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When the COVID-19 pandemic struck, many IT leaders shadowed clinical staff to view first-hand the support those clinicians needed on the front lines. And often they learned some valuable lessons.
Meanwhile, while healthcare organizations and their IT teams focused on fighting the COVID-19 crisis, hackers in the wild were not taking a break from their cyberattacks on the healthcare organizations.
The pandemic showed the importance of strategically investing in a secure and integrated foundation of digital tools, offering the ability to scale up existing offerings to respond to the demand for digital care.
But what comes next?
In this final installment in Healthcare IT News' feature story series, Health IT Lessons Learned in the COVID-19 Era, several IT leaders discuss the lessons they've learned over the past 18 months. They are:
- David Higginson, executive vice president and chief innovation officer at Phoenix Children's Hospital in Arizona. (@PhxChildrens)
- Emily Kagan-Trenchard, vice president of digital and innovation strategy, digital patient experience, at Northwell Health, based in New Hyde Park, New York. (@NorthwellHealth)
- Dr. Paul Testa, chief medical information officer at NYU Langone Health in New York City. (@nyulangone)
- Scott Waters, chief information and technology officer at Overlake Medical Center & Clinics in Bellevue, Washington. (@OverlakeHMC)
(Click here to visit the special portal containing all 12 feature stories in this series.)
Clinical informatics at the point of care
Testa and his team at NYU Langone Health quickly learned over the past year that clinical informatics done right has to be done at the point of care.
"At the start of the pandemic, we walked the halls and partnered with our clinical staff to see first-hand what kind of support they needed on the front lines," he recalled. "Working side by side with clinicians as they took care of patients allowed us to literally see the writing on the wall, as seen in the photo texted to us from a senior leader and tweeted by a colleague researcher." [Photo above.]
Clinicians needed COVID-specific data, which they took to writing on glass doors of care rooms to keep track of patients' oxygen levels and reduce the number of room entries of each COVID-19 patient.
"At the start of the pandemic, we walked the halls and partnered with our clinical staff to see first-hand what kind of support they needed on the front lines."
Dr. Paul Testa, NYU Langone Health
Watching frontline staff improvise and problem-solve on the fly gave the IT team insight into what was most important for them in dealing with the crisis bedside.
"We knew we could get them the same specific, real-time data in a more accurate way that respected their need for mobility," Testa said. "Informaticists cross-walked the writing on the wall with discrete data points in the EHR and we rapidly configured real-time digital reports that display COVID-specific patient data for clinicians to access on both desktop and mobile devices.
"These reports serve them up data in the way they need to care for our patients," he continued. "These solutions were only able to be successfully developed because of the emphasis we place on partnership between the clinical systems and IT teams."
Testa and his team will continue to partner with clinicians at the point of care and listen carefully to what they need – and keep reading the writing on the walls.
"Being present at the bedside gives us better and more actionable insights into what is and isn't working for our clinicians," he noted. "We develop digital solutions for various uses across our system, but seeing them used in practice is the best way to know what changes and improvements need to be made.
"Partnership and collaboration are core tenants of our IT department, and work side by side at the bedside with our clinicians to provide the tools they need to provide the highest quality care for our patients," he added.
Bolstering cyber defenses
On a different front, Waters of Overlake Medical Center & Clinics learned along with other healthcare organizations that while the organizations may have a singular focus to fight the COVID-19 crisis, the bad actors out there were not going to take a break from their cyberattacks.
"In fact, they capitalized on an industry that has been working to vaccinate and treat people impacted by COVID-19 for over a year without rest," he said. "The rate of cyberattacks has increased significantly and the sophistication keeps increasing. So many health systems fell victim to phishing attacks and ransomware in 2020, which created another burden on a workforce that is already stretched thin.
"We also saw the attackers going after the tools that we use to detect and defend against attacks such as was the case with the Solarwinds and now the Kaseya attacks," he added.
"We realize we can't solely rely on one or even two tools to protect us. We need to have several layers of tools from different vendors in some cases."
Scott Waters, Overlake Medical Center & Clinics
Overlake Medical Center & Clinics has bolstered its approach to defense in depth.
"We realize we can't solely rely on one or even two tools to protect us," he explained. "We need to have several layers of tools from different vendors in some cases. We also realized there is value in consolidating to single-vendor ecosystems in other cases. The basic idea is to have a flexible security program that can pivot, not if, but when the landscape changes because it changes constantly.
"Zero trust – or as close to that as we can get and still effectively provide patient care – is a journey everyone needs to be on at this point," he asserted. "We have to continue to educate our staff so that they can be good 'human firewalls' for the organization. Investing resources in user awareness education is something we have been committed to and are looking to increase in the coming years."
