This Week in Health IT COVID-19 Prep
March 16, 2020

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March 16, 2020: As the COVID-19 pandemic continues to strengthen its grip across the US, systems are increasingly being put to the test. The federal government is leaving it up to the state, and places, where the blooms have happened, have more stringent measures in place. As CIOs and CTOs, it is our nature to prepare for the worst and hope for the best. We are always thinking about plan B, C, and even D, which serves us well during times of crisis. Drex DeFord, an independent consultant, and freelance CIO sits down with Bill to discuss some of the preparation challenges many healthcare IT systems will face during this time. In this episode, Bill and Drex unpack two categories of challenges: the obvious ones and the hidden ones. They touch on the issue of communication and the responsibility of health IT to organize through and disseminate the plethora of information. Bill also discusses the importance of having accessible, easy to digest content that reaches all demographics, not only the highly-educated segment of society. Along with this, Bill and Drex also shed light on internal organizational communication and how this might pan out. They walk through other systems facing strain like self-diagnosis, telehealth, and treatment of chronic, non-COVID-19 patients. Some of the less obvious challenges Bill and Drex shed light on include cybersecurity and how the slew of information compromises safety and how changing roles can confuse hierarchy and accountability channels. The challenges are multi-layered and complex, so tune in to hear more!

Key Points From This Episode:

  • Learn more about the situation in Seattle, where Drex is based.
  • The communication challenges that face health IT during the crisis.
  • Cybersecurity: One of the less obvious but very important challenges at this time.
  • How sick staff and role changes can present challenges during this time. 
  • Self-diagnosis, telehealth, and other tools we have at our disposal.
  • With the increase in remote work, there’s increased pressure on other infrastructure. 
  • Some of the pandemic management tools and the difficulties around these.
  • This is a great time for healthcare vendors to step up and see where they can help.
  • Some of the best COVID-19 communication resources and their strengths and weaknesses.
  • A look at how to scale up self-diagnosis, through chatbots and call centers. 
  • Learn more about ‘COVID cabanas’ and the equipment they would need to function.
  • Why trying to establish a new VDI during the pandemic is not going to work.
  • Many organizations don’t have the adequate cybersecurity staff, which is being revealed now.
  • Don’t be afraid to put things that are not critical on the back burner to build capacity. 
  • The infinite timeline of the COVID-19 crisis makes it unlike any we’ve faced before.
  • An overview of flattening the curve, how it helps manage the outbreak, and China’s success.

News Day – Drex and I discuss COVID-19 Preparedness

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Drex and I discuss COVID-19 Preparedness

Episode 200: Transcript – March 16, 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.

[00:00:04] BR: Welcome to This Week in Health IT News where we look at the news which will impact health IT. My name is Bill Russell, healthcare CIO coach and creator of This Week in Health IT, a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. 

I want to thank Sirius Healthcare for sponsoring this week’s shows to discuss and share best practices around preparedness around COVID-19 and the great work that healthcare is doing right now. This week, as I said, COVID-19 discussion with our special guest, Drex DeFord. 

Good morning, Drex. How are things going where you’re at?

[00:00:37] DD: Good. I am in Seattle, which is kind of the hub of the initial COVID-19 outbreak. Things have gotten very quiet here as far as things that are happening outside. Obviously, this weekend, the governor announced that they were closing all the bars, all the restaurants, still do carry out food. No gatherings more than 50 people. We’re not locked down, I wouldn’t say, but we’re getting there. We’re getting closer and closer and closer, and all of it towards sort of the effort of flattening the curve. A lot of challenges here and some of our health systems already with supply chain stuff and having beds full. We’re getting there. 

[00:01:22] BR: Yeah. I mean, you just hit on two things. One is it seems like the federal is essentially leaving this up to the state. You saw New York. I think New York, New Jersey, Connecticut just come out with. They are taking those same measures. I think California is taking those measures as well. But if you look at a map, that would make sense given there are deeper than some of the other areas in the country. 

[00:01:47] DD: Sure. The places where the blooms have really happened and spread quickly. Obviously, those are the places who are maybe taking this more seriously than other places and so are putting these situations, these restrictions into place. For the places where the blooms haven’t happened, I mean, I don’t know what to say except I kind of am the negative guy in all of these. I don’t think this is going to go very well. Go earlier rather than later. Don’t afraid to be overly cautious and all these. 

