Field Report: Arizona Surge Line in Service of Public Health

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Bill Russell / Angie Franks

Arizona Surge Line This Week in Health IT

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May 27, 2020: One of the stand-out public health issues that the COVID-19 pandemic has revealed is the lack of integration and communication between disparate health systems within states. This has meant that some hospitals have been overwhelmed and under-resourced, while others nearby have had the necessary capacity. The Arizona Surge Line is one of the most innovative public health service coordination efforts we’ve seen, and Charlie Larsen, RN Senior Director at Banner Health in Phoenix, and Angie Franks, Central Logic CEO, join us to discuss this inventive use of technology. We kick off the episode by diving into the genesis of the problem that needed to be solved. From there, we turn our attention to how Arizona has leveraged its HIE information and used it in conjunction with Central Logic’s technology to gain insights into the spread of resources. We round the show off by discussing the importance of interoperability both in the crisis and for the future of public health. Tune in today!

Key Points From This Episode:

  • Find out more about Central Logic and Banner Health’s working relationship.
  • The genesis of the problem Central Logic and Banner Health have tried to solve.
  • Some challenges with integrating a variety of health systems across Arizona.
  • How ADT feeds help with gauging bed and ventilator visibility across the state.
  • Learn how Central Logic’s technology has helped facilitate decision-making.
  • Insights into how the surge line works and how providers access information through it.
  • How the conservation around interoperability in Arizona went. 

Field Report: Arizona Surge Line in Service of Public Health

Episode 256: Transcript – May 27, 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.

[0:00:04.5] BR: Welcome to This Week in Health IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare CIO coach and creator of This Week in Health IT a set of podcasts, videos and collaboration events dedicated to developing the next generation of health leaders.

Well, we have a live episode this week, Friday from 11 to 12 Eastern time, we’re going to talk about funding telehealth’s future with a great panel and your questions. Mari Savickis, CHIME Public Policies going to really spearhead the conversation. We have Praveen Chopra, CIO for George Washington University. Dr. Stephanie Lahr, CIO, CMIO for Monument Health and Albert Oriol, the CIO for Rady Children’s in San Diego as rounding out the panel. I’m really looking forward to this, I think it’s going to be a phenomenal conversation.

If you’re wondering what the future of telehealth funding’s going to be, you’re going to want to tune in to this and interact with your panel. Mark it on your calendar, invite a friend, let’s make it a party. This Friday, 11 to 12. 

This episode and every episode since we started the COVID-19 series have been sponsored by Sirius Healthcare. They reached out to me to see how we might partner during this time and that is how we’ve been able to support producing daily shows. Special thanks to Sirius for supporting the show’s efforts during the crisis. Now, on to today’s show. 

[0:01:22.6] BR: This morning we’re joined by Charlie Larsen, the RN Senior Director at Banner Health in Phoenix, Arizona where he oversees Banner’s access center operations. In addition, he is currently serving in a temporary role as RN Program Director for the Arizona Department of Health Services COVID-19 emergency response team. And Angie Franks, the president and CEO of Central Logic, an industry innovator in enterprises ability and tools to accelerate access to care. 

Wow, those are big introductions. Good morning you guys. Welcome to the show.

[0:01:53.8] AF: Great, thanks for having us.

[0:01:56.8] BR: Yeah, I’m looking forward to the conversation. You guys have been busy and I think it’s for good reason. I think it’s a really interesting solution. Arizona surge line is what we’re going to be talking about and it provides transparency across the state of Arizona for constrained resources during the pandemic. I’m just going to throw the questions, you guys determine who is best able to answer it. But I’m just going to start with the beginning. What’s the genesis of the solution?

[0:02:26.2] AF: Well, I’ll go ahead and start and then Charlie, go ahead if you want to jump in. The genesis overall for Central Logic of our solution, we have been in business for over 10 years working with health systems and helping orchestrate care, getting patients to the right location for the care that they need in the most timely and efficient manner possible. Typically, these have been patients with high acute conditions.

