Hospital for Special Surgery COVID-19 This Week in Health IT
April 9, 2020

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April 10, 2020: We continue our field reports today with Jamie Nelson who shares news about the situation on the ground at the Hospital for Special Surgery where she is CIO. The team there has had to rapidly change their facilities from orthopedic to general as a way of assisting the different New York Presbyterian campuses with the influx of COVID-19 patients. Jamie gives us insights into what this shift has entailed, speaking about capacity ratios, workload, IT innovations, communications, implementation speed, and which changes she hopes to see continue into the new normal. We hear about the amazing growth in telehealth, the implementation of a coding system in patients’ EPIC charts, and the role of reimbursement and commercial versus Medicaid systems in ensuring their continuation. Jamie talks about the organizational prowess of her teams, the rapid pace at which they have changed gears, and how fluid staff integrations and communication between health systems have been. This process has not been without hiccups though, and Jamie gives a few insights into the challenges that still stand in the way of speeding things up even more. Following that, our guest gives a few recommendations for teams in other parts of the country hoping to prepare themselves for a situation like the one in New York, and she strongly recommends they find a way of fluidly adapting to an ever-changing situation. Listen along and share in the insights Jamie Nelson brings today.

Key Points From This Episode:

  • Innovations at the hospital in the days while Jamie was working on its premises.
  • Discontinuing the 90% non-essential orthopedic surgeries to make space for COVID patients.
  • Quickly changing the facility from orthopedic to general.
  • Getting a sense of how much work went into adjusting the hospital.
  • How rapidly the team encoded a color coding system to view patients’ status into EPIC charts.
  • Estimations of which systems implemented now will continue into the new normal.
  • The many multiples of itself in growth that telehealth has seen and its benefits.
  • Reimbursement that needs to remain in order for telehealth to keep going post COVID.
  • The relationship between the medical and commercial spheres in funding Telehealth.
  • Space which is still being made to operate on the most serious orthopedic cases.
  • Challenges in communicating quickly with physicians and nursing leadership.
  • Governance in communications between the different hospital systems in NYC.
  • Quickly integrating staff between different campuses the hospital is supporting.
  • Ways to prepare for an oncoming crisis; being fluid enough to handle unexpected changes.

Field Report: Hospital for Special Surgery in NYC

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Field Report: Hospital for Special Surgery in NYC

Episode 223: Transcript – April 10, 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 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 podcasts, 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.

 

[0:00:55.7] BR: All right, today’s conversation is with Jamie Nelson, the CIO for Hospital for Special Surgery. A conversation I’m looking forward to having. Good afternoon Jamie and welcome to the show.

 

[0:01:04.9] JN: Bill, how are you?

 

[0:01:07.3] BR: I’m doing well. How are you doing I guess is the question?

 

[0:01:09.8] JN: I say as long as I stay clear of the virus, I’m great. 

 

[0:01:15.2] BR: Yeah, you’re working out of your home. But we were talking earlier that you have been in the hospital 

 

[0:01:19.7] JN: Yeah, I mean, yesterday afternoon I was up on the units with the team. You know, rolling carts into the ICUs to allow nurses to have some sort of visualization into the patient rooms so when they come out. So, we came up with an ingenious way to do that so I have been at the hospital for many days now. Today was my first day of doing remote work.

 

[0:01:44.6] BR: This is going to be a n interesting conversation because a lot of people are familiar with Hospital for Special Surgery. But for those who aren’t, give us some context which will help people to understand how you guys have had to turn on a dime and really change everything.

 

[0:02:01.9] JN: Until about two weeks ago, three weeks ago, we were an almost two-billion-dollar orthopedic specialty hospital in New York City on the Upper East Side. Next door to New York Presbyterian Cornel campus but not formally affiliated with. Two completely independent hospitals. Although huge clinical affiliation. We treated our number one orthopedic hospital in that world I would say we would have 35,000 orthopedic surgeries a year.