[00:02:26] BR: Yeah, but that’s our background, right? Prepare for the worst and hope for the best.

[00:02:30] DD: Absolutely. Yeah, we overbuild. We build networks that are redundant and triple redundant. We are always coming up with this is my primary. This is my backup. You’re right. We are plan B people. That’s kind of how we’ve been raised our whole career.

[00:02:46] BR: Yeah. The other thing you mentioned was supply chain shortages. Again, I can’t verify a bunch of these stuff. I saw on social media, which is again one of the best sources for information at this point, unfortunately, but I saw shortages in Boston. Some of the hospitals were actually calling to the community to supply things like masks and other things. 

[00:03:08] DD: N95 masks, yeah.

[00:03:10] BR: I don’t know if that’s accurate. That’s the problem with social media. It’s not a verified source. You’re counting on some of your peers to verify that. Again, supply chains. That’s how we’re going to address this topic. You and I could talk for the next three hours on this, but we’re going to try to organize it and, and here’s how we’ll organize it.

[00:03:32] DD: Got it.

[00:03:32] BR: Challenges we’re trying to address, and we’re going to break it down to two categories. Obvious challenges, this is the stuff that everyone in health IT is going to go. I mean, we’re going to do these things. Then the not so obvious, maybe the things we’re not thinking about. 

All throughout the first obvious challenge, and that’s communication platform. You want to be the source of information for your community around the pandemic that is impacting them. When they’re doing a search in – I’m in Naples, Florida, you’re in Seattle, I want to hit the local health system or as a health system, local health system, you want to be the one that I hit. I go to your site, is see a blog, I see articles, I see reassuring videos and posts from physicians. I see instructions on what to do. But not only that, from communicating with the community at large, but also the community internally, there’s an awful lot of information to coordinate within the four walls of the hospital. There’s state and federal guidelines coming down. There’s CDC. There’s just a whole host of things that it is a responsibility of health IT to organize that information in a way that people can get it at their fingertips when they need it and all those things. That’s one of the obvious ones. How about you? What’s another obvious one? 

[00:05:00] DD: I mean, I think that’s a really great track. Talk to your MarCom people. Pull them in to this. Don’t make this about a technology thing. Help them decide what they need to communicate. When and how they need to communicate it and then provide them the infrastructure that they need to do that. If you’re using Slack inside your organization or you’re using internal web portal, whatever the case may be, figure out how to make it work. This probably isn’t the time to try to standup brand-capabilities around com, but it’s clearly a very urgent component of managing your crisis.

[00:05:38] BR: Let’s drive that. Let’s drive that. By the way, on this, what I just want us to do is identify them. Communication – We’ll keep going through them. Then we’ll dive deeper into them. But I think that’s an important point that you just made, is some people are going to be tempted to start standing things up very rapidly. In some cases, you’re going to look at things and go, “Look, we can go to the cloud. We could stand that up. We could do this,” and there’s not a lot of considerations, but you and I have both worked in healthcare. We know there’re significant considerations. There are very few systems that sit on their own. 

If they do, great. Stand them up in the cloud and away you go. But if they require any integration at all, any planning, you’re probably too late. What you’re doing today is planning for the next pandemic, whenever that might be.

[00:06:26] DD: Yeah. Hey, the other thing, when you talked about maybe not so obvious, right? Especially when it comes to cyber security or when it comes to communication, I would say think about cyber security in all of these. There’s a lot of com coming out. There’s a lot of stuff that looks super attractive to click on in emails. Here’re the latest updates for your zip code. The boss is getting ready to make an announcement. Make sure you click on this website to register for the webinar that he is going to be doing at 4:30 this afternoon. 

I mean, the scammers are scamming, man, and they are really, really good at it. Be really thoughtful about talking to your teams about cyber security. Make sure you’re doing all of the management detection or response stuff that you should be doing to make sure that you’re in a good spot. They’re not slacking off right now.

[00:07:22] BR: Yeah, and I’d love for them to find those people after this is done. Track them down. I would like them to institute these stocks just on the outside of Costco and just let people throw stuff out.

[00:07:34] DD: Yes. I think that would be a great idea.

