Envision Healthcare This Week in Health IT
May 14, 2020

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May 14, 2020: Our guest for our Field Report episode is Kristin Darby, Enterprise CIO for Envision Healthcare. We sit down with Kristin to talk about Envision Healthcare, the impact that COVID-19 has had for them, and how they have responded. Technology, especially telehealth services, have been extremely important to a data-driven organization like Envision, as has collaboration with members of the healthcare industry. In this episode, we discuss how Envision addresses their platforms and architecture in order to respond quickly to a rapidly evolving set of use cases, and Kristin gives us some example of specific use cases they have encountered and how Envision has scaled their telehealth systems to respond to unmet needs. We close the episode with a discussion about unique versus out-of-the-box solutions and how the tools Envision has developed are useful not only in acute settings, but in office practices, post-acute, and urgent care centers too. Don’t miss this Field Episode with Kristin Darby!

Key Points From This Episode:

  • Kristin tells listeners about Envision Healthcare.
  • The impact of the COVID-19 pandemic on Envision Healthcare and how they responded.
  • The importance of telemedicine and collaboration for Envision during COVID-19.
  • How Envision addresses their platforms and architecture in order to respond quickly.
  • How Envision scaled their telehealth services and the particular use cases they encountered.
  • The importances of easy-to-use technology for all providers.
  • Kristin gives some examples of the use cases and evolutions of the tech they encountered.
  • How Envision acquires and develops their technology solutions based on evolving need.

Field Report: Envision Healthcare

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Field Report: Envision Healthcare

Episode 248: Transcript – May 14, 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.

[0:00:04.8] BR: Welcome to This Week in Health 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 podcast, videos and collaboration events, dedicated to developing the next generation of health leaders.

Have you missed our live show? It is only available on our YouTube channel. What a fantastic conversation we had with Drex DeFord, David Muntz, Sue Schade, around what’s next in health IT. You can view it on our website with our new menu item, appropriately named Live. Or just jump over to the YouTube channel. While you’re at it, you might as well subscribe to our YouTube channel and click on get notifications to get access to a bunch of content only available on our YouTube channel. Live will be a new monthly feature only available on YouTube. How many times did I say YouTube in that paragraph? Subscribe to YouTube. We have some great stuff over there.

This episode and every episode since we started the COVID-19 series has 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.

[0:01:13.8] BR: All right. Today’s conversation is with Kristin Darby, Enterprise Chief Information Officer for Envision Healthcare. Good afternoon, Kristin. Welcome to the show.

[0:01:23.7] KD: Good afternoon, Bill. Thank you for having me.

[0:01:26.1] BR: Well, I look forward to the conversation. Yeah, and thanks for taking the time. I know this is really a busy time for you guys. Tell us and tell the audience a little bit about Envision Healthcare.

[0:01:39.0] KD: Envision Healthcare is a national medical group. We have 27,000 clinicians that deliver approximately 35 million annual patient encounters. Our clinical services are provided at approximately 1250 locations across over 40 states. Our medical group specialty expertise includes emergency medicine, anesthesia, radiology, women’s and children, and surgery. AMSURG is our ambulatory surgery division, where we manage over 260 centers. For patients receiving care at home, Evolution Health provides patient-centered care for home health, infusion therapy, and also provide hospice services.

[0:02:27.1] BR: The impact of the pandemic was probably pretty significant. Give us some idea of what you guys experienced during the pandemic.

[0:02:36.9] KD: Well, we recognized early that technology helps relieve the COVID-19 strain, and it protects clinicians, which is critically important to us in addition to protecting patients. As a result, we quickly mobilized our efforts to deploy telemedicine. I think some of the other observations just about the pandemic in general, collaboration has really been unprecedented. Everyone’s recognized it’s a public health crisis and the speed of execution is at an all-time high, which has really been required in this dynamic situation that has been changing on a daily basis.

One area specifically that I’ve been really, really pleased with is the expeditious data sharing and really just the collaborative effort that has enabled us to develop a very robust, community-based bio-surveillance system that we’re augmenting with community-based information and then the information we’re seeing with patients that are presenting on the threat lines during this crisis. Envision is very much a data-driven organization, so that’s really been critical for us to have the information, to be able to respond to most successfully on behalf of our hospital partners, the clinicians, and then also helping us just, things like, prioritize resources and understanding where we need to be focused to respond to that in that geographic area, etc.

[0:04:03.4] BR: Yeah, so it’s interesting you bring up well, two things I’d love to talk about. You talked about bio-surveillance. You talk about a data-driven organization. There’s no doubt at this point that IT plays a significant role in business agility and ability, political ability as well. You guys had to react or respond pretty quickly. Give us an idea of how you guys think about the platforms and the architecture in order to give you the ability to respond.

