April 17, 2020

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Field Report — Cedars-Sinai with Darren Dworkin.

Episode 228: Show Notes.

Continuing with our surveying of the field, we welcome Darren Dworkin, CIO of Cedars-Sinai to the show! Darren shares his point of view on the current conditions in LA and his experiences at the hospital amid this health crisis we are all enduring. We talk about public behaviors in the city and how the authorities are preparing for summer, the productivity levels he has noted during this time of remote working and the multitude of new ways that operations are being conducted at the institution currently. Darren shares his excitement about how things have moved so fast in the health sector in face of new hurdles; there has been so much collaboration and innovation in the past couple of weeks, it only goes to show what is possible! We chat about telehealth and how new systems have been put in place at Cedars-Sinai before getting into some of the amazing interactions Darren has had with his group of vendors during this time. We also discuss keeping up with the normal workload under pressure — a challenge for any hospital. So for all of this, and another piece of a hopeful picture, listen in with us!

Key Points From This Episode:

  • The mood in Los Angeles right now and the outward appearance of the streets. 
  • Productivity levels during this ‘work from home’ period. 
  • New ways of doing things; shorter meetings and check-in throughout the day 
  • Surprising expedience and hurdles in the uncertain territory. 
  • New policies and on-the-spot decision making about the new normal. 
  • Cedars-Sinai’s continuing journey with telehealth and preserving PPE. 
  • Darren’s experiences with his core group of vendors during the crisis.
  • Continuing with the normal business of the hospital in this period and preparing for after. 

Tweetables:

“I have never seen LA function in a way that it is currently functioning.” — @DworkinDarren [0:01:32]

“The good news is that the shelter in place and the social distancing really seems to be taking effect and it really does feel like people are listening to the guidelines.” — @DworkinDarren [0:01:50]

“We have really, really tried to get folks to stay where they are, stay in place, work from home and just be where they can be safe.” — @DworkinDarren [0:02:45]

Links Mentioned in Today’s Episode:

Sirius Healthcare

Darren Dworkin 

Darren Dworkin on Twitter

Cedars-Sinai

Zoom

Epic

AT&T

Cisco

Webex

Apple

Salesforce

Dell

Bill Russell Slack Resource Email

Bill Russell Email 

This Week in Health IT Email

Health Lyrics 

VMware

Galen Healthcare

Starbridge Advisors

Pro Talent Advisors

Field Report: Cedars-Sinai with Darren Dworkin CIO

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EPISODE 228

 

[INTRODUCTION]

 

[0:00:04.5] DM: Welcome to This Week in Health IT news where we look at the news which will impact health IT. This is another field report where we talk to leaders in health systems on the front lines. 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.

 

As you know, we’ve been producing a lot of shows over the last three weeks and Sirius Healthcare has stepped up to sponsor and support This Week in Health IT and I want to thank them for giving us the opportunity to capture and share the experience, stories and wisdom of the industry during this crisis. If your system would like to participate in the field report, it’s really easy, just shoot me an email at [email protected]

 

Now, on to today’s show.

 

[INTERVIEW]

 

[0:00:55.2] BR: Today’s conversation is with Darren Dworkin, the CIO for Cedars-Sinai in Los Angeles. Good afternoon Darren, how’s it going? 

 

[0:01:01.2] DD: It’s going great, how are you Bill? It’s interesting times. 

 

[0:01:04.7] BR: It is interesting times. Give us a little context what is going on in LA? What’s going on, what’s the mood, are people congregating yet or is it still shelter in place? 

 

[0:01:16.2] DD: Yeah, you know I think it is becoming more and more of a cliché but I think it is still applies. This is unprecedented times and I think that it would be fair to say that I have never seen anything like this in LA. I am not a native. So I can’t go that far back in history but I have never seen LA function in a way that it is currently functioning, which I assume similar to the way other people observing their localities. 

 

The good news is that the shelter in place and the social distancing really seems to be taking effect and it really does feel like people are listening to the guidelines and following sort of the rules and doing the best they can and I think everybody just triying to adapt in terms of what this “new normal” looks like and feels like. 

 

[0:02:08.2] BR: Is your shelter in place? Are the parks still open or are people generally not on the streets? You are obviously in the office, when you came to the office today were the streets pretty empty? 

 

[0:02:20.3] DD: Well let go just first say because I am in the office that we have strongly encouraged all of our employees to work from home. That was a massive effort in itself and I frankly have the luxury to work from the office because I believe I am the only one of the floor today. And so we have really, really tried to get folks to stay where they are, stay in place, work from home and just be where they can be and be safe. 