That is all about making sure that they get that care and generate much better clinical outcomes. Banner Health has been a client of ours for a number of years. Going on two years now and have been doing some really innovative work with Central Logic and I would say that was the genesis of how we got started with this project in the state of Arizona and Charlie is certainly the right person to describe what that’s all about. So, Charlie, I’ll let you give an overview.

[0:03:28.9] AF: Sure, thank you. Yeah, as Angie mentioned, Banner Health has been a client of Central Logic now for going on two years. And have had a lot of success with it. But you know, as this COVID pandemic has started to spread or has been spreading, the Department of Health Services here in Arizona reached out to some of those places that we hit earlier and reached out and just try to find out what do they wish they had done differently, what’s going well. Because in Arizona, we’ve been a little bit lagging. Not lagging but we weren’t experiencing the surge at the same time as some of the other places were. We were much more in preparation mode. 

One of the things that we heard was, you never know where these pockets of COVID-19 outbreaks are going to pop up. And depending on where they are, the hospitals in that area are being the closest hospitals and can get overwhelmed very quickly as they saw in New York.

What they told us was, we’d have some hospitals who are bursting at the seams and need ventilators, need capacity, need nurses and we have other hospitals at capacity and everything kind of waiting permissions. What they had wished that they had done is exactly what we have active was something to load balance these patients that they’re being transferred around the states. We worked to get them across the different organizations across the different hospitals so that no one hospital gets overwhelmed, while again, another one has the resources available so that they can get the quick access to care.

Partnering with Central Logic, we’ve been able to do that successfully with all the visibility and the integration and protocols and procedures to make those successful very quickly.

[0:05:05.9] BR: Wow, all right. I’m going to go straight to the questions I think a CIO for health system would ask. Obviously, Banner, I think is the largest in Arizona. But you have Dignity which is now CommonSpirit, you have so many great health systems on there,but you have a lot of small players as well, you have HonorHealth and some others. You’re going to have to integrate all of those in order for them to communicate at a state level.

What does that look like? How do you stand that up?

[0:05:40.8] CL: Yeah, that’s right, there are quite a few kind of what we would miniature health systems in the Phoenix Metro and Tucson Metro area. And what we found that we needed to be able to see and integrate and work together on the most with the bed visibility, we need to know who has beds, when and where. And with that, you know we need ventilators, who has the staff and those kinds of things.

And so, a big win for us was that our, and what made us successful earlier was that our state Health Information Exchange, Health Current, already had ADT interfaces with 95% of the state. And so, with Banner Health, we have a specific integration with Central Logic for our own bed visibility. But the HIE allowed us to do is to have Central Logic interface with HIE to get the information in and translate into the language that we needed to go to see the beds. 

So, it was very quick turn on I guess to be able to see the beds across the state and you know, it’s just not really a flip of a switch for everyone at once. So, we started with the bigger systems and then just keep on plugging away until we get everybody’s bed visibility. 

[0:06:54.4] BR: So, it is basically just ADT feeds? Is that what you are picking up from the EHR and from the HIE? 

[0:07:01.5] CL: That is really the basis of it because the ADT’s they have the information in there that has you know all of the beds mapped and so where at the beds located, what kinds of services, is it an ICU bed is it not. And then are there patients in it? So, with the ADT being sent Central Logic and Health Current has partnered to work together with each system transfer set for each system you know subject matter experts to on the backend of the map. 

So, if it is the 4th floor, in room 412, what is that bed? That bed is an ICU bed and so we map all of our Central Logic has mapped all of those beds across the state with the system. And then the ADT feed can tell us if a patient is in that bed or not. That is really the basis of it. And then we get into the ventilators and the reporting of those and those kind of things to know, really found out our visibility across everything. 

[0:07:51.4] BR: Yeah, so Angie, I mean the natural next question is if the HIE has a lot of this information, what is Central Logic’s role in that point besides being an aggregator for the rest of it, I assume there is some reporting, there is some visibility, some dashboards and whatnot that you guys provide out of the box? 