Integrated foundation of digital tools
The COVID-19 pandemic showed Testa the importance of strategically investing in an integrated foundation of digital tools for both patients and clinicians.
"When the pandemic hit, we were able to scale up our existing offerings to respond to the demand for digital care, rather than some forced pivot or buy some standalone third-party solutions," he recalled. "At NYU Langone Health, we made the choice to commit to integrated systems that prioritize the patient and clinician digital experience.
"Rather than use several niche systems across our organization, we have fewer, but more strategic systems in place that are integrated with one another."
With this in mind, the organization has committed to a single-app experience for patients, which allowed staff to respond quickly and stay connected to them when the pandemic began.
"Through our NYU Langone Health app, patients can book appointments, access test results, conduct a video visit and securely chat with providers all in one place, rather than being sent to multiple locations," Testa explained. "While this approach requires more integration and feature implementation, it paid dividends and allowed for the rapid acceleration of digital engagement with patients over the past year.
"Our telemedicine capabilities were offered through our app before the pandemic and grew exponentially to connect with patients where they live," he continued. "With a strong foundation of technology already in place, we were able to quickly scale up from approximately 1,000 appointments per month to more than 160,000 at the height of COVID-19."
NYU Langone Health will continue to strengthen its foundation of digital tools and put the patient and clinician experience at the center of all it does.
"The reason we were able to successfully scale and stay connected to patients during the pandemic was because we thoughtfully designed our capabilities to benefit both patients and clinicians, not one at the expense of the other," he said. "Our telemedicine offerings allow care to be brought more conveniently to patients in their homes, but also offer our clinicians more flexibility around where and when they can offer that care.
"We will continue to work with both groups to ensure that the tools we create are allowing them to provide and receive the highest quality care, even in the most unforeseen circumstances," he added.
Modernizing and maturing texting practices
Very early on in the pandemic, it became clear that text messages were going to be required at Northwell Health to accomplish many of the communications and coordination efforts that it was trying to deliver.
"However, our health system's policy around using text messages had been written in another era," said Kagan-Trenchard of Northwell Health. "We were only allowed to send notices about upcoming appointments with so little detail that a patient found it hard to understand who this appointment was with or for.
"Any other texting use-case outside of appointment confirmation was considered too risky to even be considered," she continued. "Our legal team's perspective on the safe use of SMS texting had not been updated to reflect the ubiquity of, and consumer demand for, text message communications, nor had the privacy standards governing the content of these messages been updated to reflect current best practices."
"We worked with legal very, very closely to not only adjust our text messaging policies for the short-term crisis management but update our larger texting consent management framework in order to ensure that SMS could be an active channel for patient communications in the long term."
Emily Kagan-Trenchard, Northwell Health
Furthermore, the texting utilities the organization did use were not communicating back to appropriate source systems when patients opted out of these texting campaigns, resulting in a confusing jumble of text message consent data that rendered it nearly useless for other applications.
"We worked with legal very, very closely to not only adjust our text messaging policies for the short-term crisis management but update our larger texting consent management framework in order to ensure that SMS could be an active channel for patient communications in the long term," she explained.
"With these new legal standards in hand, we now had to coordinate implementation between all of the teams currently using text messaging, as well as those setting up to do so in the near future," she said. "We needed to coordinate like never before on everything from how we would manage opt-outs on various short codes, to ensuring that cell phone information was up to date, to aligning on timing, content and message triggers."
This required staff to not only implement tools that could send automated and conditional logic messages, but even transition the conversation to a live person for a real-time reply in certain circumstances.
Rapid custom app development
Kagan-Trenchard also learned something that she said the pandemic made clear: Health systems cannot simply outsource their own digital flexibility.
"Custom software and application development is a muscle all health systems need to have, to some extent, within their own workforce," she said. "This skill set needs to be one that can both build scaled enterprise utilities, as well as custom, rapid response tools as was often called for during the pandemic.
"This means we not only need to look at the talent we employ, but also the server environments, the code repos, development frameworks, data and API management architecture, along with our design capabilities, user experience strategy, microcopy and much more," she said.
This is not a set of skills that Northwell Health had built exclusively for use during the pandemic, but during this crisis it became abundantly clear why it was not just a need for one-time special projects, she said. It is a critical capability of a health system's IT response to unexpected circumstances, she added.
"Custom applications were used for basic coordination of people and appointment logistics, COVID testing, managing vaccination rollout populations and scheduling, and rapidly activating pop-up locations as directed by the state," she said.
"During the pandemic, the digital patient experience team and IT custom software development groups leaned on their existing agile development and design practices to pivot their resources and get to work, sometimes turning around tools in as little as 48 hours."
Some areas of the business turned to platforms such as Salesforce to stand up their own custom email and campaign pages for certain things. But even with those WYSIWYG utilities, there is still a need to consider the product and experience design components, she said.