 

This is our normal thing and we had a great year. We’re doing very, very well. A lot of growth, looking at digital, all the normal things. And then on, I think March 15th or so, made the decision that with the COVID  crisis mounting in New York City that number one, clogging up the system with nonessential orthopedic surgery was not in the public health’s best interest. Number one.

 

Number two, if we could empty those patients out of our hospital and not treat them, it would allow us to take patients from other hospitals, mainly New York Presbyterian, to allow them to take COVID  patients.

 

Our idea was stop our surgeries which is non-essential surgeries, it’s 90% of our business. The initial idea was to stop those surgeries, take in critical care, very sick patients, from New York Presbyterian, non-COVID, so they could take care of the patients. That lasted I don’t know, a day or two? Because we quickly understood that there was no patients coming into New York City Hospital that were not COVID -positive. I’m exaggerating a little bit, But truly, the hospital,  Cornell did not have non-COVID  patients so they really needed us to help with their COVID  patients.

 

So, we very quickly changed our whole in-patient from being an orthopedic surgery hospital to being a general medical surgical hospital that is taking trauma orthopedic. We now take EMS patients which we never have in the past but like – We are taking patients directly or from New York Presbyterian who are COVID-positive and need critical care. So, need ventilators. They come with DNR orders. These are not healthy patients. These are very sick patients.

 

[0:04:25.8] BR: I mean, the questions – I have about 75 questions. I’m going to narrow it down.  It’s This Week in Health IT, clearly, I could ask a lot of questions around the situation in New York. But I don’t want to be insensitive to that but I do want to focus on our topic. And there’s this question – If you’re doing that, the build in the EHR is pretty significant. You know, you’re implementing all new workflows and what not. Can you give us some idea of how you triaged and managed all those builds and all that work?

 

[0:04:58.0] JN: Well I’ll tell you. We just looked at the amount of hours that our staff have put on COVID  projects in the month of March and it’s 6,000 hours. We only have 180 people in our IT department. You know, we’re a two-billion-dollar organization with a fairly slim IT function. That’s an amazing amount of hours.

 

And I will tell you what we learned is to be agile and flexible. and a lot of the old processes are gone. For instance, I was in the hospital this past Sunday, doing rounds and one of our lead physicians looked at me and said, “Jamie, we need an Epic to have COVID- positive, pending and negative coded in the EHR. So, if we see red, we know what that means, yellow, we know what that means, green, we know what that means.”

 

That’s a Sunday afternoon. Monday afternoon, that was gone through our Epic team, gone through our clinical content board. You know, all the necessary – Within 24 hours, those changes were in. Normally, my CMIO said that would take two, three weeks. 

 

So, when I think about – I think that’s just an excellent example of the rapid speed that we’re working at because these truly are life and death things that we’re doing. Again, not something we’re used to in an orthopedic hospital. Certainly, our colleagues in the general hospital especially those with large ICU’s are used to this.

 

But I don’t think anybody is used to this, even in those hospitals. They’re not used to the pace of change because this virus is different than any clinician has seen in any time. It’s just a whole different paradigm.

 

And Bill, I’m hoping that some of the changes we’re making now, in terms of our processes, will stick after we’re back to our new normal because I think there’s a lot of good we can take necessary. Very difficult situation.

 

[0:06:51.9] BR: Yeah, what do you think are some of the things that – just one or two of the things that you’ve discovered that you hope stick over – once we’re post-COVID?

 

[0:07:01.9] JN: Doctors and patients like telehealth. That’s another great. I think we have about 300 positions in our – Between surgeons and medical doctors in our organization. Again, last month – where are we? April 8th?  Yeah, about this time last month, we had maybe three or four clinicians actively using telehealth. We now have 200 physicians signed up telehealth. We have physical therapy now in telehealth. Because we do a lot of rehab.  I would love that to be something that sticks, I apologize about the dog barking outside. That’s something that I really hope sticks going forward. 