[0:08:11.5] AF: Right, yeah so well the HIE made it easier, obviously, to have all of that data pulled together in one spot. But the technology that we have built and designed is really what I would say is a key part of the secret sauce. It allows the health system or in this case the state and the call center at the state level to have a master bed board and to have the visibility to all of those critical care beds and staff, the resources, the physicians and then ventilators. 

So that when the calls come in the decisions that need to get made as to where is the best place for this patient to go, that agent has visibility to who has capacity, who doesn’t, who is moving into a state where they have got maybe pending demand that is going to put them into a status where we don’t want to route more patients to this facility. We want to leverage other resources in the states to move those patients and if you look at places like – 

You know in Banner’s case and in the state of Arizona’s case, they had some time to prepare for this. They saw what was happening in other parts of the country. It may be that the folks in New York City and the state of New York did not have that time to prepare but if you look at some of the things that happened, I know there is a story a week ago on the New York Times about you have these health systems in New York City and 15 minutes away, there is 3,000 beds across multiple other health systems being unused because they lacked the ability to understand and know at a coordinated state or regional level who had capacity and who didn’t and make those decisions in a centralized fashion that is what we’re bringing to the table. 

So, we bring the tools and the technology to facilitate that decision making. The HIE provided us a much easier and faster way to get access to that data. Without an HIE, we would just pull that ADT data from each individual system. 

[0:10:26.2] BR: Right, you can do it. It is just a work that is going to be done at each IT department. You know there is going to be a significant amount of work done in public health following this pandemic whenever it does run its course and it is these kinds of solution, so from a public health standpoint, it really had to be driven by the state of Arizona and I could imagine, they have a dashboard of that level.

But how does the provider sort of interact with that data? Do they go to the state and say, “Hey, where is their capacity?” Or do they have visibility down at that health system or even at the hospital level of how to direct patients in the case of a surge? 

[0:11:10.4] CL: Yeah, totally. The way that we build the surge line is the technology of course, and as we talked about what the bed visibility and then the reporting and everything that comes with that. But what it also is, is that it’s a center of agent that take these phone calls. So, we have all of these tools in our fingertips at the surge line. The referring hospitals maybe in rural Arizona, they don’t look at the bed visibilities, the ventilator visibilities. 

They pick up the phone and they call the toll-free phone number and essentially with that call, they are calling every health system in the state. And so, they are calling the surge lines. The surge line will then – we have an algorithm of different things that we look at. We look at the critical nature of the patient who has the related bed, market share and who’s got the most beds in the state. 

We want to make sure that at this the point health system has 10% of the total beds and another health system has 50% of the total beds, we don’t just want to divvy them up one for one. We want to make sure that we are following bed. So, we look at that. We look at what our last few transfers, you know where have they gone, so that we don’t inadvertently send you know five or six patients, throwing system back to back. So that they have the time to bed and come and catch their breath a little bit before we come again. 

So, they look at all of these things. And this transfer center, this surge line kind of sit on top of the other surge line, of the other transfer centers. So, we don’t want to impede on their process flows. We just, at the Arizona state level, we decide which health system it’s going to. We hand the case off to that transfer center and then they connect the physicians and follow their normal processes to give the patient in place. Does that make sense? 

[0:12:53.5] BR: Yeah, that makes sense. You know I am sitting here thinking, “Okay, if I were in charge of this in New York City or Pennsylvania or wherever and we brought a task force together and they said, ‘All right, here is what we are going to do,’” you know I already sort of said, you know how the conversation is going to go. I can see people going, “Well, we have HIE’s across the state. We just pull that information in to make it look nice.” 

Then I can see people saying, “Well, you know most of our health systems are on Epic so you know, can’t Epic just provide?” I mean I would imagine the conversation in Arizona probably went down that path as well. So, like, “We could do this, we could do this, we could do this.” But the reason you can’t, I would assume the reason you can’t do that is because of it is not Epic across the entire state. Everything is not as integrated into an HIE as we would like. 

So, it does require some sort of intermediary layer to aggregate and to function. Is that – am I accurate in that assessment of how the conversation went? 

