May 8, 2020

 – Episode #

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May 8, 2020: Today’s conversation is with Josh Sol, Director of Innovation in Ambulatory Clinical Systems at Houston Methodist. We kick things off hearing about Josh’s role at the institution and the many facilities it is comprised of before our guest gives a little background on how they have progressed through the pandemic. Josh informs us of the great job they have done training physicians to scale virtual medicine before he sketches out some of the solutions they came up with for challenges in areas of IT, physician support, and operations. Josh gets into the many innovations the institution has implemented in this time, listing their use of different Epic tools, a virtual lounge, Alexas and iPads in patient rooms, and even a virtual ICU center in the pipeline. Central to these implementations is their Technology Hub, and Josh discusses the role it plays in their sophisticated innovation framework. From there, we chat about what virtual implementations will become a part of their standard procedures as hospitals start opening up again, and Josh stresses their ongoing focus on patient experience and accurate clinical documentation. Wrapping up, Josh talks about how useful the common architecture they began developing as early as 2016 has been for integrating recent IT implementations from a preparedness standpoint. Tune in for a this brilliant report from an institution that had a great framework in place to help them scale to meet the crisis.

Key Points From This Episode:

  • What Josh is in charge of and the facilities that comprise Houston Methodist.
  • Background on Houston Methodist as it progressed through the pandemic.
  • Scaling virtual medicine and training physicians through the virtual training center.
  • Solutions to challenges on the IT, physician support, and operations side.
  • Josh’s breakdown of the innovation and testing framework at Houston Methodist.
  • How digital is going to help in the process of reopening hospitals in Texas.
  • Tech implementations that will continue into the future: a virtual ICU, and more.
  • Developing a common architecture to integrate different tech implementations.

Field Report: Houston Methodist

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Field Report: Houston Methodist

Episode 244: Transcript – May 8, 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 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 and 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 I say YouTube in that paragraph? Subscribe to YouTube, we’re going to have some great stuff over there. 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. 

[0:01:25.4] BR: Today’s conversation is with Josh Sol, Director of Innovation in ambulatory clinical systems at Houston Methodist. You have a really long title Josh, I’m sorry I messed that up a little bit.

[0:01:27.1] JS: No, no problem, that happens.

[0:01:29.1] BR: Well, welcome to the show. You’re really in charge of innovation around the outpatient, patient engagement interoperability, and all that stuff for Houston Methodist, is that pretty close?

[0:01:39.6] JS: Yup, that’s correct.

[0:01:41.1] BR: Fantastic. Houston Methodist, obviously the name tells us where you’re at but isn’t that where president Bush was there? Is that – 

[0:01:53.1] JS: He was treated with us. We’re about an eight hospital system. We are  an integrated academic location that the Texas medical center. We’ve got about 2,393 hospital beds with about 25,000 employees. That kind of makes Houston Methodist as a whole, so yeah.

[0:02:18.8] BR: Wow, that’s big. By the way, I didn’t violate any HIPA that was in the news that president Bush was at Houston Methodist. Thanks for taking a few minutes to meet with me today, I really appreciate it. Give us a little background on your organization as it progressed through the pandemic, what kind of things did you experience, what kind of things did you roll out?

[0:02:40.1] JS: Yeah, I think you know, our leadership has some really great foresights looking at COVID and how the pandemic was progressing and you know, in my world, we took some really strong steps in virtual medicine. We kicked off right around the March 6th and 9th timeframe. We started training our physicians,  prepping for virtual medicine. 

We started with about 66 MDs that were doing virtual, treating virtual urgent care or doing primary care but quickly within about three weeks, we trained about 900 MDs. This was a  huge undertaking to be able to train and for those of you who don’t know Houston Methodist, we actually developed what’s called our Center for Innovation Technology Hub, that’s where we jsut really focused in on tools, digital health tools that our end users, whether it be patients, consumers, clinicians, come in and try all these technologies that are going to be really breaking the mold of the future. What we did with that technology hub, it’s about 3,500 square feet.