[00:07:38] BR: I don’t know if – All right. Here’s a couple of the other obvious. Pandemic management tools. You’re going to need [inaudible 00:07:45] dashboards, screens. You’re going to want to know equipment usage, beds, rooms, people. Which of your people internally have come down or ill or not coming into work. Anything that’s a resource, a limited resource that is potentially going to be needed, you’re going to need those management tools and dashboards. Hopefully, we should have all the skills to stand this stuff up. What’s another obvious one that you’re thinking about?

[00:08:16] DD: I think when you talk about people who may be sick or maybe have changed roles. You and I have a conversation earlier today about CIOs who are also clinicians who maybe pulled out of their CIO clinician, CIO roles and put into clinician, moved back into the ED and moved back into the ICU that having an org chart and hopefully you already have sort of a human continuity plan. What happens when this person isn’t available? Who’s the backup? Then who’s the backup to them? That stuff should be documented and easily accessible so that if I need to talk to the CIO and it turns out the CIO is neck deep in PPE in the emergency department trying to take care of patients that there’s a backup plan. Who can I talk to and do they have the authority to make these kinds of decisions? Put that kind of structure together and put it out there now so that it’s easy to find.

[00:09:14] BR: Yeah, and we’ll come back to that. I think things that allow for the clinicians to keep this, the self-diagnosis stuff is awesome. If we’re telling people to self-quarantine, stay at home, do those kinds of things, we still need to give them ways to figure out what their status is chat bots we’ve seen proliferate as a result of this, which is fantastic. We’ve seen phone banks get expanded significantly, or even repurposed during this time. I mean, you don’t need to be doing a lot of collections right now. If you want to get a black eye on your health systems, be making collections calls right now. That’s a good idea. 

You have a whole bank of phones that you could redirect to clinical purposes during this. Anyways, so self-diagnosis, supporting drive-through testing in telehealth. I’ve heard a lot of people stating those kinds of things, and I think one of the things that’s falling through the wayside is we have a bunch of existing work, like chronic patients that are non-coronavirus type patients, but they’re chronic patients that we continue to care for. I think that’s one of those maybe obvious, maybe not so obvious, how are we going to care for them? I think the last one that’s pretty obvious is just work from home, really. 

One last not so obvious. You just got your Internet back just prior to recording this show.

[00:10:39] DD: Right.

[00:10:41] BR: You and I sort of train this way, but there is this sort of escalation of problems that can happen over the course of time where we just put all these people at home and now these platforms for like Zoom and other Zoom is I think in the scale just fine. But Internet service providers, whatever, they could break.

[00:11:05] DD: For sure. Yeah. I mean, I think you look at – So this sort of like different levels in this, right? One of them is, yes, I want to make sure I have access to Zoom, because that’s probably how I’m going to do a lot of my meetings. Also, if we have teams, I might want to have teams as a backup. I might also want to make sure that we have WebEx accounts available for at least some select people should something fall apart there. Kind of at each of these levels, you want to make sure that you got it. Got it set up. 

You’re right. I just had a problem with my Internet going out. Now, I don’t know exactly what the problem is, but I have a fair guess that probably somewhere in my neighborhood there’s a bottleneck because the kids are home and they’re watching Disney and mom screaming, music on Apple Music, and dad is – I don’t know. Doing whatever dads doing and right on down the line and suddenly this stuff is overwhelmed. I’m sure that there are peaks in network infrastructure in good old plain old Internet stuff that’s we’re bumping up against now. 

They’re also scrambling for new equipment, expanded capacity, all of those kinds of things, because there’s seeing traffic they’ve likely never seen before. I’m looking at – The way I was going to do this or one of the things I was considering was I can tether my phone to my computer and use regular cell minutes. It may not be as quick or as fast, but it’s things like that. Again, I think we’re always a plan B, plan C kind of guys, and whatever you do during this crisis, think about your plan B and plan C and what your backup, because your primary may not always work. 

[00:12:49] BR: All right. Let’s talk solutions. We’ll go down this list. Pandemic management tools. Do you think the EHR providers are going to do this or do you think we’re just taking our build teams and saying, “Look, build out this dashboard we need to look at constrained resources. Let’s talk to the physicians. Determine what resources they’re concerned about. We’ll build these out and build them into the workflow,” or are we expecting the EHR providers to provide these things?

