The director of the Centers for Disease Control and Prevention said recently that the U.S. might be finally turning a corner in the COVID-19 pandemic. It’s been a relentless 16 months, and healthcare CIOs and other health IT leaders can no doubt use a breather.
During the course of the past year-plus, these executives have learned many lessons spurred by the manic pacing of the pandemic. Some of them center on the importance of data and analytics, the need for more patient engagement, the requirements of keeping telehealth up to par, and the need to focus technologies on enabling enterprise-wide strategic plans.
In this seventh installment in Healthcare IT News‘ feature series, Health IT Lessons Learned During the COVID-19 Era, four top IT executives from provider organizations nationwide share what they’ve learned during the past year and discuss how they’re applying these lessons to improve their organizations. They are:
- Clark Averill, director of information technology at St. Luke’s Regional Healthcare System, based in Duluth, Minnesota. (@StLukesDuluth)
- Dr. Roxana Lupu, chief medical information officer at Sanford Health, based in Sioux Falls, South Dakota. (@SanfordHealth)
- Leonard T. “Skip” Rollins, CIO and CISO at Freeman Health System, based in Joplin, Missouri. (@FreemanCares4U)
- Matthew Russo, IT director at Helio Health, based in Syracuse, New York. (@Helio_Health)
The increased importance of data and analytics
Overall, the COVID-19 pandemic has catapulted the importance of data analytics and data in general, said Lupu of Sanford Health.
“At Sanford Health, the largest rural health system in the country, our leaders have always recognized the importance and the power of data, but the COVID-19 pandemic revealed the meaningful benefits of investing in the resources and infrastructure needed for a strong data analytics department,” she said.
For example, the data analytics team designed an algorithm to sort and pull relevant data from the records of more than 100,000 patients who had been diagnosed with COVID-19, identifying those at highest risk of complications from the virus.
“In early November 2020, the FDA issued an emergency use authorization for the therapeutic use of monoclonal antibodies for COVID-19-positive patients, which had been shown to prevent hospitalizations in a limited number of trials,” Lupu recalled.
“Our leaders have always recognized the importance and the power of data, but the COVID-19 pandemic revealed the meaningful benefits of investing in the resources and infrastructure needed for a strong data analytics department.”
Dr. Roxana Lupu, Sanford Health
“At the time, hospitals across the Sanford Health footprint were experiencing a rapid increase in COVID-19 hospitalizations, stretching hospital capacity and creating unprecedented challenges for our health system and its frontline workers.”
Staff were able to use data analytics to proactively screen and contact patients who were at highest risk of developing complications from COVID-19 and schedule outpatient monoclonal antibody treatments.
To date, Sanford has treated more than 2,700 patients with antibody infusions at more than 19 sites across its vast rural footprint, prevented nearly 1,000 days of hospitalization, and averted at least 15 deaths, Lupu reported.
“We were also able to harness our data analytics in our vaccination rollout strategy to efficiently and equitably get vaccines to people,” she added. “Early on, when vaccine supply was limited, Sanford Health followed state eligibility guidelines and then stratified the list based on patient risk factors, prioritizing the highest-risk patients and inviting them to be among the first to schedule COVID-19 vaccination appointments.”
This all would have been a much tougher lesson if Sanford had not already had this infrastructure in place, she said.
“We see immense value in applying predictive models and risk stratification to our patient population,” she said. “For example, we can leverage the data to deliver more personalized care through predictive models that take into account all aspects of patients’ histories. Data analytics also will be critical as we move toward value-based care with a focus on prevention and keeping our patients healthy rather than just treating sick patients.”
More, more, more patient engagement
For Averill of St. Luke’s Regional Healthcare System, the impact of patient engagement using patient portal communication, virtual visits and digital appointment scheduling provided a big lesson.
“St. Luke’s primary use of the patient portal prior to COVID-19 was as a tool for providing patients access to their health information, especially lab results and physician/patient messaging,” he explained. “The importance of using the portal as a patient engagement tool was highlighted when in-person patient visits were limited due to COVID-19 protocols.
“Patient engagement consisted of using the portal for self-scheduling patient visits, patient messaging via the portal, remote patient monitoring, and implementing virtual visits,” he continued. “We also expanded the amount of clinical information sent in real time to the portal since delivering in-person results wasn’t possible.”
On March 5, 2020, St. Luke’s had 27,305 patients enrolled in its patient portal, which was 18.92% of its patient population since going live with Meditech Expanse on May 1, 2019.
“We decided to implement self-scheduling for the COVID-19 vaccine. Self-scheduling has been an overwhelming success and patient satisfier.”
