,” said Minear, who has held the CIO role at Lehigh Valley Health Network for six years. “I get excited about what it can do for patients and clinicians.”
Not only should it help make the clinician’s job easier – and the patient experience better – but they should feel “it was the right thing to do,” and should have input into what’s being implemented. It’s that philosophy that has created a “deep partnership” at the 10-hospital organization, and what he hopes will propel them going forward.
During a recent interview with Kate Gamble, Managing Editor at healthsystemCIO, Minear offered perspectives on how LVHN is expanding to better serve patients in eastern and central Pennsylvania — especially those in rural areas; why finding the right vendor partner is critical; and the tremendous benefits he has gained from teaching graduate courses.
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- Lehigh Valley Health Network, a 10-hospital system based in eastern and central Pennsylvania, is rapidly growing, with 2 new hospitals being built, and more in the works.
- Rather than the “big-box hospitals of the past, LVHN is designing smaller, more ambulatory-centric facilities in targeted geographic areas to better serve the patient population.
- Although LVHN has long had the infrastructure and ability for telemedicine, it was used mostly for providers to communicate with each other. The rapid rise in virtual patient encounters during Covid has opened the doors to more utilization.
- Rather than putting the onus on providers, “patients should drive this,” Minear said about telehealth.
- To enable patients to communicate with their families – and physicians to connect with patients without donning PPE – the iPads previously installed in patient rooms had to be rebuilt and reinstalled.
Q&A with CIO Mike Minear, Part 1
Gamble: Hi Mike, thank you so much for your time. Let’s start with some background information. Lehigh Valley Health Network is a 9-hospital system in eastern Pennsylvania, correct?
Minear: We’re now 10 hospitals, located generally in eastern Pennsylvania, north of Philadelphia and into the Poconos. We’re physically building two new hospitals and planning to build six additional hospitals through partnerships.
We’re growing very rapidly. In addition to our hospitals, we have well over 3 million ambulatory encounters a year. We have large reference lab business that serves other health providers and a lot of other services. We’re about $3.7 billion in revenue.
An alternative to “big box hospitals”
Gamble: That’s interesting that you guys are expanding so quickly. It’s not something we’re hearing a lot. Is that part of the organization’s long-term strategy?
Minear: Yes. We are growing because we feel there are parts of our market that are underserved, and we would better serve our overall patient population by having additional locations. But when I say, ‘new hospitals,’ these are not the big box super big hospitals of the past. They’re more like an ED with a smaller set of surgical capability and smaller inpatient rooms, because we predominantly provide ambulatory care. It’s trying to fit more of a modern definition of a hospital — fairly small, but integrated with our ambulatory care and ambulatory surgeries, and in very targeted geographic areas. It’s really a continuation of our ambulatory care, but not in the traditional way.
Gamble: It’s interesting what you said about the typical big box hospitals. There’s a need for brick-and-mortar buildings, but ones that are set up differently. It seems reflective of what we’ve seen the past few years.
Minear: We have an integrated Epic EHR. When a patient comes to one of these hospitals or ambulatory care sites, we’re managing them under the continuum of care. One thing we’ve done in our new hospitals, and in the hospitals we’re building, is to set up large televisions that provide programming. But they’re also linked to a high-definition camera. That way, in every patient room and every ED exam room, we can do a tele-video encounter that’s high-def for the patient and the remote provider. In our rural facilities, we don’t have a cardiologist, orthopod, and oncologist at all these locations, but if a patient comes in and needs a consult, we can do that digitally, very quickly, and it’s all on the same EHR. These are some examples of how these new facilities are really fitting into our continuum of care, leveraging our common EHR.
“Barely using” telehealth
Gamble: Right. You already had Epic installed throughout the organization. What needed to happen from a digital standpoint to enable things like remote monitoring and telehealth?
Minear: One of the most interesting parts of the pandemic from a technical perspective is that we’ve actually been doing telehealth for 15 years, but it was provider-based, not the traditional provider-patient encounter. A lot of the reasoning is that Pennsylvania didn’t reimburse for digital encounters. We did have a full digital infrastructure implemented with Epic and we could do video encounters, but we were barely using it.
With the exception of expanding one license, we didn’t have to do anything new for the massive growth of digital encounters brought on by the pandemic. During a 10-week period in April of 2020, when we had to start shutting clinics down, we went from essentially no video encounters in Epic to about 60-plus percent of all of our ambulatory encounters — well over 3 million — were being done digitally, either by video or phone or with synchronous e-visit.
“Everything clicked into place”
The bulk were video visits. Payers started paying full price for video visits, which was very helpful for us in those days. We were ready, and then the payment and everything else clicked into place. Around 90 percent of our psychiatric visits were done digitally.
Since then, we’ve scaled back, like everyone else. We’re doing about 12 to 15 percent of our encounters through video. That’s probably where we’re going to stay. Although now that our patients, providers, and care teams have learned to use it, we think some encounters are done just fine — if not better — digitally. We’re trying to move a little bit higher than 12 to 15 percent, but only for the encounters we think are appropriate and make sense.