[00:13:18] DD: Yeah, it depends on the size of the organization, right? I think that some of the smaller places, if you think about 60% of their country, 60% of the country gets their healthcare from a small and rural hospitals, those folks – I mean, I can tell you that sitting down in Eastern Washington with some small hospitals a couple weeks ago, they were poking fun at each other about how do you get for people in your IT department? I only have two people in my IT department. those guys don’t have build teams and they’re not building anything that doesn’t already exist or isn’t coming from a vendor. 

If you’re at a big health system, I think we already see good examples of that where organizations are building their own pandemic dashboards and dashboards for the community and things like that that we’re sharing both internally and externally. Yeah, analytics is going to be a huge part of this. Seeing what’s happening and where it’s happening and trying to decide how you make that move to sort of cut it off at the pass, whatever that turns out to be. 

[00:14:16] BR: Yeah. If you’re an EHR provider right now listening to this show, and I know we have just based on listens, I know we have a lot in Boston. We have a lot in a certain place in Wisconsin that listen to this show as well. I think it’s a matter of opening up the sharing platforms, which they all have. If I’m developing something in Seattle, it can easily be deployed elsewhere. There are some large health systems on Meditech, which runs a lot of the smaller health systems. I know they have the capacity to move some of these stuff around as well. 

[00:14:47] DD: Yeah. I think that if you are a vendor in the healthcare world, part of the reason at least I would like to believe, and I know, because I’ve done this for years, part of the reason those companies are in healthcare is that they are also addicted to the mission just like all the rest of us. It’s all about better, faster, cheaper, safer, easier access care for patients and families. 

Those companies have made a lot of money in the last few years. This is a great time to tip back in your chairs and say, “What can we do to help right now?” and put your teams on that. That may mean spending more time with your customers when they don’t have time to try to ask those questions, or it may mean just trying to come up with some stuff on your own that you know would be useful. But put your shoulder against it. Everybody’s going to appreciate it. 

[00:15:38] BR: Yup, absolutely. All right, the next one is communication tools, and I’m really passionate about this. I have a handful. If you have some, that would be great. UW in your neck of the woods, put out a document sharing site. This is really around a whole health system response and health IT response, and it’s covid–, which means it’s probably a share point site. Really good outline. It’s really designed not for the community. It’s designed for the internal community. I like the fact that they shared it with all of us. So it becomes a really good resource. 

But that’s sort of on the side. One the folks on is you have Mayo Clinic has a really good page, We’ll come back to the naming. Stanford Healthcare is a good one. Actually, a lot of people do have good ones. Some the ones I have are not so good. I want to cover some of the things that I find to be good and not. Now, Baptist Health Kentucky. I just interviewed their CMIO this morning for a show that we put out there, and here’s the thing I like about theirs,

Okay, so the first thing I’m going to say is we know how to do redirects. We make the stuff easier to get to., that’s what it should be, and not only should it be COVID-19. It should be COVID19. It should be coronavirus. They should all points of the same page. No matter what people are doing, they should be able to find this thing. That’s the first thing. 

Second – I’m sorry. I’m going to go off on my little tangent over here.

[00:17:38] DD: It’s all right. Go ahead.

[00:17:39] BR: It needs to be above the fold. It needs to be in the banner. Some of you are putting it in your news section, which is like three quarters of the way down the page. I’m not going there. It needs to be at the top. It needs to be a nice little red banner. I see it. I know it’s there. 

Use your design team. There’s a lot of ways – Some of you don’t have designers. That’s fine. Designers are real cheap online, but have them look at your page, colors, design, communicate things. The other thing I like about Baptist Health, some people just throw a whole bunch of links and a whole bunch of resources. That’s great for the people in your community that are college-educated and all that stuff, but you have to consider the entire community. You have to communicate in a lot of different ways through pictures through nice, easy to understand video, a nice, easy to understand text. Those kinds of things. Know how it looks on the mobile device. 