[0:04:35.2] KD: Yeah. I think when this was evolving, nobody knew what to expect, right? Since we’re all still learning very much. I think just a bias for me has always been, I prefer open architectures, I believe very much in interoperability. I think our technology portfolio is reflective of that. When we started this, we had assumptions as to needs that we were going to have. What we tried to do is understanding that there could be side chain disruption, or there could be other types of challenges that occur.

What we did is each of those assumptions, we tried to have two to three different ways of addressing it. We knew some would fall. What we didn’t want to do is be standing there and have to tell our clinicians, or any of our operating units that we couldn’t deliver in times that they needed us most. As we did that, certainly we did have things fall out. I think some of the things that really came through is some of the more robust, just platforms that we had were scalable. They were able to perform.

Luckily, we have an incredibly skilled engineering and software development team. Quite frankly, most of what we’ve done, we’ve built and we built it in an incredibly rapid turnaround time. It’s not things that I think, with the evolving use cases that have occurred, and a lot of this is really been in the virtual health area, so as we had a remote workforce change that occurred. Then there’s been the frontline work of really supporting the clinicians and the patients that are serving around the clinical needs that have evolved.

With both of those, but more on the telemedicine side, it’s really required those advanced technical skill sets and also the deep knowledge from a clinical informatics perspective and just awareness of how a hospital operates, how a lot of practice operates, and what is the right technology to address and meet the needs most effectively? Based on the situations that were involving, predominantly in the surge areas. But we’re certainly, for example, telemedicine, we have distributed in 11 states right now. The surge areas were where most of our sense of learning was occurring at a very rapid pace.

[0:07:05.0] BR: Let’s talk about telehealth, because that’s – given the nature of Envision Healthcare, you guys really rely pretty heavily on telehealth, remote monitoring, and those kinds of things coming into in this, or as a result of this. I really want to get pragmatic here, because a lot of systems have come on and said, “Hey, we scaled from this to this and that’s really neat,” but how have we scaled? How have we experienced it from a clinician side and how have we experienced it from a patient side? Because really, that’s the direction I want to take you. First, let’s talk about how you guys scaled it. Did you have a national platform that you just you called them up said, “Hey, give me another 10 licenses,” or did you guys – was it more sophisticated?

[0:07:51.1] KD: As I said, in each of those assumptions, and one is that telemedicine was going to be needed. I think there was a lot of discussions around that in February, but was it the traditional urgent care type call, or was it an office space call? In an acute setting, I’ve had many telemedicine programs over the years, but it was things like tele-ICU, or just very particular use cases. In this situation, we didn’t know what to expect.

We did go down the avenue of some of the telemedicine platforms that you could purchase, and they were dealing with a surge also of demands. It quickly became clear that the use cases we were being asked for would have been built pre-COVID, just for out-of-the-box solutions. The timeframe to get anything addressed was just not going to be there. If we really wanted to meet the needs of our clinicians and I will tell you that the four drivers that became really, really clear, was initially – was PPE, which the personal protective equipment. We’ve all heard on the news that in the areas that were surging, the limitation of PPE was really a number one factor.

How can we use technology to help reduce the need for PPE? Or somebody who was doing something minor that maybe didn’t require physical contact, but maybe it’s looking at a monitor, right? Do they really need to get fully dressed in PPE to be able to see what the monitor sets? Just to enter a room. Just real simple needs, that really aren’t hard technically, but equipment has to be there, that wasn’t there for that purpose. The second was alleviating just half of the strain in the hospitals, the third was pre-screening patients that were suspected COVID.

Lots of discussions initially about tents, which is we started designing for that. Then front of emergency medicine entrances to pre-screen. I would say the front entrances took off. We absolutely had some times we were supporting. Initially if you ask me, I would have thought we’d have hundreds of that. That didn’t necessarily emerge to the scale that we expected. What did emerge is the need for specialized treatment samples at a scale that wasn’t anticipated initially. Emergency medicine, the need to be able to see the patients, because COVID-19 is something new and everybody’s learning across all disciplines.

The more that they can see and interact with the patient, the better guidance they’re able to provide. The more that they’re able to talk to the other providers, especially critical care areas and other areas we were doing a lot of specialty consults.

A lot of our initial designs were around those concepts. When we talk about provider adoption, I think there was a lot of discussions about it in week one, two, how would we use it, what’s the perfect workflow? Then the surge just started hitting some of the areas. The absolute necessity for it became very clear. A lot of those other anticipated challenges were overcome very, very quickly, because the need was clear. All providers, we had a few that really, really embraced it from day one, just tech savvy. We knew when we were designing this, it had to be easy and it couldn’t be complicated.

Some of the challenges we had was the staff was evolving, right? If you think of the surge area, you might be redeploying people from other facilities, maybe potentially hasn’t gone through yet, maybe user accounts are in provision. You have experience with this. It usually takes a little bit of time, right? All those processes with every location, weren’t necessarily tuned to respond to 10-minute requests, right?

