MacGyvering Telehealth with Texas Health Resources

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Bill Russell / San Banerjee

Texas Health Resources This Week in Health IT

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March 26, 2020: San Banerjee from Texas Health Resources joins us on the show today to share his expertise on telehealth and to continue our series on COVID-19. He unpacks how systems can easily get started on the telehealth project if not already up to speed by using easy apps and resources such as Skype and FaceTime. His recommendation is to connect these different platforms in order to cover all the bases needed for an effective telehealth service. San explains how Texas Health Resources has laid out their system, using Microsoft Teams as the centerpiece. We also get into just how quickly these advancements have been engaged with and adopted by health professionals whose institutions were maybe not quite up to speed before the corona crisis. In addition, the conversation covers some of the challenges that can arise trying to stand new operations during a crisis and our guest shares some information about a helpful app that he and the organization adapted to address these. Listeners will also hear about the idea of the democratization of EHR and what is going on on the ground in Dallas at present. Make sure to listen in as we show you just how possible it is to get up to date with telehealth!

Key Points From This Episode:

  • Making a start on telemedicine; using simple tech to get connected. 
  • Employing a combination of services to build out a telehealth system. 
  • Microsoft Teams’ utility in tying the different pieces of telehealth tech together.
  • The response from doctors to the imperative for telehealth; enthusiasm and progression.
  • Arising challenges in the crisis and the healthcare app that San and his team have launched. 
  • Maintaining a single point of truth during the crisis; the democratization of EHR. 
  • An update on the current situation in Dallas; patient numbers and more. 

COVID-19 Series: MacGyvering Telehealth with San Banerjee of Texas Health Resources

Episode 210: Transcript – March 26, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[0:00:07.5] BR: Welcome to This week in Health IT with our continuing series on coronavirus prep, we’ve moved from understanding the health IT problems to start looking at the solutions around these problems. My name is Bill Russel, healthcare CIO coach, creator of This Week in Health IT, a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

Before we get going, I want to give you three resources for those in health IT during this crisis, the first is for CIOs. I’m currently helping my coaching clients as a sounding board and advisor through this time. If you want to connect with me over the next couple of months to experience what coaching is like at no cost, shoot me a note, [email protected] For anyone in health IT who find themselves in uncharted territory, and wants to crowdsource solutions with a team of seasoned professionals we’ve setup two ways that you can do that.

The first is a slack channel and the slack channel is monitored by and supported by our sponsors. VMware, Galen Healthcare, Sirius healthcare, StarBridge Advisors, Pro Talent Advisors and myself, Health Lyrics. Slack channel allows you to get your questions answered around telehealth, BDI, you name it, There’s great resources in there, there’s technologists, there’s CMIOs, there’s CIOs, just great resources.

If you want access to the channel, send a note at [email protected] and we’ll get you setup immediately. Our sponsors are also supporting an email channel at [email protected] If you just want to shoot an email over, I will get you routed to the expert in the area that your question pertains to from our group of sponsors. I really appreciate our sponsors stepping up to provide these services to our listeners and to the industry. 

 

[0:01:53.9] BR: Now, to our guest. San Banerjee is the VP of Digital Experience for Texas Health Resources and I’m excited to have them on the show, we’re going to talk telehealth specifically and how health systems are piecing these things together. Incredibly creative, incredibly resourceful, I look forward to this conversation with San.

Now to our guest for today. San Banerjee is the VP of Digital Experience for Texas Health Resources. Good afternoon San and welcome back to the show. Former guest in the show.

 

[0:02:24.9] SB: Happy to be here.

 

[0:02:27.3] BR: Yeah, I’m excited to talk about you. I saw a LinkedIn post that you put out there and I was really intrigued, it said, you know, just read it. “If you’re seeking advice and recommendation on how to implant telemedicine in your health system or regional health centers to respond to COVID-19, please contact me, I would be happy to help.” 

 

And here’s what we’re finding. People are scaling these things up and there’s all sorts of need and you know, telehealth is really seeing a boom right now but a lot of people on our Slack channel and other things, where people are asking questions, they’re trying to figure it out, because there’s a lot of challenges. What kind of things are you seeing and then what kinds of things are you kind of you know, advice are you giving people as they implement this?

 

[0:03:12.0] SB: I think these are very uncertain times, Bill, and telemedicine used to be an end in many things for providing care. But the way I’m seeing this is priming the critical path in terms of how we can give and distribute care. Ensuring that we can do virtual care, keep our providers safe and also ensure that we can do it in a very quick and fast way. When I put the post in LinkedIn, I think my whole aspect was you know, all health systems have different technologies in place today, right? How do we bring all those technologies that we have to really provide telemedicine. I’ll use some examples.

 

Many health systems have Skype for example, that they use for collaboration tool within the system. Skype can be used for telemedicine. I can help setting up Skype to ensure that you know, you can see your patients with using Skype. It may not be an integral experience but it will be a good place to start. Similarly, that the FaceTime on the phone.