I would say the other thing I liked about Baptist Health is know the questions people are asking. I should be able to hit it and very quickly know, “How do I self-diagnose? How do I diagnose remotely with the help of a physician? How do I get testing without going into the hospital? If I need care, where do I go? If I don’t have coronavirus but I have an appointment for something else, what am I supposed to do? Who am I supposed to go –”

I mean, there’s a whole bunch of questions that you could just look at the searches people are doing on your website. You should have a way of capturing that and you should be able to turn that into a page that answers those questions very quickly. Those are those are just some of the things that I’m seeing on some of these pages. I’ll let you comment on that. 

[00:19:26] DD: No. You’re right on the money, right? A dozen questions on an FAQ page probably will answer 90% of what people are coming to your page for. You don’t have to be perfect. So you know what those dozen questions are. I mean, they’ll just give them to you. Come up with the answers to those for your health system. Put them out on a page. Put the banner at the top of the, like you said, above the fold. Don’t make them go search for it. Give it a really easy to use name. You nailed it, Bill. That’s exactly it you’re you’re going to come with the community, if you’re going to communicate with the internal staff, you got to give them really easy to use, really easy to access stuff. 

[00:20:03] BR: All right. I’ll give you the next one. How do we scale up self-diagnosis? We’ve seem chat bots and call centers do the mechanisms that people are offering, and maybe you have some others. But how do we scale these things up?

[00:20:17] DD: Yeah. I mean, chat bots are call centers are definitely good ones. I think I’ve gotten a lot of calls this morning and this weekend as folks have continued to try to do things like stand up drive-through cabanas and then figure out, “What do I do in my EHR to add a new location? How do I get equipment out there and what are we going to do to make sure that the Wi-Fi access that we just put in the parking garage for this is secure?” and right on down the line. 

You’re definitely being asked as a CIO and as the CIOs team to stretch and be flexible and do things quickly that you’ve not been able to – Not been either asked for or allowed to do in the past. Yeah, you definitely got to look at all these other channels.

[00:21:09] BR: All right. As a quick tangent, let’s assume I’m standing this up a Walmart parking lot. It’s the biggest parking lot in our community. We set up the cabana. I have to get them internet access to that location. I assume you’re looking at maybe a partnership with Walmart to get on their Wi-Fi would be one way. Maybe the ISP has a way of doing it, and then I guess mobile cell is another way. Are there other ways that you would get them access?

[00:21:44] DD: Those are the three ways that I would think of right off the bat. 

[00:21:49] BR: How are you going to do that? How are you going to secure it? 

[00:21:51] DD: Exactly. Make sure that whatever you’ve done from the perspective of virtual private network or some kind of tunneling to make sure that you’re secure, don’t forget to do that. 

The problem that happens right now in a lot of these situations is that we are acquiring new gear. We’re putting new gear into place either to send people home, to work from home, to stand up drive-through cabanas, whatever the case may be, and we’re buying it, we’re deploying it really quickly and we’re not running it through our normal protocols around cyber security. 

Make sure that you’re doing all the things you should. Don’t leave the admin password out don’t. Don’t let yourself get smoked on something that seems painfully obvious. I know they’ll take a little more time, but you just can’t lay landmines that you know you’re going to step on later. Take a deep breath and be decisive. This is a perfect time to cut through red tape if you think there’s unnecessary red tape, but a lot of that red tape is there for a reason. 

[00:23:03] BR: No. Absolutely. 

[00:23:04] DD: Don’t skip it.

[00:23:06] BR: Two types of equipment we’re probably sending out there. We’re probably sending out laptops. I don’t assume we’re sending desktops out. Laptops with VDI likely to get to EHR and maybe some biomed devices. I don’t know. Is that what you’re thinking the cabana looks like? 

[00:23:25] DD: That’s a good question about biomed devices. Certainly, my impression right now is that they are probably collecting samples and then there’s somebody who’s a runner that’s taking them back to the lab to either be processed or shipped.

[00:23:43] BR: Yeah. That makes more sense.

[00:23:44] DD: I can’t imagine that they’re doing actual on-site testing at this point. I’ve talked to health systems. The whole process kind of in the beginning was we had to ask the CDC for test and then they had to ship them to you and then you had to do the test. Then you had to ship back to the CDC, and the CDC would send you a result. That took a while. 