We were trying to figure out how do we sit in there and make sure that this continues to be secure? Which, throughout this process, we’ve never compromised on any of the security standards, or different requirements. Those are absolutely critical to us and we feel it’s a responsibility to our patients and in the health systems that that we serve the patients on behalf. As we were designing that, some of the – I’ll give you a couple examples of just some of the use cases that appeared that I certainly wouldn’t have anticipated that initially. We had a mother that was in I believe, late 50s, 60s, admitted, adult children brought her to the hospital, not in good condition. They had relieved her at the emergency department.

During the crisis, the visitation is suspended for family and friends. Mother admitted almost immediately in very critical condition, ended up being intubated. Normally in a situation like this, a physician is talking to a patient, but also their family is surrounding them, about these are the options you have available to you. These are the courses up here we could take. There’s an exchange of pros and cons.

Without the family there, these doctors were having these sessions with patients that weren’t necessarily prepared to be making those types of decisions, right? It’s difficult decisions and they may not have been able to. What we were called about is, how do we get a patient, us, the providers which might have been more than one and family altogether, where the family could see the patient? We can have a discussion about this. We ended up designing a multi-point secure video conferencing solution. Initially, it was for those meetings, right? Discussions about how to make critical decisions around patient care needs.

Then it evolved to when the physician said, “Why disconnect the call? The family still wants to be connected and watch the patient, right? Or their family member stay with them and support them and make sure they know they’re safe. They can’t be there physically to hold their hands, so why not be on video right there with them?” Absolutely makes sense. Don’t hang the connection up, right? It’s a secure connection.

Those types of things, just replacing would so just critical from a human perspective really was important for us. Another one that – the doctor came up with this, I just don’t know that I would have envisioned this – is we had a critical care patient that was in the ICU, but was conscious, awake and intubated. There’s a very advanced bed, called our robo-prone bed, that is often used for patients that have acute pulmonary complications. This patient, COVID-positive, but having complications with the lung, that they felt that the bed, which puts you in a prone position, which is basically upside down. It’s the best course of action.

If you just think about being scared that you’re COVID-19 positive, right? A patient, and this is a few weeks ago, still not a let know, right? Lots of uncertainty. You’re awake. You know you’ve been intubated. Now you’re in a bed upside-down looking at the floor. Between the bed and the floor, there’s about this much room. The challenges, he said to me on the phone, “How am I going to get a nurse down to talk to the patient?” Even if they laid on the floor in a pro-bender, they’re not going to be able to give those personal updates that are so critical just to be able to say, “We’re here for you.” This is the status. This is what we’re seeing. This is the path to recovery and this is where you are on it.

What they did is they used the solutions that put a tablet under the patient. They were able to come on and say, “We’re here. You’re doing good. Everything looks good, right? Checking in on you. You’re not alone, right?” Those are things that are so incredibly valuable for a patient trying to get through what is probably the most vulnerable point in their life. In addition to that, just the fact that technology can help with that. I would have never anticipated that use case if you’d asked me that two weeks earlier.

[0:16:41.9] BR: Well, I appreciate you sharing those stories, because my father-in-law went into the hospital, probably about three or four weeks ago, and we couldn’t be there with him. He’s been in the hospital a couple times. Most of the time, the doctor or physician ends up talking to us about him. I mean, he’s involved in the conversation with us. I can see that as a really – a real need for, I don’t know, just the whole care experience and everyone feeling comfortable. The last thing, because I’ve taken up a fair amount of your time. The thing I – you seem to be an organization that leans more on creating your own solutions as opposed to relying on out-of-the-box. Is that accurate? Then how has that played out through this pandemic?

[0:17:32.1] KD: Yeah. I would say that we probably – the majority of what we purchased, we would always lean toward bias preference, unless there’s specific reason around some types of proprietary activity we’re doing, or something that is a differentiator that we’re developing. Otherwise, we would always look to buy, especially if something is commodity-based. I think what drove us from a development perspective here was clearly time to response, based on the evolving need. The inability to have the purchase option, that was able to respond in the way our clinicians really needed. It’s a response to be able to meet these unmet needs.

If we gave them a traditional structured station, or cart, or just these things that were created for other types of use cases, we wouldn’t have been able to have the flexibility that we’ve been able to have, and truly benefit not only our helpful system partners, but most importantly the patients and their families that are going through this crisis.

We certainly have described an acute setting, but we’ve been using this in our office practices, also the post-acute and urgent care centers. It’s really been valuable tools to help us navigate this crisis.

[0:18:51.2] BR: Fantastic. Well, I really appreciate you sharing. The thing that really has come through is responding to the needs of the clinicians; listening to them, hearing what their needs are, determining build versus buy and then moving forward with the right solution to be there. That’s what really come through. Kristin, thanks a lot for your time. I really appreciate it.

[0:19:14.5] KD: Thank you. I appreciate it.

[0:19:16.4] BR: That’s all for this week. Special thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics, Sirius healthcare and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders.

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Thanks for listening. That’s all for now.

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