 

I think that we really are seeing that, to your question, the parks, they are closed, really just pure essential services and I would say other than a few missteps here and there, most people really do seem to obey it. The part that I think we’re a little bit worried about is as the weather starts to get nicer, you know cabin fever starts to develop and everybody starts to think that well maybe I can go outside a little bit. But we’ll keep our fingers crossed and hope that people will obey the orders. 

 

[0:03:28.6] BR: Yeah, you know I have a series of questions I have been asking. I’m going to steer this one a little bit, talk to me about your work from home experience. So what we anticipated would happen if we were to talk like two years ago, we would anticipated if we pushed everybody to the home, that the productivity levels will go down pretty significantly. What’s been your experience? I would imagine productivity is pretty high at this point. 

 

[0:03:51.3] DD: Yeah, I mean listen you know it’s been unbelievable to sort of watch this forced change take place. So practically overnight we went from maybe 2, 300 people in our workforce working from home on a regular basis to well over 5,000 and you know that’s had its growing pain. So people have had to figure out how to use Zoom and AT&T 

ex I think the word mute might be the most uttered phrases in all mediums these days. 

 

“Am I on mute? Am I off mute?” I’ve gotten to meet employee’s dogs and gotten to understand a little snippet of their homes and see where people live but I think people are adapting and trying to figure out what makes sense. I think I get the most feedback from managers and leaders how hard it is for them to adapt in terms of managing and leading their teams. A lot of folks are just very used to this sort of line of sight and sort of managing literally what is in front of you in terms of tasks or people. 

 

And it’s just been a very different experience to schedule things and work through a world in which we are using the technology. It’s also been interesting to watch folks having to adapt to just sort of certain things that they weren’t used to doing. So we were, as an academic medical center used to long meetings. We have adapted to sort of huddles and check ins and try to have more frequent shorter meetings and that seems to be the thing of the day. 

 

And then people are just working through the barriers. Some of them are just learning curves in terms of how to use the technology others are real things. For me, I find that at home it is difficult to get the right bandwidth just because of the area I’m in and the availability. I also happen to have two teenage kids, they’re doing video schooling and so that’s competing for bandwidth during the day and so it’s things that you should have never otherwise would have thought of, become real issues and problems. 

 

[0:06:03.1] BR: Was there anything from the technology side in terms of standing it up? I mean there is an awful lot of stuff that happened in a very short period of time and when you sort of said, put that many people out of the house, were there things that were not anticipated? 

 

[0:06:20.8] DD: Of course and you know I’ll touch on sort of ‚ so one of the silver linings is and to back up a little bit, I have been in healthcare long enough to sort of watch us go through ebbs and flows of work and one of the things that always amazes me about our teams is when we go to these very large Go-Lives of everybody coming together and how much we get done in such a short period of time. 

 

And I think the analogy to Go-Lives are in crises like this pandemic arrive. And it is really amazing how much people can get done by sheer force of will and can-do and we’re not going to let small things stand in our way. And so, you know projects that ordinarily probably would have taken us months measured in long timelines with lots of check ins, we really put in place over days. 

 

Now some of those things were a little bit tricky. I think that we had to make some early compromises in some of our policies and some cybersecurity things. We have quickly had those catch up and get as many back into place as we can or we are still living in a little bit of a balanced mode between what might be some of the best practices versus what is the most practical. And finding that balance as started to find a little bit of a normalization. 

 

But you know some of those are early things where not everybody has computers, do you let them use home computers, do personal computers now connect to the network? Do you let people take computers from your facility over? Do you deploy new computers? I mean it was just a lot of things that we quickly had to think through and had to keep balancing sort of the imperative and the practical with what we’re important policy decisions. 

 

[0:08:14.9] BR: And I am wondering if somebody is walking around with a little pad and you are going here is our new policy we are going to do this, they just write this down and it becomes like a policy within minutes kind of thing.

 

[0:08:24.9] DD: Yeah and you know I think similar to my Go-Live analogy I think what happens is when you are in these high pressure situations is you rely on people to do the right thing the right way and you hopefully empower people to make the right decisions at the right time and when all of that stuff gets thrown to the pot and you know it is time to execute that’s really what you’re sort of counting on. And I think what you start to do as the dust settles and you start to add a little bit of a normalization is you start to look at, “Okay, how do we start managing the edge scenarios and the things that we’re maybe a little to creative.” 