Then it’s sort of expanded into there were other places you could get the test, like the University of Washington came up with a testing protocol and testing capabilities. You could send it to the local university and get results back. CDC has now decentralized a lot of the stuff to public health organizations throughout the country and you’re seeing health systems, according to one that I talked to the end of last week that are ordering their own equipment that hasn’t been arrived, hasn’t arrived, hasn’t installed yet, but their intention is that they’re going to do their own testing inside the hospital. 

It’s getting better and better. You’re getting closer and closer to being able to sort of do the test to get the result back pretty quickly. But that would be amazing to have the testing in the cabana. I don’t think we’re there yet.

[00:24:53] BR: Yeah. We’re seeing that those timelines start to come down. I saw Roche was talking, bringing it down into the minutes category versus the get the test back. Again, you have to manufacture that equipment, get it out, all that.

[00:25:11] DD: There are reagents, there are a lot of stuff that goes with this. 

[00:25:15] BR: All right. Let’s talk work home, and I’m going to give a little credit to Lee Milligan on this one who I interviewed recently for the show. That’s going to be released pretty soon. He said – He goes, “Look, I just ask my team real quick, three boxes of people, people can go home today and work from home without any problem.” Then he goes, “I need a second category of people, people who can work from home but need X, whatever X is. They need a computer, they need Internet, they need a VPN, whatever. Tell me who that group of people is and what they need and get that list together.” Then the third list is cannot and will not work from home. 

I thought that was just real good – You can count on any ED doc to come up with something like. Let’s triage this really quickly. Give me this list. I think that’s a good approach, because that list is going to tell you the things that you need to stand up very quickly in order to do this. 

But let’s talk a little bit. So one of things that we talked about a law earlier is one of the things that people are sort of throwing out there is, “Well, you can just do this VDI. Stand this up real quick and being able to do this.” I’m a former CTO, and you’re extremely technical as well. VDI environments, how much can we stress please? How much can we scale them? I mean, how do we determine how far we can push these things right now?

[00:26:48] DD: Yeah. I think when you look at organizations who run VDI internal to the organization, they have some pretty good ideas about what their capacities are and what kind current number of desktops they can run. They probably have some good experience with that and they may actually have the capability of being able to tap their vendors and scale up pretty quickly if they’ve already taken those steps, right? 

Some of the challenge in this is that if you’re deciding today that you’re going to try to scale up VDI, when you call your vendor, they may have a challenge supply chain-wise, getting you what you need tomorrow. Hopefully you’ve already taken those steps. 

Likewise, I think if you’ve done stuff in the cloud, if you’re doing VDI and Azure, you’re going VDI and AWS or something like that, you have the kind of experience that you need to be able to scale. You should be able to scale up pretty quickly. But for everybody else, trying to start a VDI program right now in the heat of the battle might be tough.

[00:27:50] BR: Yeah. VDI gives you the illusion that it’s limitless, right? You just, “Oh, look! All I have to do is go to my workstation and provision this and provision this.” We had 6500 VDI clinical workstations at St. Joe’s when I left, and we had to solve two problems. One is we had to get all those apps to run on the VDI environment, and then we had to scale. We worked our way through both of those things. But at the end of the day, of VDI environment still runs on a physical set of hardware, hypervisors, you name it. If you’re like order your equipment from Dell today, I guarantee that supply chain isn’t going to drop those things in your data center tomorrow. 

The other misnomer is that Azure is limitless, AWS is limitless. They’re not limitless. I have had people tell me they’ve run into constraints, specifically in some of the Microsoft data centers that they didn’t have capacity. They had to build our capacity. It’s a misnomer the cloud is unlimited. It has the potential to be unlimited, but they have the same constraints we do. It all runs on something. 

[00:29:08] DD: Yeah. I mean, I think you talk about, “Okay, Zoom, or WebEx or Teams, that’s an application constraint. But now we’re really talking about things that probably would be considered in the utility. Maybe not a utility, but kind of a utility-like category. Whether does your Internet provider have the capability to provide all the bandwidth that they need? Do the cloud service providers actually have all the capacity that they – All the capacity that everybody’s going to want to eat right now at the same time. The kind of running joke is that you have to build the pipes in the condo, in the big building. You have to build it so that everybody could flush the toilet like 7:30 in the morning, and they’re dealing with the same problem. 