 

Now, the new regulations that CMS has declared two weeks back helps all the providers to really be on the phone, be on Skype and be doing the telemedicine the way has never been thought or done so far.

 

[0:04:33.0] BR: Yeah, break these things down, a telemedicine those in platforms has a handful of things, one is, it has a queuing system. It queues up patients, has an education platform, so while you’re waiting, they’re streaming videos or those kinds of things. Some of them have an input mechanism where you’re actually typing in some things before you actually see the physician.

 

Then you have the teleconference technology and then generally, you have a documentation platform and I think what people don’t recognize in a lot of these telehealth platforms, the documentation platform isn’t the EHR, it’s the telehealth platform and it’s so – anyway, we’re going to break these things down and I want to walk through it with you. If I start using Skype or I start using FaceTime, those are great but those are – they’re designed to be one to one kind of things and there is no queueing mechanism, so how are you going to set up those calls? Are you initiating outbound calls to patients?

 

[0:05:32.0] SB: I kind of walk you through a couple of scenarios here, right? Just looking at Skype, right? Skype is a technology to use to do teleconferencing but you can put Microsoft Teams to do queueing. Anybody who has Microsoft in Microsoft ecosystem can use Microsoft Teams for doing queueing and then use Skype to do the teleconferencing or whatever the conferencing that is needed and then keep the EHR to do documentation.

 

In this whole process, the three pieces together and those three pieces will be stand up in a week. Less than a week. And Teams is already available and people can use that for collaboration that is needed.

 

[0:06:09.8] BR: Yeah, that’s fascinating. You bring teams so the EHR should be the documentation platform, you just need a big enough screen and they’re going to do that and I think that makes sense to a lot of people. Talk to me about the teams as a queueing platform. 

 

What are you giving your patient community to say, hey — here’s what’s happening. A lot of our primary care physicians,  their offices are empty and they’re empty because people are afraid to go to the offices but they still want to see patients, they still need to see patients so we’re standing them up with telehealth very rapidly. How do we stand up Teams as the front end system and what do we give the community to get in line to see that doctor?

 

[0:06:55.2] SB: I think the Teams, the way it works is, the teams has given for providers. Providers will have the Teams access, right? Anybody having an Outlook account or whatever the account looks like so they can be set up on the Teams. The patient typically gets sent request or they can initiate request from their perspective.

 

All it does is, it kind of comes and add to the Team queue for the provider. If the provider is all tied together, right? And on teams. Now, the provider can initiate a call and the Skype call can be connected to Teams. The Skype and because Skype is part of the Microsoft ecosystem, it is all connected with Teams.

 

Nobody has to do anything separate to start a Skype call, right? Because it’s connected. The patient can initiate that and it comes to a provider queue and then provider picks it up and uses Skype to do the call. The other part of this is that we can use quick technologies like if somebody has a Salesforce, if some enterprise has Salesforce, Salesforce has texting mechanism, that can be put on people’s phones. You can use sales force for queueing when somebody comes into the text channel. 

 

That can be given to the providers as a small app and Salesforce has this texting app that can be used for queueing. What the provider is doing is provider has a Salesforce mobile app on the phone which is used to really see who is coming through and then use the EHR for documentation and use any other video conference to do the conference and like a FaceTime.

 

[0:08:24.5] BR: You know this is fantastic. I mean what are you finding the response being from doctors, so some of these – a lot of doctors have used tele-visits to be fair but it didn’t have wide adoption. I mean if we are just honest, we were just ticking above nominal numbers and then all of a sudden now, our numbers are through the roof. How are doctors feeling about it? How are they responding it? How are we getting enough training and those kinds of things? 

 

[0:08:54.4] SB: So I think the way I see it is that the need has brought us all together. So people are doing extra hours to train themselves even if I send a document to them they just look at the document and say, “San, I am ready.” And just to give you some perspective in the last one week, I have onboarded 970 physicians on telemedicine. 970.

 

[0:09:17.7] BR: Wow, yeah that’s amazing. I mean we are not pushing any technology but what was your platform before this? I am sure it was a well thought out telehealth solution. It wasn’t what you’re doing now but what was your primary telehealth solutions? 

 

[0:09:32.4] SB: It was Amwell that we started off with. So I started off with Amwell and now because we have to scale up so much, first of all Amwell is basically we are using it for primary care but within the hospitals we are using Microsoft Teams, we are using Skype and other technologies that we can bring together. So we have brought all of these things together on the hospital pretty quickly and Amwell, you know we have ramped up 970 primary care providers in seven days. 

 

[0:10:00.5] BR: Yeah and this is the exciting thing about this time is you got health IT is really shining at this point. You guys are MacGyver. You are sitting there going, “All right what do you got here? We got this, we got this.” And you are pulling it together. Are there other areas where you guys are stepping in and trying to help with solutions to challenges that aren’t – I am sure there’s just challenges popping up all over the place. 