 

Now, of course, we have to have our clinicians and the workflow’s down that they want to continue doing this. We also need to – We also are hoping that the third parties who are now paying for things they weren’t paying for a month ago, will not rescind those change. 

 

You know, there’s structural changes within physician offices. How patients are reacting. How the payers are reacting. If those things stay, that will be something that would be wonderful to keep. By the way, we did these doctors in two weeks.  Again, that would have taken us a two-year methodical plan service client to servers. It is amazing which you can do when you have to.

 

[0:08:26.1] BR: Yeah, when you have focus. You know, I’m thinking through telehealth because I did get the question today – I was talking to somebody offline and we were talking about what’s it going to take for this telehealth thing to stick? And I’m like, “Well the reimbursement – If the reimbursement goes away tomorrow –” 

 

[0:08:44.4] JN: That is going to fall. 

 

[0:08:46.6] BR: Yeah. We are going to snap back a little. Buit but I am not sure we’ll see that from the federal side but we might see it from commercial payers. We might see it who knows. 

 

[0:08:55.1] JN: But the commercials generally follow Medicare. 

 

[0:08:58.4] BR: Yeah, which would be great. 

 

[0:09:00.1] JN: Yes, it’s simple. If Medicare sticks with this, I think the commercials would be hard pressed to do anything differently. 

 

[0:09:05.8] BR: Which should be fantastic. And then you guys are in specialty care, which is the other question that I sort of got, which was they were saying, “Well we see this sticking here.” But I see now that you know physical therapy is now reimbursed telehealth and that’s a huge move and very practical, actually.

 

[0:09:27.9] JN: Yeah and we are very careful clinically deciding who would benefit from a telehealth visit and who would not, who has to literally come into the organization. But I think that with those clinical screens, we are doing an excellent job. We have surgeons doing their initial visit, their pre-op visit with the patient. Now they have already done lots of screening. They looked at films and MRI’. They have done a lot of pre-work that they normally do to screen patient and bring patients in really who are needing our services. So, the fact that they are able to do that initial visit virtually is just amazing. 

 

And then post-op – You know we’re in a tri-state area. But some people in the tri-state area have to travel over an hour or two to get into New York City. So, for that post-op visit for a patient who is doing really well to have that done virtually, is great for the patient. Really much better for patients. 

 

[0:10:29.0] BR: So, what are you doing for the 10%? You said 90% of our patients we’re sort of pushing off their elective surgeries. But the 10% they are still emergencies. 

 

[0:10:37.7] JN: They’re still emergencies and urgent. And yes, they are coming into the hospital. So, our OR’s are working. Our surgeons are taking care of those patients because some patients cannot wait. So, we are taking care of those. And then we are taking care of injuries. Traumas. So, as I mentioned for the first time in our 150 so-odd year history, we are taking direct ambulance to HSS. 

 

Normally patients are brought by ambulance to another facility, stabilized in their emergency room. And then if they need our services, they’re transferred over. Now we are taking them straight off the ambulances, which is very, very different. 

 

[0:11:13.2] BR: And so, what’s been the most challenging thing to sort of turn this thing on a dime from where you sit? 

 

[0:11:21.9] JN: You know I hate to use this old adage, but it is very much changing the wheel and the tires, you are going down 80 miles an hour down the road. So, you know we are getting very quick requests for physicians from our nursing leadership. So being able to get back to them, get clarification, turn things around very quickly. We have to not be afraid to bother them because they really are the ones making the requests and going back and forth with them. They are absolutely wonderful. They don’t mind.

 

But that is a real change in mindset that we have to be able to just very quickly go back and forth a much more agile way of doing things. So, really quite different. 

 

[0:12:08.6] BR: All right. So, talk to me about the communication. I think this would be the last question because I know you’re busy and I appreciate the time. But talk to me about communication between health systems across the New York area. How is that being coordinated? How are you working through peers? And you know I assume people are getting stuck and they’re reaching out to each other?

