CIOs tackle barriers to innovation, telehealth integration, analytics more
Structural and nontechnical barriers to innovation are a big reasons why technical innovation is so challenging. The need to integrate telemedicine quickly an opportunity for a better patient care model caused a digital transformation road map to accelerate. The COVID-19 crisis put laser focus on how clear it is that data advanced analytics can be powerful weapons in the fight against pandemics.
These are some of the lessons learned by chief information officers during the past year or so as the healthcare industry has been tossed turned by the COVID-19 pandemic. The CIOs in this tenth installment of our Health IT Lessons Learned in the COVID-19 Era feature series explain these lessons how they are going to apply them moving forward.
(Click here to access the portal containing all the feature stories in the series.)
The health IT leaders discussing their 2020s 2021s in this edition include:
- Dr. Bruce Darrow, senior vice president of information technology, deputy CIO chief medical information officer, at Mount Sinai Health System in New York City. (@MountSinaiNYC)
- Ben Patel, executive vice president CIO at Cone Health, based in Greensboro, North Carolina. (@ConeHealth)
- Scott Richert, CIO of Mercy Technology Services, at Mercy, a health system based in St. Louis, Missouri. (@FollowMercy)
- Dan Waltz, vice president CIO at MidMichigan Health, based in Midland, Michigan. (@MidMichigan)
Structural, nontechnical barriers to innovation
Darrow of the prominent Mount Sinai Health System said that he his team learned since early 2020 that structural, nontechnical barriers to innovation are a big reason why technical innovation is so challenging.
“Telehealth is a great example,” he said. “Prior to 2020, payers didn’t want to pay for it, physicians were largely comfortable with a business model that had patients lined up outside their doors waiting to see them. Both of those barriers fell by the wayside in March 2020, allowing us to focus on more pertinent issues, such as how we could use the technology to make the experience more reliable easy for our patients clinicians.”
The example of telehealth highlights the importance of advocacy at multiple levels of government to simplify the complex regulations that make it such a challenge to use the technologies that are prevalent in so many other fields of business, he insisted.
Between the mandates of the federal government the individual states, there is so much ambiguity between the origin of a good idea the realization of a successful initiative, he added.
“Addressing the technology comfort level of the clinicians about how well they can do their jobs via video is another matter,” Darrow observed. “Before 2020, telehealth visits composed a miniscule fraction of our ambulatory care.
“Today we have sustained virtual visits at about 15-20% of total. In many cases, we needed to overcome the barrier of, ‘I can only do my job with my patient physically present’ with a tolerant combination of, ‘In some cases, virtual care may be an appropriate alternative’ ‘Perhaps your patients don’t want to spend so much time traveling sitting in your waiting room for the privilege of seeing you.'”
Darrow his team succeeded, he said, by identifying early adopter physician champions allowing them to endorse both the technology the workflows.
Building equity into the system
On another note, Darrow said that Mount Sinai’s patients may not all have the same access to the organization’s health IT options, it is the responsibility of the health system to intentionally build equity into the system.
“When we retrospectively assessed how our patients used telehealth in the spring of 2020, we saw variations on the basis of age, race, ethnicity preferred language,” he explained. “While it’s an important first step to provide technology options equally to all of our patients, it is not valid to assume that all patients will take advantage of them at the same rate.
“We have worked to build in options for translation services with our telehealth encounters, as an organization obtained several FCC grants to allow us to provide technology to some of our most vulnerable patients, including patients who are homebound, cancer patients at-risk pediatric patients,” he continued.
“We’ve also established a strong partnership with our organization’s Institute for Health Equity Research Office for Diversity Inclusion to make sure we incorporate their viewpoints into our initiatives, including the impact of social determinants of health on how our patients embrace technology.”
The power of focus
For Richert of Mercy, the first lesson he points to is, as he puts it, “the power of focus.”
“As the pandemic emerged, there were clear objectives on which to focus agreed-upon metrics by which to measure our progress,” he recalled. “We’ve had plenty of successes accomplishments prior to the pandemic, the focus agility of the entire leadership structure resulted in faster decisions, alignment between multiple teams focused on the same outcomes.
“This permeated into our technology response as we developed fast minimally viable products fast improvement iterations for digital solutions for testing, home care, follow-up eventually vaccination management,” he added.
Today, Mercy has maintained much of the leadership decision framework that was activated during the pandemic.
“We’re still focusing on clinical quality operational efficiency objectives with similar focus urgency,” he noted. “The challenge is to maintain that operational agility to solve operational problems quickly, but also keep in mind all of the long-term ‘change the game’ strategies that we know will be necessary for long-term success.”
This can be challenging, he added, to balance the urgency of the short-term operational improvement sprints, but also making sure the long-term strategies (technical otherwise) are being served by the operational improvements, that investments in long-term objectives don’t take a back seat to the urgent, operational objectives.
“This plays out in governance resource planning, has many practical implications in budgeting, architecture organizational change management,” he said.
Moving to connected health telemedicine
COVID-19 placed tremendous pressures on healthcare provider organizations that did not have enough beds, equipment or personnel to handle infected citizens while still providing emergency chronic care to other patients. This novel virus also endangered exposed healthcare workers, many of whom became infected.
“We quickly learned that digital care would be the best method to take care of patients to comply with CDC guidelines,” said Patel of Cone Health. “We went into execution mode to install enterprise virtual care platforms along with remote monitoring. The goal is to provide e-visits/video visits become more situationally aware of patients’ symptoms conditions before they become acute require hospitalization.”