It actually turned it into a virtual training center where our physicians could come in and get hands on experience with using tools which is support treating patients when they’re in isolation. We had a huge influx of training and our technology hub was able to support that. As the pandemic started to really hit, our teams focused in on more and more virtual. We were doing about a thousand virtual visits a week prior to. We now average about 15,000 a week. We just recently hit our 100,000 virtual visit mark in a span of six weeks and it’s just amazing to see the growth that has occurred.

[0:04:31.3] BR: Is the hardest part of that – gosh man, 15 questions. Focus Bill, let’s see. Is the hardest part of that the training because it sounds like you already had the virtual workflows in place, you already had the telehealth solution platform in place so you just scaled that up a little bit. You had to train the doctors, the workflow was already baked, is that pretty accurate?

[0:04:58.7] JS: Yeah, it is actually. The training was the hard part but we also experienced issues like many other telemedicine groups are seeing where you just couldn’t anticipate the growth and so we had to licenses to be able to do a concurrent connections and we continued to add them up so that we could keep the movement of the video exchange occurring. 

We, like many others were just continuing to ramp up and up so that we could and had enough of those licensing. That was a struggle from an IT perspective. The other struggle was establishing support. Now that you have more physicians doing telemedicine. How do you support that?

We had a couple of strategies, we actually developed a telemed rapid response team where originally two individuals then it turned into eight. We focused in on Epic tools, Haiku, Canto, making sure that they were video applicable. That way we could support that. We also had [inaudible 0:05:57] as a group that we – was a virtual urgent care. We had team members that we were able to support that through our My Methodist app. Developing that support was really important. 

On the operation side, who did an amazing job of supporting their physicians and patients, they actually spun up a patient support line so that when patients have issues, they could call directly and we instituted a thing called tele rounding. I’m sure many of your other organizations have done that as well but our tele rounding, our CMIO, Dr Nicolas Desai had a vision to create what’s called tele lounges in certain conference rooms inside of a hospital so that our physicians can go into those tele lounges and beam into a COVID isolated patient which started to create our tele rounding experience.

We think that is going to continue to expand, I don’t see that stopping, it helped us to save on PPE and created a good positive experience for our patients.

[0:06:55.8] BR: Wow, you know, I had Nicolas Desai was on the show a while back with the CEO of Notable, Pranay Kapadia I think it was. Yeah, that was an interesting solution as well so you guys have a pretty sophisticated innovation and digital capability. You guys seem to be pretty advanced into how you’re solving problems. I mean, is there a framework or methodology you have in place for innovation at your organization?

[0:07:30.6] JS: We certainly have strategic goals that we’re working to hit and we continue to develop a solid framework of reviewing technology, developing the strong business case with our operational partners and then developing success metrics to say whether or not this project was successful. If it was successful, fantastic, we move forward, if it wasn’t, then we would succeed fast or fail fast. We will fail that project and we actually highlight those because that is an opportunity for us to learn and so by learning that, we can grow the mission of innovation going forward. The other big thing that we did was because I mentioned before is we developed that technology hub. That technology hub is where we are trialing breakthrough technologies like ambient listening in outpatient application clinic rooms to be able to capture sound from a physician and patient, differentiate that, and then code and create the notes for the physician and create actions around it. 

Notable is another one of our innovations where we saw success around essentially taking in WAV files and using automated intelligence robots to type up the note for physicians and create actions on it. Same for the orthopedic physicians – have tremendous amounts of clicks as you guys know, you know ours are really task oriented click heavy. Our goal in the technology hub and center for innovation is to reduce the amount of clicks and to create that physician to patient eye contact. 

That when you integrate an EMR and the screen right in the middle, you kind of break that. So our goal is to really break that barrier into not happening anymore. 

[0:09:08.7] BR: All right, so we are entering a different phase here. So you’re in Texas, I am in Florida. These are two markets that are starting to open back up. So how is digital going to help in the process of reopening the hospitals? 