 

[0:10:23.7] SB: Yeah so one of the things that we are doing is we have stood up a texting app for COVID-19 specifically. This is a SMS text-based app, we just call Hospital2Home. So anybody can download that and if you are part of our patient list then you will get access to that free for whatever time it is needed and once you start texting you will basically will have a response for an emergency physician within 30 seconds. 

 

Okay, so this helps on the access part of this. To really route the right patients in the right place because putting that behind is not the answer – 

 

[0:11:01.7] BR: The texting application is this something that you have already in place or something that you guys have to go out and source once this came out? 

 

[0:11:11.3] SB: So we already had a texting app that we had that will app for Hospital2Home, people who are coming out of our emergency room and giving support for seven days. We rebranded that completely to support COVID-19, in three days. 

 

[0:11:29.4] BR: That is interesting. So what are you doing for your single point of truth? So one of the things that’s important in the health system is that everybody has access to the same information – well similar information if not the same information so everybody is up to speed on what is going on in the community, in your hospital, things like inventory, you name it. There is a lot of inventory issues that we are looking at, a time for test to be done. How are you – what technologies or what mechanism are you using to keep everybody informed? 

 

[0:12:01.9] SB: I think we use something called Community Plus in Salesforce because we are a Salesforce shop and what we are doing is we are trying to bring the Community Plus up and get all the feeds that we need from the community into one place so that we can get that out all informed. That has really helped us and it was given by Salesforce pretty much you know to us we are caused to ensure that we can handle the situation better. 

 

Also the way we are doing, we are democratizing access to EHR, which is Epic for us so that all providers you can go and view our documentation and as long as the documentation is in some format we will put it into EHR and there is a team to do all of that today. So then we don’t have to bog them down in terms of doing documentation in the right format. 

 

[0:12:46.3] BR: Yeah and you know just to close out because we are trying to keep these conversations pretty right because we know that people don’t have a lot of time and we want to give them access to things, what do you see – what’s got here in the Dallas marketplace – well actually you are in a bunch of marketplaces but Dallas being home for you guys, what do you guys experiencing right now and where are you at? So we are at Tuesday – no it is Wednesday isn’t it?

 

[0:13:15.2] SB: Wednesday, yes. 

 

[0:13:15.8] BR: Wednesday, days are meshing together here but it is the 25th on Wednesday you know, what is the situation like in Dallas at this point? 

 

[0:13:24.8] SB: So we have reported and they have reported saying 5,000 patients have been tested kind of person of interest positive and we are seeing the influx into our hospitals and phone calls in terms of our contacts center, our health center. So we saw about 800 patients in the last two days, people who are of interest and somebody was tested positive and that number continues to grow.

 

[0:13:56.3] BR: Yeah but you are at the front end. So this is a very manageable number at this point. 

 

[0:14:01.3] SB: That’s right. 

 

[0:14:02.3] BR: Yeah. So well you know that’s – I mean thanks, I really appreciate you coming on the show. I appreciate you breaking me telehealth down. I think it is important to understand you know in most cases, if we didn’t have everything buttoned up and we went to the physician community and said, “Hey, here is out Telehealth solution” they would have looked at us and said, “Go back and keep working on it.” 

 

But today, you know necessity is the mother of invention. And they are what I am hearing in the field is physicians are extremely happy to adopt really well thought-out solutions but maybe not all tightly integrated like we normally would deliver to that. 

 

[0:14:44.1] SB: I think the word that I am going to use Bill is let perfection not be your enemy at this point and telemedicine is a game changer. It is needed at this point to really help and distribute the care that we need and I stand it to really help whatever is needed. If any health system, regional health centers who are looking for help, I am there to help to really get to the situation here. And I know some of those things can be pulled together to really help. So my appeal is do not be shy, it is not to be perfect, you know get whatever you have to really help your communities. 

 

[0:15:20.5] BR: Sounds good. Well thanks San, is there any way people can get in touch with you? 

 

[0:15:25.0] SB: Yeah so I am on LinkedIn and my LinkedIn profile is San Banerjee if you just look it up and then my email address is [email protected]

 

[0:15:35.7] BR: Fantastic. Hey, thanks again for taking the time. I really appreciate it and we look forward to catching up with you after this to see how much of this stuff becomes a part of the normal operating procedure, it will be interesting. 

 

[0:15:48.7] SB: Absolutely Bill and it is always good to talk to you. 

 

[0:15:51.0] BR: Thanks, take care. 

 

[END OF INTERVIEW]

 

[0:15:52.6] BR: That is all for this week. Special thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics and Pro-Talent Advisors for choosing to invest in developing the next generation of health leaders. This show is a production of This Week in Health IT. For more great content, you can check out the website at thisweekhealth.com or the YouTube channel as well. If you want to support the show, the best way to do that is to share with a peer, however you do that. 

 

We’re going to be back again tomorrow and the next day. We are going to be keep dropping episodes with — around solutions and with influencers who are going to help us provide meaning around the different things that are happening during the pandemic that is going on. Thanks for listening. That is all for now.

 

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