Clark Averill, St. Luke’s Regional Healthcare System
With the expansion of virtual visits, St. Luke’s launched a major effort to increase the number of patients enrolled in the patient portal. As of April 19, 2021, St. Luke’s had enrolled 63,546 patients, 34.47% of patients. Of patients with an assigned primary care provider, 55.51% of patients are enrolled in the portal.
“Patient self-scheduling became critically important as we implemented our COVID-19 vaccine clinic,” Averill noted. “As we started to receive the COVID-19 vaccine, we struggled with the best way to schedule appointments, given the volume of patients we needed to vaccinate. Our original plan was to schedule these appointments via traditional methods, but we believed those methods couldn’t scale to the volume of patients we needed to schedule.
“St. Luke’s had begun a pilot project of patient self-scheduling for annual wellness visits,” he continued. “We decided to implement self-scheduling for the COVID-19 vaccine. Self-scheduling has been an overwhelming success and patient satisfier. Patients appreciate the ability to select the day and time of the appointment.”
St. Luke’s is continuing to expand patient engagement features of the patient portal:
- Self-scheduling – Increasing the number of appointment types available for patients to self-schedule.
- Virtual visits – Continue to enhance the number of appointments that can be completed using virtual visit technology or include remote caregivers during an in-person visit.
- Remote patient monitoring – Expand the number of patients that can be monitored away from the hospital or clinic for medical conditions to enhance patient care and reduce readmissions.
- Non-patient onboarding – This new feature of the Expanse patient portal allows people who have not been patients at St. Luke’s to enroll in the patient portal and schedule appointments.
When telehealth is not up to par
One major lesson Helio Health learned last year was that its telehealth presence was not up to par. On the other hand, the health system also learned that its teams could implement a telehealth presence fairly quickly.
“We had to pivot quickly to be certain our patients’ critical care would not be interrupted by restrictions put in place as a result of COVID-19,” said Russo of Helio Health. “We were already using Microsoft Teams internally as our video conferencing solution, so it was a natural choice to begin to use for remote one-on-one therapy sessions and group counselling sessions as well.”
Helio Health equipped staff with as many laptops, headsets and webcams as it could get its hands on. The supply chain was extremely strained, but Helio’s vendors were able to come through.
“For our inpatient services, we procured a large quantity of iPads so that our counselors could still meet with our patients without being face to face,” Russo said. “This helped during the patients’ initial quarantines and for when there were active cases of COVID-19 in any of our facilities. We upgraded our phone systems to be able to handle the increased volume of over-the-phone telehealth support.”
“It was really impressive to see everyone come together and work toward the same goal of providing the best care possible during one of the most challenging periods of our lives.”
Matthew Russo, Helio Health
Helio Health’s methods evolved over the course of last summer. It was able to quickly adjust to changes thrown at it.
“The IT and HIT teams at Helio Health went through some of the most intense months of our careers, but I am so proud of the team and how we were able to persevere so that our patient population would still be taken care of,” Russo said. “To be fair, this was the case for our entire staff and for most of the world. It was really impressive to see everyone come together and work toward the same goal of providing the best care possible during one of the most challenging periods of our lives.”
He added that Helio Health is continuing to improve its posture in the areas of remote working and telehealth services and is committed to investing in new technology to help staff be ready for anything the future throws their way.
Leveraging technology to further strategy
Rollins of Freeman Health System said 2020 was a great year for health IT for many reasons.
“Many important initiatives were pushed forward and implemented in attempts to react to the ever-changing needs of our customers,” he explained. “I have always been very aggressive in staying in touch with technology and how it might further our needs. One of our fundamental directives is to understand how we can leverage technology to further Freeman’s strategies. This approach has worked well when we were forced to shuffle and re-shuffle priorities during 2020.”
The guiding principle has been to never impede Freeman’s progress or response to patients’ needs. Having a firm understanding of how one’s IT organization is positioned to react is very important, he added.
“When the CEO turns to you in a meeting and says, ‘Can you do that,’ you must be ready to provide a confident response,” he stated. “Answering with, ‘Let me check,’ is not a good answer.”
“When the CEO turns to you in a meeting and says, ‘Can you do that,’ you must be ready to provide a confident response. Answering with, ‘Let me check,’ is not a good answer.”
Leonard T. “Skip” Rollins, Freeman Health System
All health IT leaders know how difficult it can be to get funding for new or changing technology platforms. Flexibility in infrastructure gives CIOs the ability to have a “can do” approach to the varying needs of health systems, Rollins said.
“Our EHR platforms are utilitarian and are what they are, the magic happens in the echo systems around the EHRs,” he said. “Maximizing the ability to pivot and use new applications or technology to solve problems can make CIOs heroes, not having the ability can make you look out of touch or behind the times. Get flexible. Do not commit to strategies that put you in a corner. Stay nimble and look for opportunities to leverage your ability to react quickly.”