[0:09:23.2] JS: I think we are going to continue marching down the same path that we are doing. We are focusing on patient experience and accurate clinical documentation and interoperability. So we, as part of our efforts with COVID we deployed 250 Alexas into the room so our patients who were isolated could feel less isolated. They can play music, they could chime into breaking into their echoes. They use the echoes for their loved ones. 

We also deployed patient engagement iPads where our patients could play games, Netflix, Hulu type approach where they actually have it in the room. Now we see that expanding. We see the patient experience focus, continuing to expand across the organization. You know we have started to open up with surgeries, elective surgeries and we have started to do diagnostic imaging and we see that volume ramping up. 

Our clinics have opened up and we are starting to see patients in a measured way, a very measured way. We are also continuing to leverage telemedicine. So we see that being as a constant and so we are trying to grow all of that together. Where we see digital is creating that positive patient journey that frictionless journey. One of the tech hub roles is to create a contact list check in, where we’re not actually passing questionnaires back and forth or collecting money. It is all done through our mobile check in. 

[0:10:48.8] BR: Yeah, it is interesting. My daughter who is going to Bailer or not going to Bailer at this point but she is going to Bailer and she was asking me, “Do you think this would be the advent of essentially mobile pay?” and those kinds of things is how she phrased the question and this will change our behaviors in a lot of different areas. I mean you mentioned you put Alexa in all the rooms. I assume you are not going to take those Echoes out of those rooms. 

You probably put cameras in a lot of rooms that didn’t have cameras before to facilitate the physician lounge. That is probably not going to go away. There is probably not going to be as much paperwork. What other behaviors are you looking at and what are the things that you are looking at that potentially might change as a result of the environment we are currently in that you have to put different types and solutions. 

[0:11:41.5] JS: So we are currently invested into a virtual ICU. So we started that deployment this year. It was about an 18 month plan to deploy and now we’ve accelerated that ramp up to do it on an entire system with virtual ICU by the end of the year. So we see that as being a big win. So creating a foundation of virtual care is going to be a continued focus for the organization. 

[0:12:07.6] BR: Yeah, so when you think about long term impact, it’s – you know we have changed the behaviors. We have changed so many behaviors over these couple of months. That really does catapult things forward. Is the challenge just integrating all of these things? I mean okay, so we have an Echo, we have a camera, we have a virtual lounge but at the end of the day, these things have to feel as sort of architected and orchestrated, don’t they? In order to create that process and what is that work look like? 

[0:12:40.7] JS: So you know our goal has been to develop on a solid foundational platform. So we are on the same platform and talking the same language as organization. We can really start to innovate. So our goal for virtual for example, we did a couple of virtual vendors, maybe three to four. We are now consolidating down to just two possibly creating that just kind of level of playing field. It changes our discussion, we no longer have to think about the technology and we can think about the business strategy and support that business strategy. 

The same thing with moving to Epic. We work with [inaudible 0:13:19] before where we have multiple integration points and now we’ve gone onto Epic in about 2016 and that’s when our innovation really started to flourish because we are all speaking the same language. We are no longer worried about master patient index and multiple systems. We now have one patient and one record and we are able to have different conversations around the experience. 

So I think to your point developing that common architecture so we can support our business leaders has been a mission of ours and we continue to push on that. 

[0:13:45.9] BR: Yeah, I bet. You know Josh, thanks for taking the time. I bet you guys are happy that you finished that in 2016 because you’re trying to deal with some of that now would be very difficult. 

[0:13:58.0] JS: Definitely. Definitely glad we went through that. 

[0:14:01.4] BR: Well thanks again for your time. I really appreciate you and all of the stuff you’re doing. We will have to check back later. I’d love to hear how things progress. 

[0:14:08.3] JS: My pleasure, thank you for your time. 

[0:14:11.1] BR: That is all for this week. Special thanks to our sponsors, VMware, StarBridge Advisers, Galen Healthcare, Health Lyrics, Sirius Healthcare and Pro-Talent Advisers 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 them an email, let them know that you value and you’re getting value out of the show and also, don’t forget to subscribe to our YouTube channel while you’re at it. 

Please check back often as we continue to drop shows until we get through this pandemic together. Thanks for listening. That is all for now.

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