If it’s VDI, at 7 AM, everybody is spinning up a desktop. That doesn’t mean that you can support all of them later in the day. It’s the same flattening the curve problem that we have with coronavirus, right? I don’t want everybody to show up at the same time, because you overwhelm the infrastructure that we’ve built. When you’re thinking about analogies to what we’re dealing with now from a healthcare perspective, that probably is a good one too. 

[00:30:24] BR: Let’s talk cyber security real quick. Is just a matter of – We already have the protocols in place. Just make sure you follow protocols. I mean, that’s what I heard you say earlier. Is there something, anything else we should be considered?

[00:30:37] DD: I think it’s about following the protocols, but it’s also the reality that I think a lot of organizations don’t necessarily have all the people that they need today to be able to do the work that we’re asking them to do around cyber security. In some cases, we see it’s not cyber security professionals, but other IP people who are carrying a lot of the cyber security load. That distractions just on its own can be a challenge to cyber security. 

I was hired to do networking, but I’m actually doing a bunch of cyber security stuff as an additional duty. When the balloon goes up, when all these stuff is going on right now, those folks are really, really focused on getting their networks expanded and getting stuff out to the cabana and doing all of that. They have a tendency to slide these things on the back burner around cyber security, and that’s a bad situation. 

I would say this is a great time also to start thinking about all the places that you can think of that you might be able to offload to a partner. You should think about, “Is this a good time to try to do that if it’s simple and easy to do and not super complicated?” as you were saying earlier, right? We don’t try to do something that’s going to turn into a giant project. 

But if you’ve got something, you can offload to a partner, whatever it is, cyber security, monitoring, something else, that should be part of your planning process right now. What can I get out of my hands so that my people can focus on the important stuff?

[00:32:09] BR: Yeah. Let’s talk about that. If you were to ask me a week ago, what are you doing about nonessential projects? I would have said I’m going to let them go. But by Friday, if you’d asked me, “What are you doing about your health IT nonessential projects?” I would have said, “Not only am I putting all those on the back burner and putting them on hold.” I probably would’ve put a significant number of mainstream projects on hold. 

Now that I’m talking to some CIOs, I there are also getting to that point where they said, “Hey, we’re in the middle of a merger and we just took that entire team off the merger work and they are now focused on building out screens, building out dashboards and things.” They were building out new capabilities for the merged entity. Where would you be – I mean, I’m at a point now where am I’m probably looking at it going, “Look, the worst is probably going to happen over the next 2 to 3 weeks. Our preparedness from an IT perspective was two weeks ago to probably the end of this week to really have our things done.

I think sometime last week, the thing switched in my head to say, “No. No. This is an all hands on deck. Let’s make sure everybody in IT gets all these things stood up,” and maybe that was even late to the game. You probably would’ve flipped that switch maybe two weeks ago.

[00:33:35] DD: Yeah, maybe. I think right now my advice would be create as much capacity as you can. If it’s not essential, stop doing it, or put it on the back burner and let it simmer so that you’ve got capacity to do the things that you know you’re being asked to do now that our mission is essential to serve patients and families. Don’t be afraid to – This is an opportunity to be decisive and be bold. You’re going to have to force the issue with some of the other people around the table around the need to build capacity to be able to serve the mission at-hand today. 

You said you think it’s going to be the worst over the next couple of weeks. I think it’s going to ramp up over the next couple weeks. I actually think it’s going ramp up over the next several months. I think this week will be the week that we will see the real upturn in the hockey stick, but I think that up-line is a really long line. So we have to be prepared that this is unlike any kind of crisis that we’ve faced before. A lot of us have gone through storms, or tornadoes, or hurricanes, or other things like that. I’ve been fortunate that I’ve been in combat and shot at and missed, but those things have a definite amount of time. They last for a short period of time. You’re a crisis manager for a week, or two weeks, or a month, or something like that, but there is light at the end of the tunnel. This is a long game, and I think we have to think about this amount of effort and this kind of management and prioritization, re-prioritization as a much longer game than we’re thinking of today.