[0:13:57.2] CL: Yeah, I will let Angie talk a little bit about the interoperability of the platform. But what it does, the platform and why it’s necessary is it provides a whole charting documentation platform for our surge line agents. And so, they will document the demographics of the patients, where they are coming from, are they COVID presumed or are they COVID positive? 

You know all of those types of things and with that, we pull all sorts of reports, all sorts of epidemiological reports that will help us understand, you know now Navajo Nation right now is one of the highest rates of coronavirus per capital in the United States, right there with New York and New Jersey. And so, we are getting a lot of patients from Northeastern Arizona from Navajo Nation. And so, that helps us understand how many patients are coming from that area at any given time, what are the trends that we can look back and surge lines stood up. 

And we can look at all of those details that the transfer center charts. And that is agnostic of what health system EHR is being used at the local levels. 

[0:15:08.9] AF: Yeah and I will just chime in. Bill, you are spot on that the interoperability is the key here and it doesn’t even matter if you are on the same EMR. Many times, across even within the health system, but certainly across the state, even if you are running the same EMR, you all are running Epic, you are on different versions of Epic. You have different configurations of Epic and it doesn’t add that most systems do not interoperate well. 

Our technology is truly Switzerland. We integrate not only with the EMR’s and the ADT systems but we integrate and interoperate with many other systems to facilitate the decision-making process and navigation process of getting creations to the right care. 

So, I think you also have to look at something that is very purpose-built for taking in information, rapidly gathering the right clinical data, following protocols, time stamping and documenting and then facilitating the decision and then getting the transportation, ordering the logistics and getting the patient to where they need to be. And it is just vastly different from what an EMR is designed to do. 

[0:16:23.7] BR: All right, so this is what Arizona is doing, any word on what other states are doing at this point? I am throwing you a curve ball. I haven’t heard of anything like this yet.

[0:16:38.8] CL: You know I have heard of rumblings of New Mexico doing something similar, but I haven’t heard of anything you know to this extent. 

[0:16:47.7] AF: Yeah. So, what I’ve heard and what I have seen is states right now, I think there is a call, a conference call with governors and state task forces that are happening on a weekly or a bi-weekly basis. They’re all looking at or attempting to do or thinking about how they’re going to put in place the infrastructure to handle surge and demand in the future, but I haven’t seen anything to the extent of what the state of Arizona has done. 

We have heard that the state of Nebraska tapped one of the CHI systems and it is another Central Logic client where they are facilitating a similar type of surge demand kind of a centralized function but it is being routed through that health system for decision making is my understanding but I have not, we have not seen any other states go quite to the level and the vision that Arizona has implemented against. 

[0:17:52.6] BR: You know it is interesting, we need data to make decisions and I see all across the board you guys are talking on a state level but even on a national level and I see even the military is moving those ships around. You know they are moving in to New York Harbor then they moved in the West Coast. I mean there is so many people that could use – I mean this pandemic may not have hit the surge numbers that people anticipated early on. 

So those ships were not used in the field hospitals were but to have that even on a national level, you realize they are so many pieces being moved around based on data that’s being cobbled together or is not complete. This would be an interesting part, one of the first public health programs that should be put in place at almost nationally so that we could make decisions in the future pandemics. 

[0:18:42.6] AF: I think it is absolutely essential that there is a technical infrastructure to support this type of logistics. And this patient navigation and logistics in the case of any surge and that could be a mast shooting, it could be a hurricane, it could be an earthquake, the next pandemic or bad flu outbreak. It is really, in my opinion, fundamental to good public health that we have the ability to integrate, communicate, orchestrate care and turn that on, on a dime when the conditions demand it.

[0:19:22.0] BR: Absolutely. Well, I want to thank you guys for the work that you are doing in Arizona. I love following your governor, I follow him LinkedIn and see some of the posts and great work being down there in Arizona. And the work you guys are doing is excellent. And I am glad we are able to share that with the community, with our community and get that word out there. So, thanks for everything you guys are doing. 

[0:19:45.2] AF: Thanks for having us on, Bill. It was good to talk with you today. 

[0:19:48.7] CL: Yeah, thanks for the time. 

[0:19:49.6] BR: I appreciate it. 

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