Gamble: I imagine having that foundation in place was a key factor in being able to get this moving so fast.
Minear: I was very grateful we had it in place. We had a secure texting. We had VPN and e-mail in place. Even though we sent more than 3,000 employees to work at home, during that same time our teams were working 7 days a week, 10 to 15-hour days. We had a lot of the things in place already; it was more converting, training and support. We didn’t have to go out and deploy new things — and we were very grateful for that.
Gamble: I’m sure. You mentioned you want to stay around that 12 to 15 percent — what are the keys to doing that post-Covid?
Minear: Patients really should drive this, in my mind. Patients were saying, why do I have to drive in, take time off work, go to an exam room, and go to a waiting room, when it’s so much easier to do it in my office or living room. And we agree. It’s better for some things to be done remotely.
Remote patient monitoring
We also had a fairly extensive remote patient monitoring system in place that we highly expanded around Covid, and we’re adding to that. We have a kit that’s customized for each patient’s diagnosis. We have devices like blood pressure monitors, digital scales, etc. that we either deliver or give to a patient when they’re still in the hospital to take home. They do their testing using MyLVHN. The tests come in through these consumer digital devices; we put in a cellular modem for the patient, and there’s no charge for them.
Once they take a reading from one of these devices, in about 8 seconds, it’s in Epic. We have a call center of registered nurses that manage the inflow of data, and in some cases manage the patient, because it’s all on Epic. So they’ll work with the primary care provider or discharge physician to make sure the patient is cared for. We had that in place and expanded it a lot.
We had variations of testing devices just for Covid. At the height of COVID in December 2020 when we had a holiday surge, we added At-Home, which is for more advanced or serious conditions. And we added the ability for pop-ups in Epic. If you have a Covid patient in the ED, and your physician is deciding if they should admit them or send them home, we gave them a third option: send them home with testing devices.
When we sent those Covid patients home instead of admitting them — and that was key because in that December time frame, we didn’t have hospital beds available — we sent them home with devices. We followed up with video visits with a specific physician specialist. We had home nurses also using Epic, and we had the call center. By doing so, we’re able to give them more services as they are more acute, and that was more of a continuum for us. We didn’t have to start it from scratch, we were just adding services and testing procedures, alerts on Epic, for more ill patients.
Gamble: Based on what you’re saying, it sounds like optimization is really a priority, especially with Epic.
Minear: When we talk about the scale, it wasn’t just about doing more encounters. For example, a lot of people would think about telehealth or video visits as a traditional physician-patient encounter. During the first 30 to 45 days of the pandemic, we certainly brought up the physician and patient video visits — which we already had the capability to do — for more than 60 different use cases.
We had a group psychiatric video visit where psychiatrists do a group encounter; this used to be done only in person. We would do physical therapy and other types of therapy by video. It’s not optimal for a PT to do that via video, but it was either do it through video or don’t do it at all, because the physical therapy offices were closed.
We did an oncology encounter where a patient was newly diagnosed with cancer. We had a group of providers that would do the encounter with the patient and their family. It’s a big deal when you first get a cancer diagnosis and we figured out how to do a group-to-group video encounters. It wasn’t just about doing encounters; it was the richness of how we did it. It was the richness of different kinds of providers, not just the scale at which we did it.
Using devices for patient communication
Gamble: And so, the capability was there to utilized devices like iPads in hospital rooms, but it hadn’t been used to the extent that it was once Covid started?
Minear: It was in place, but we had to change it. For example, we had iPads available at bedside in every patient unit that connected with MyLVHN, but it wasn’t used dramatically. When we first deployed it years ago, we had a security mindset; patients could use it for video encounters with their family. It was considered a lockdown device.
Within a few weeks of Covid really hitting our hospitals hard, it was obvious that the ability for the patient to use the device in a broad way was paramount. We had teams literally working around the clock for about a week to rebuild every one of those iPads and reinstall them. We offered a few different ways in which a patient could use the iPad on our nickel, whether it was a video encounter, or to use FaceTime or Zoom. Whatever they wanted to do, we would help them. We turned that on.
One thing that was very difficult was that families couldn’t visit patients in the hospital at that point, and so we had patients saying goodbye to their families on the iPad if they were dying of Covid or about to be intubated. We had a neat story where one of our first patients who survived Covid and was extubated used an iPad to connect with his family and tell them he was still alive. It was heartbreaking.
Beyond patient-family communications
We love the fact that we could help patients connect with their families. But beyond that, we were able to do video visits with providers who were onsite. The patient did have to be awake and able to interact, but it saved the provider from having to don PPE and go into the room.
We did a lot of things on the inpatient side beyond the new cameras and TVs at our new hospital, we’ve leveraged Epic over in just playing video encounters over iPads and inpatient rooms too and ED exam rooms alike.
Part 2 Coming Soon…