 

[0:09:07.6] BR: So talk to me about telehealth, you have a lot of specialist, academic medical center, Cedars’ world-renowned but a lot of those things didn’t used to lend themselves to telemedicine but that sort of changed overnight. So talk a little bit about your journey there, journey your couple week long journey I guess it is. 

 

[0:09:26.9] DD: Yeah listen, it was a journey and it is still continue along sort of that timeline. Look, you know I think that the first and most important thing to say is that we’re not at normal, which is sort of probably stating the obvious. For us at Cedars, you know what that meant was a cancellation or posting of just about all elective procedures and surgeries and visits and quite candidly as much as we could. 

 

We were very much in sort of a crisis mode of trying to preserve PPE. Trying to preserve contact, trying to really hunker down and create a small of a circle as was practical. And that’s resulted in a significant amount of cancelled and postponed visits and so our overall ambulatory volume has dropped more than 50% that is sort of the difficult news. What we are going through right now is that the decision making that went into what to postpone or cancel when we thought it was going to be a week or two is very different when you think it is going to be a month or two. 

 

And so we are starting to now re-look at what that means. You know somebody brought up to us yesterday which I sort of heard for the first time made a complete a lot of sense, is that even the word elective surgery or elective procedure, for those of us who are in the bubble of healthcare, we understand what that means. But to patients they don’t use the word elective the way we like to use the word elective and so we’re probably even using the wrong terminology. 

 

In terms of having to slice and dice which things are going to happen now, which things aren’t and we never really had to go through that exercise before and so we are starting to do that on the video side though which is a question you asked, I guess the good news front is that of the 50% drop of what was left, we have half of those still happening in-person because they are critical and important and are very urgent like things that require face to face interaction. 

 

The other half of the half have gone virtual. Some of those are telephone, some of those video and we have been watching that number change when we first moved those things to virtual. We saw big increase use of telephone visits. Again, for probably the various terminology that we are seeing executives are working by telephone first because they are more comfortable and as you try your first couple of video visits and you start to get a little bit more of a feel for it. 

 

We are starting to see those rise and candidly I think we’ve got better at rolling up the tools, maybe some of the very early quick roll outs, they were working but maybe not optimal and so you sort of clean up the edges. We are starting to see that rise, today probably about 25% maybe a little bit more of our ambulatory visits are happening in video or maybe 15, 20% more telephone. And the rest is sort of still happening on an urgent basis in person because it is the nature of what they are. And probably when you dig into those is that they require something that is document patch. 

 

The biggest growth though and probably the most helpful televideo is really been on the in-patient side and so the most spectacular part to me has been watching our teams deploy and watching our clinicians adapt to almost overnight EICU happening throughout the facility and even broader than EICU, offering a video help into our med-surge rooms that are acting as ICU-like. 

 

And that’s really been phenomenal to watch and then alongside that we rolled out an amazing amount of what we call ‘video visitation.’  And so when you think of the true heart break and this really difficult situation of what it means to restrict visitors into an acute hospital, offering back our patients families some way to stay connected has been a big priority as well and so that has had a large use and a large adoption. 

 

[0:14:10.5] BR: Yeah so, you know part of what I ask you is you generally have a core group of vendors that you work with. You are a true believer in not having a million vendors but having a few that is an efficient to run your organization. Talk to me about how you were able to team with your vendors to really move forward. You’re obviously an Epic shop and you have some other vendors. This is again off script and I appreciate you answering this if you can. But just talk about what that experience. What were you looking for from your vendors and how do you interact with them? 

 

[0:14:46.9] DD: Yeah look, I think you know the euphemism that one often and uses is our vendors are our partners and I think that one of the things that an exercise like this or that demonstrates is really who are your partners. And where are they willing to step up and sort of what ways were they going to step up. And I’ll say two things emerged and I don’t want to sound jaded at all by because I think it really was genuine. I think for the most part, we got tons of really sincere legitimate offers of, “Wow, I could only imagine what you are going through. Here is from services we offer. If they can be helpful to you, please take them and let us know if there is an easier way for us to give them to you to consume them in smaller bit size chunks.” 

 

We got a lot of that, a lot of that naturally came from vendors and partners that we have never really interacted with before and I think for us what we found was that scaling existing platforms and existing partner relationships was just easier for us. Given the speed and the scale by which we had to get to. There was a few exceptions, where we took on some new vendors that we hadn’t worked with. But for the most part specially when it came to technology, it just was easier for us to jump in with our partners and I will say a few of them really stood up and if you don’t mind I’m even going to name them but AT&T was one of them. I am sure somewhere in my past I may have said a negative word about AT&T’s service at some point. 