"Everything from the field typed, form flow and validation practices to experience integration, accessibility and health literacy issues cropped up," she noted. "Many areas of the business didn't know they needed these skills until there was a fire that needed to be put out.
"So it is not only the engineering side of custom application development that is important to cultivate – it also is the design strategy and user experience components that make for a successful rapid application development team," she added.
The predominant lesson Higginson of Phoenix Children's Hospital learned over the past year has been that his team can get things done quickly – very quickly.
In normal times, new projects and initiatives take some time to get off the ground, but necessity is the mother of invention, and the pandemic expedited work to find solutions to new problems, he said.
"An example of this was our work to place cameras in every patient room," he said. "We had installed cameras in our NICU a few years earlier and wanted to do this across the hospital, but COVID-19 pushed this initiative to the top of the list.
"So we innovated our own solution: We purchased cameras from a company called Axis and created our own HL7 ADT solution that automates the patient-family connection throughout the hospital experience."
David Higginson, Phoenix Children's Hospital
"Like other health systems, our visitor restrictions were very strict, only allowing one parent or caregiver in the room at a time," he continued. "We knew this would be difficult for families – parents, grandparents and other loved ones were anxious to see these children – and we were eager to provide a solution and put families' needs first."
Of course, purchasing this particular type of camera for every patient room can be expensive. In addition, boxed vendor solutions are imperfect in many ways, he said.
"Beyond the expense, the cameras require regular involvement from clinicians including manually disconnecting each family from the system when their patient is discharged or transferred," he explained. "This creates too many opportunities for error, especially for providers who are already managing many details for complex patients.
"So we innovated our own solution: We purchased cameras from a company called Axis and created our own HL7 ADT solution that automates the patient-family connection throughout the hospital experience," he continued. "It also disengages the family once the patient is discharged or transferred, eliminating the possibility of human error."
Staff also designed and sourced a unique gooseneck with medical-grade infection coating that attaches directly to the camera and allows parents and clinicians to adjust the angle – aiming the lens at a child's face and away from a wound or surgical site, for example.
"Another feature of our solution was a light ring around the lens that would change colors anytime a camera was accessed," he added. "This provided a visual cue to clinicians that families were actively utilizing the technology and could see the patient."
The IT team worked with Phoenix Children's Hospital Foundation to cover the cost of this project, which amounted to about $600 for each room (compared to $7,000-$8,000 for a vendor solution), Higginson said. They also got their solution implemented in about three weeks' time, while a boxed product would have taken considerably longer to implement, he added.
"More importantly, we know that it made a difference for families," he said. "On average, parents and other loved ones accessed the cameras roughly 20 times a day for just a few minutes at a time. The opportunity to see their children virtually was the next-best thing to in-person visitation."
More than just video conferencing
Waters discovered that as an organization, Overlake Medical Center & Clinics needed a virtual communications platform that would deliver more than just video conferencing functionality.
"Like many other health systems prior to the pandemic, Overlake was already using audio and video conferencing solutions for some of our meetings, but there was a significant preference to meet in person for almost everything," he noted.
"Being at the epicenter of the COVID-19 outbreak in the U.S., we had to shift our preferences of in-person meetings to the practical and safer approach of meeting virtually and we had to make this shift quickly."
They discovered that their solutions at that time for video conferencing did not allow for robust communications among project and committee teams.
"Functionality such as chat that could persist after the meeting ended, being able to set up virtual spaces for collaboration on documents in real time and asynchronously, and of course video conferencing with screen sharing was of critical need," Waters said. "We implemented Microsoft Teams and it was a game-changer when it came to streamlining our communication needs during the pandemic, but what we have found is that it has really become a significant enterprise tool that will persist into the future."
Overlake Medical Center & Clinics has invested more deeply in Microsoft Teams as an enterprise communication platform.
"One example of how we are investing is our deployment of the Microsoft Teams Family Connect application we are preparing to go live with," he noted. "This application will allow for a more cohesive consultation experience, involving the provider, patient and their families, creating a more holistic approach to care planning.
"Our expectations that meetings have to be in-person have changed as an organization," he continued. "At the same time, the expectations of our staff to be able to work remotely have also become stronger and more vocal. This has to be a cultural shift at Overlake that has taken some time to get used to but across all of our productivity metrics we have shown it to be a successful transition."
There will always be situations where a virtual meeting just cannot replace the face-to-face interaction of in-person, but there is a permanent place for virtual work at Overlake for certain roles.
"The biggest lesson with this shift has been that flexible thinking is our greatest attribute at Overlake," he concluded. "We pride ourselves on being a forward-thinking healthcare organization that can meet and anticipate the needs of our patients, staff and community."
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.
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