[00:35:32] BR: This is probably where you and I get in trouble, because neither one of us are clinicians, but you have to determine who you’re going to trust in this. I trust numbers and I trust people with good track records. [inaudible 00:35:45] is a good tracker, and he’s saying things like exactly what you just said, which is this ramps up. It ramps up really big. This is why we’re doing the social distancing. This is why we’re shutting down bars and other things. This is why we’re limiting travel, because it flattens the curve. For those who don’t understand flattens the curve, if this thing does a hockey stick and goes directly, we do run out of beds, we run out of ventilator, we run out of all these, supplies, you name it. We run out of all that stuff. But if it happens over the course of a couple months, if we’re successful in flattening the curve, we’re going to save a lot of lives just because our health system is going to have the capacity to manage it overtime. It’s the age-old supply and demand. Io if we can manage that overtime, we’re going to be better off. 

Who you’re going to trust and what do the number say? So we can look at China and trust the numbers somewhat. Now, understanding China is a very different place than the United States. I mean, they have a different form of government. So they were able to lock down that city and put up guards and make people stay in their houses and those kind of things. I don’t think we’re going to get to that point, because I’m not sure we would respond real well to that, and it’s s not our form of government. But with that being said, we have done the social distancing. We have done those things in an effort to flatten the curve. But the numbers would indicate, even with those measures, that we are going to see a significant number of cases. 

This is where we get to the prepare for the worst, hope for the best. I mean, where the worst that – The worst that could happen if you over prepare is good, right? People don’t show up –

[00:37:40] DD: Somebody is going to make fun of you, right? Oh, you were crying wolf and you’re over-prepared. Always better to be over-prepared than underprepared, right? Say what you want about the Chinese. They’ve flattened the curve. They also, I think, probably really understand that as soon as they start to release some of those people from their homes to go do things, they’re going to bloom again. This is the end of it for them. They’ve built a bunch of hospitals and they shoved everybody in their houses and they turned everything off because they needed to manage the capacity until they can get everybody to a vaccine or they can manage a certain level of sickness that doesn’t overwhelm the whole system.

The other thing about supply chain to think about is that a lot of the stuff that we’re using comes from China. The first guys in line or stuff that’s being manufactured in China are the Chinese. They’re going to get it first. They’re doing a really great job of managing this, but you’re right. They’re taking some really harsh draconian measures to get there. I’m with you. I don’t think we would respond to measures like that very well. But we’re going to have to think really hard about how to flatten that curve. 

[00:39:01] BR: We’ve covered a lot of stuff. Let me give you one last thing. In terms of the chain of command, one of the things I’m telling my clients is who is your trust number two? Know who that is, and you might as well move who your trust number three is. To be honest with you, the recovery rate on this is really high in certain age demographics. It may not be that big of a deal – You may not think it’s that big of a deal. But if you’re a CIO physician, as you talked about earlier, and you get draw-in, you’re going to need a trust number two. I don’t think if you’re working, whatever shift you’re working, you’re going to want to work a double shift as a CIO and as a clinician. I just don’t think that’s a good place to be. 

You just have to think through that. Who’s going to step in? How is the team going to respond? Are they ready to respond? One of the things I’m offering my coaching clients and I’m sure you would step in and do the same thing is if you’re number two, it has to be moved into those kinds of roles. They could easily call me, they could call. We’d be more than happy to support those people as they’re trying to figure it out, because if you want to talk about combat by fire, I mean, this is literally it. They would be stepping into a very challenging situation as their first foray into the lead role. We’re there to support you guys. We’ll keep doing it with information. We’ll keep doing it with shows. Keep interviewing CIO. See what the best practices are in getting them out there, and then by all means, they could reach out to you. Very easily to do, and reach out to me as well.

[00:40:40] DD: Yeah. Yeah. Thanks for doing this, Bill. Thanks to Sirius for sponsoring this, right? I think this is a good opportunity for us to chat, and have me back anytime, you have me on. I’m always happy to be here.


[00:40:54] BR: Yes. We’re going to do that, Drex. For the Newsday show, you have a busy schedule, so we’ll continue to drop you in. We’ll tart with once a month. We’ll if we can get it all scheduled, because I think these are great conversations and I appreciate your perspective. 

That’s 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. The show is a production of This Week in Health IT. For more great content, check out the website, or the YouTube channel. If you want to support the show, share with a peer. If you want to communicate with us, send me an email, [email protected] We’ll be back again on Friday with another interview with an industry influencer. Thanks for listening.


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