 

But I got to say one of the first things we realized is we needed some agility in our telecommunication lines and how they were configured especially with phone in terms of work and capacity was and AT&T’s only concern was how to help us as quickly as they could and they’ll figure out the contract game and the rules and sort of all of that stuff later. Cisco was another great partner with how they’re working with us with Webex, which was our predominant platform that we use for video conferencing. 

 

Epic of course was wonderful in terms of helping us scale some of our systems. I think about the some of the six and eight and 12 month Epic projects that we had and things that we have deployed in a matter of days, I don’t know. I don’t know if I am going to go back to my clinical colleagues and tell them, “Yes that is a really good idea. I am going to put that on the list, it is a four month project.” People just moved really, really quickly and helped in great ways and then some new partners. 

 

You know we don’t do a lot of business with folks like [inaudible] but they were very helpful to us in terms of getting us some video carts that we needed for some of our tele-ICU applications. Apple was phenomenal in terms of getting us iPads probably on a more priority basis. Sincere calls from folks like the CEO of Salesforce and Dell and others really looking for, “Hey, how could we help in ways that don’t get in the way and help you get to the goals that you have?” And so it was all very, very necessary. 

 

[0:18:17.4] BR: Fantastic, you know I appreciate you giving us a little extra time and you know the last question and again, feel free to defer this one. But I am wondering we’re looking at the numbers it seems like according to the model that we’re all looking at it seems like you’re two days away from your surge and that number is pretty low. You know, how are you guys trying to make that decision of when to transition? Are you going to take a state lead? And this is outside of health IT so if you want to defer that’s fine. I was just curious as a leadership team you have to be wondering when do we start to either move off or continue with this. 

 

[0:18:58.3] DD: Yeah, I won’t even try to jump into guess where things are going and how things will play out, other than to say that I think our general strategy and I am proud to see our organization go through that, is one of “and” and not one of “or”. And so when it comes to what do we do, it’s been focused on trying to be as prepared as we possibly can and doing as many plans in place as necessary. So you know I think it is okay for us to think about the planning of what would it take to ramp up more surgeries and more procedures and caring for more patients. 

 

While at the same time, deeply planning for how would we scale to doubling the number of ICUs we have and taking care of more critical patients as the need or should the need sort of arise. And we’ve told folks it’s okay, you don’t need to feel guilty about praying for and feeling for that day, this is the peak and it is going to get better but you know that can’t be our only play. And you know one of the things that has been really important for us to stay focused on is that we have a lot of patients in our hospital today that are non-COVID. 

 

And you know a lot of very important lifesaving things happen in our hospital that our community depends on us and we have to make sure those services, those essential services are continuing. So there is lots of planning going on in our cancer service lines and in our heart service line and our neuro-service lines run all of those things that the community needs and you know we’ve told people it’s okay. It is okay to plan for those but it’s the business of “and” in addition to that let’s make sure that we really are as really prepared as we could be. 

 

And thus far, you know we think that we are doing the best job that can be done given the circumstances and I would be remise if I didn’t work this in some way, you know as wonderful and as proud as I am to be in the IT teams for all of the enabling technology that they have deployed, watching my friends and colleagues on the frontlines who I have always got an admiration for but now just an unbelievable extra admiration in terms of being able to see what they do and how they are doing it and watching them run through the danger not away from the danger really is spectacular. 

 

And you know I think on the administrative side I probably spend more time than I should on the business side and the planning side and the technology side but you know it is easy to sort of lose what healthcare delivery is all about and watching these folks do what they do is really the mission and really the objective of why Cedars-Sinai exists for the community. So it’s been wonderful to watch them. 

 

[0:22:11.1] BR: Absolutely, Darren thanks again for your time. I really appreciate it and yeah, I look forward to catching up with you a little later and we’ll see how this progresses. 

 

[0:22:21.0] DD: You bet, thank you Bill and thanks for what you are doing. 

 

[END OF INTERVIEW]

 

[0:22:23.7] BR: That is all for this show. 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. If you want to support the fastest growing podcast in the health IT space, the best way to do that is to share with a peer. Send an email, DM whatever you do. You could also follow us on social media, subscribe to our YouTube channel. 

 

There is a lot of different ways you can support us but sharing it with a peer is the best. Please check back often as we would be dropping many more shows until we’ve flattened the curve across the country. Thanks for listening. That is all for now.

 

[END]

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