Freeman Health System always is reviewing and re-evaluating its approach to the healthcare environment. As mentioned, it is difficult to always stay the direction with strategies, Rollins said.
“Things change, so we annually evaluate our plans and strategies to validate they are consistent with the direction things are trending,” he noted. “This process allows us to adjust and stay as close as we can to being ready to react when things change. It’s not easy and it’s not the least expensive way to operate but it will position you better to have the right answer ready when asked, ‘Can we do that?'”
Keeping strategies dynamic
Another lesson Rollins has learned over the past year is that health IT and organizational strategies must leave room to adapt to the environment.
“All CIOs have said, ‘I really wish I knew that when I made that decision,'” he said. “Things change, as should your strategies. Our strategies are certainly with the organization’s plans, but we try to leave them open enough to adjust. We had made decisions and commitments related to mobility that had to be revisited during 2020.”
Rollins is being transparent when he admits he and his team missed on how many of their mobility tools would be used, and encountered limitations in some areas.
“Our care providers evolved, and we were not completely able to follow them because of some of the commitments we had made,” he said. “This miss scared me and caused me to sit with the IT leadership team and reevaluate mobility and how we could support the direction it was headed. We made adjustments in device management, BYOD and other components of the strategy to give us more room to ebb and flow with the ever-changing workflows and needs of the care providers.”
This miss was a surprise – they thought they had it figured out, but they did not. Many of their assumptions about how the equipment was going to be used were wrong, he admitted.
“As a result of the miss on mobility, we have evolved this strategy,” Rollins said. “On a broader scale, we have changed how we make technology decisions and built in more flexibility. The flexibility need drove us to redefine mobility and how we would provide the capability. Our big mistake was we had an idea of how the users would use the tools, now they are planning with us and helping us to better understand the possible uses of the tools.”
The moral of the story: Get closer with users, understand their workflows, and understand how they use technology before making commitments, he advised.
Streamlined and efficient decision making
On another front, the pandemic has underscored the importance of having a structured mechanism and system in place for streamlined and efficient decision making, said Lupu of Sanford Health.
“Prior to COVID-19, if our operations teams needed to address certain topics, we worked through a committee structure to gather feedback, propose solutions and build consensus – it was not uncommon for this process to take months before a decision was reached,” she said.
In March 2020, Sanford Health activated its Incident Command and started closely monitoring COVID-19. A multi-disciplinary team from across the organization sat around the table – including health system leaders and operators, medical directors, advanced practice providers, nursing, pharmacy, enterprise data analytics, clinical informatics and clinical research. They were able to make decisions, pivot and implement new protocols in real time, she said.
“For example, on Friday, April 16, the FDA revoked the EUA that allowed for the monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19, due to ongoing analysis of emerging scientific data around its resistance to new variants,” she recalled.
“With the support of our revamped reporting and decision-making structure, we were able to immediately make the necessary changes in the electronic record, and notify our providers, pharmacists and operational leaders in real time to ensure we remained in compliance and protected the health and safety of our patients.”
Sanford Health now has restructured its optimization committees to improve efficiency in the decision-making process. It sees the value in having a more streamlined way of expediting issues that need to be addressed.
“Before COVID-19, if colleagues were not present at our optimization committee meeting, we’d have to follow up and have a back-and-forth discussion before moving ahead with a decision or resolution,” Lupu said. “Now we have a more centralized approach to our committees, with a clearer structure and pathways to lift up issues and execute change.”
Standardized processes and equipment
Another lesson Helio Health has learned is the need for standardization of equipment and processes, Russo said.
“The vast majority of our computers were desktop PCs,” he noted. “With a grant from the FCC, we were able to standardize our outpatient facilities with Microsoft laptops, which allow us to work and provide support from anywhere. Users are able to come and go from remote work to in-person work easily.”
With a recent merger between Helio Health and two other organizations, much of the hardware from the other organizations was dissimilar to Helio Health’s standards.
“We are upgrading them and shifting them to our standards,” said Russo. “This includes standardizing computer models, Ruckus cloud wireless, bringing them into our eLAN through Spectrum, implementing Ricoh Follow Me print, etc.
“With everyone on the same platform, it is easier to troubleshoot issues,” he added. “The Ricoh Follow Me print is a pretty neat feature we are implementing across the organization. You can basically press print, and then go to any printer or copier in the organization and release your print job by authenticating with an RFID badge.”
The lesson learned, he concluded, is to be on the cutting edge of hardware, software and security so that an organization can be ready for anything that life throws at it.
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.
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