 

[0:12:27.5] JN: Well you know of course the Greater New York Hospital Association and the New York State Department of Health and the City Department of Health are really coordinating efforts. And they are doing an excellent job. But we have a very strong, in this case Governor whose had an excellent job of really taking charge of the situation, dealing with some data and with some facts. The Governor’s office speak with our CEO and the mayor’s office speaks with our CEO.  So there is a lot of direct conversation with authorities and then they bring the hospitals together.

 

And then really initially there is so – New York Presbyterian Healthcare System has so many COVID-patients that we have not had to look any place else to fill our own beds. We are really helping Cornell New York Hospital Queens and New York Hospital downtown. Those three campuses, that is where we’re really taking patients right now.

 

And our clinicians go back and forth literally between the organizations. They visibly walk back and forth. We have credentialed so many New York Presbyterian physicians now on our side. We have given them access to Epic quick training. It’s just – Again, things that would have taken weeks, months, years to do, we’ve done very quickly to support these other organizations. 

 

[0:13:47.7] BR: Anything that you would say to another health system that’s maybe preparing for a surge that you guys are going through? 

 

[0:13:54.7] JN: I think trying to think ahead. We just can’t respond to this request, you have to think a couple steps forward. Because that those few steps forward of course are usually going to happen. So, you really have to be thoughtful with that, taking care of what is immediately in front of you but thinking a few steps ahead. Our CEO operates in that manner so it’s really easy for the rest of us to do that. 

 

So, I think listening to your peers, seeing what is going on around the country. Being very thoughtful about preparing is important. Making sure that your staff knows that this is actually a fight that they’re in with the rest of the clinicians. I would – our IT department has been absolutely amazing in terms of rising to the challenge. You know working nights. Working weekends. We have a group of staff that remain at the hospital who are going into these COVID units, into these patient care areas. 

 

We have donning and doffing like they’re caregivers so they’re safe. But there is a real sense of “We’ve got to beat this with our clinicians.” And making sure that your IT departments understand this.

 

But you know that is what IT is about. You know we are here to solve problems often so this is just an extension of that many of my colleagues have with their departments as well. But you know things change all the time. And the things that we figured out in New York are going to change as the disease progression changes in other cities. So, I think being prepared for the things that are fluid and you have to be flexible and just ready to move and zig-zag to move forward is really critical. 

 

[0:15:37.5] BR: Yeah, absolutely. Jamie, thanks for taking a couple of minutes out of your day. I really appreciate it and I really appreciate the work that you are doing. I look forward to catching up with you after this slows down a little bit because – 

 

[0:15:51.6] JN: On the other side of the mountain, we hope. 

 

[0:15:52.8] BR: Yep. And because you have to change the whole thing back at some point. It is going to be – 

 

[0:15:58.4] JN: Yeah, well, the hospital and IT have returned to – we call it return to new normal. But one of the things that our CEO Louis Shapiro did, which of course is really wonderful is, while many of us are fighting this fight, he has a group of leaders who are just thinking about, “Okay what is it going to be like when this is done, when we return to normal, what are we going to do?”

 

So, we have some people on that committee. But even with our IT are thinking about what’s the return to normal going to look like? What are we going to have to do? What are going to be the steps? 

 

And that is wonderful because that also keeps us looking at the positive future not just mired in this very difficult present. 

 

[0:16:41.0] BR: Yeah because this too will end and there will be a new future. 

 

[0:16:43.5] JN: Yes, there will. 

 

[0:16:44.6] BR: Absolutely. Well thanks again Jamie. I really appreciate your time. 

 

[0:16:48.9] JN: My pleasure, Bill. Stay healthy. 

 

[END OF INTERVIEW]

 

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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 flatten the curve across the country. Thanks for listening. That is all for now.

 

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