The remote monitoring solutions include widespread use of sensors for data collection like heart rate, oxygenation levels, blood pressure temperature, he added.
“Our digital transformation roadmap got accelerated due to this lesson an opportunity for a better patient care model,” Patel said. “A digital blueprint has been developed with key stakeholders. We are now deploying self-service digital tools such as digital front door, medication adherence a remote patient monitoring platform. This is in addition to our enterprise virtual care platform for virtual visits to patients consumers.”
Recently, Cone Health kicked off an initiative to outline its hospital-at-home care model. This will help the health system take care of patients in their home or preferred care setting.
Telehealth woven into the care model
Over at Mercy, the massive health system has been successfully conducting telemedicine for years.
“During the pandemic, as we looked for options to solve the clinical operational challenges extremes of the pandemic, we found our investments expertise in virtual care to be extremely valuable,” said Richert of Mercy. “During the pandemic, we learned that virtual care services are most effective when they’re completely woven into the fabric of the overall care model – digital, virtual physical.”
Going forward, the IT organization will be enhancing the effectiveness efficiency of the health system’s care model with an extremely high level of virtual care integration.
“We’re discovering the ever-growing harmony we can create with an integrated digital/virtual/physical care model,” he explained. “Not just sending patients down one channel or the other, but leveraging digital virtual woven into inpatient, outpatient care-at-home population models.
“Also, thinking about virtual digital care beyond the simple concepts of two-way video alternatives to in-person care, which we certainly provide have increased during the pandemic, but also realizing that building workflow tools that make it easy on the patients the caregivers to request a virtual service,” he continued.
“Skills-based routing, request queuing, SMS messaging surveys, other ‘service-management’ type capabilities, become very important when you’re scaling virtual services need to make sure they are easy to request, that service fulfillment is managed in a service management model.”
For instance, if an inpatient nursing staff can easily request episodic virtual assistance for something without breaking out of their workflow, they can depend on reliable service levels, then that virtual service is going to thrive add value, he added.
Authenticity, vulnerability transparency in place
A whole different kind of lesson comes in the form of building trust in a health system its leaders. This was key to Waltz of MidMichigan Health.
“It would be difficult to build trust after an emergency occurs – in our case, we had the pandemic break out, then the historic Edenville dam flood two months later – so my thinking is that you must have authenticity, vulnerability transparency in place with your leadership team staff prior to an emergency,” he observed.
“A couple of things we did to help was to encourage virtual daily huddles with Teams, weekly management meetings, all-staff meetings every other week,” he added. “We did this for about a month until the staff leaders asked us to back off a bit.”
In these meetings, Waltz encouraged leaders to use empathy transparency – looking to help those who were impacted by remote work those who had damaged homes or relocations because of the flood.
“We encouraged teams to help each other whenever they could,” he said. “We allowed staff to work very flexible hours, knowing that schools were going back forth between on-site, hybrid remote scheduling. These situations caused lots of stress on the teams. Many times staff would get together in remote locations even without their leader to work on issues or to just be together.”
In routine meetings, leaders staff focused on business priorities on what “had” to be done.
“We had open time to allow team members to ask questions bring up concerns,” he explained. “The teams really appreciated how we managed these challenges many never worked harder to keep up the great support project work that had to be done.
“We routinely discussed the mission of healthcare before after the pandemic flood,” Waltz continued. “We would talk about how working in healthcare is a privilege having the opportunity to help patients clinicians during their greatest need helps to keep us all focused. It is truly about the mission.”
Waltz created a personal goal to have a virtual lunch with a small group of employees twice a week.
“We have arranged random team members to join me virtually for lunch,” he said. “We talk about vacations, kids, books we’ve read, then I will end with a few things that are going on at work ask if they have any questions. This has been great for me as I get to connect with all the team members in my department. I have received positive feedback from the team members management staff as well.”
Data advanced analytics
The COVID-19 crisis has put a laser focus on how apparent it is that data advanced analytics can be powerful weapons in the fight against pandemics, said Patel of Cone Health.
“COVID-19 has reinforced the urgency to focus on data strategies investments to support ongoing containment, mitigation bio-surveillance activities,” he said. “Lesson learned is that data analytics could have changed the game from detecting the outbreak, to responding to critical shortages of tests, resources, beds supplies, to helping us be more operationally adaptable.”
Advanced analytics, artificial intelligence, algorithms, data visualization tools graph technologies are being applied at Cone Health to understCOVID-19’s nature character.
“Our enterprise data warehouse platform is leveraged to build the pertinent data marts for the advanced predictive models forecasting solutions,” he explained. “AI-based predictive models have been developed to forecast susceptible populations, hospitalizations PPE needs. Moreover, we incorporated mobility data from Facebook Google into these predictive models for accuracy.”
Patel said they need a regional HIE to effectively manage pandemics like this for data sharing to improve predictive models.
“Going forward, linking clinical travel data with personal data collected from social media, such as family history lifestyle habits, it’s possible to create detailed predictive models relative to individual risk profiles health outcomes,” he said. “We need to implement pathogen disease surveillance, advanced warning signal capabilities.
“Our plan is to be agile by making data accessible, liquid fluid across our health ecosystem,” he concluded. “And we must execute an enterprise data architecture that connects interoperability, integration real-time capabilities.”