June 19, 2020: Jefferson Health was busy pre-COVID with various capital-intensive and operational improvement initiatives. While the pandemic has diverted from these projects, the organization has risen to the challenge, adapting to the changing times. Nassar Nizami, today’s guest, and CIO at Jefferson Health, joins us to share how they have dealt with the large-scale shifts COVID-19 has brought. In this episode, we gain insights into what their response has looked like from March until now. While there was an initial rapid adoption and scaling of telehealth, remote work, and online learning systems, there is a steadier rhythm now. We also discuss some of the major cultural shifts Nassar has seen both from providers and patients in terms of telehealth. The uptick has been encouraging on many fronts. Nassar then unpacks how many of these shifts will have long-term impacts on the health system. He believes that the remote work model will endure post-pandemic, so finding a way to balance this will be crucial. Along with this, we explore some of the digital and financial priorities of Jefferson and what the organization is doing to prepare for a potential second surge. For all this and more, tune in today!
Key Points From This Episode:
Field Report: Jefferson Health with Nassar Nizami
Episode 268: Transcript – June 19, 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.
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[0:01:35.9] BR: This morning we’re joined by Nassar Nizami, the CIO for Jefferson Health. Good morning, Nassar. Welcome to the show.
[0:01:42.4] NN: Good morning Bill. Good to be back.
[0:01:44.2] BR: Yeah, I’m looking forward to the conversation. Thanks for taking the time, I know this remains an extremely busy time for everyone at Jefferson. It was a busy time before COVID at Jefferson, I can only imagine what it’s like right now.
[0:01:59.0] NN: You’re absolutely right. We were extremely busy before COVID with a number of capital-intensive initiatives and a number of operational improvement initiatives and so forth. Obviously, for us within IT, application upgrade and expansion was one of them. But there are many other and this COVID hit us in March and we had to go pretty much everything in. For the last three months, we have been very focused on everything related to COVID. And just now, we are coming out of it, barely.
[0:02:38.5] BR: Yeah, what are some of the things your team was able to do? And give us an idea of how you experienced COVID, so far from about the March timeframe to now?
[0:02:50.1] NN: It’s been just a rollercoaster ride. An experience that is incredibly unique. We obviously are adjacent to New York, right? We are Pennsylvania, [inaudible 0:03:05] area. We were closely monitoring what’s happening in New York, but the things escalated very quickly. In New York, and strongly, even in Pennsylvania. We are a university and a hospital as you know, in the medical center and the university.
So, like second week in March, we’ve been two days’ notice. We went online learning and we are not known for online education just to give you an idea, prior to COVID, we had our 50 sessions that were online. Now, we are running some 2,700 plus sessions that are online. Within a week, the next big thing that happened was we’re coming from all of our corporate departments, roughly 5,000 people and again, Jefferson is a very much a face to face organization.
We had remote work, very limited remote work We were fortunate, some due to our preparation, some due to luck, we were able to redirect our infrastructure and more Epic and really move within four or five days everyone remotely. I’m happy to talk about experience which has been just phenomenal. I mean, in terms of that. Since then, you know, significant time, my team has spent supporting that.
Obviously, on the clinical side of things, telehealth evolved. Again, just an incredible and terrible story. Jefferson was the leader in telehealth going into COVID situation or leaders, Jefferson is known for telehealth. But we saw 70 times increase. We are now dealing withmore than 3,500 visits a day which is just incredible, you know, increase.
Literally, every week, we were seeing 200, every day sorry, two, 300 new patient visits in telehealth. That continued through April. I would say that through March and April, April was exponential increase on everything digital to like Zoom, Microsoft Teams and you know, telehealth, online learning, working from home. And in May is when we started seeing basically, you know, what I’m going to call is not – just a rhythm.
Folks knew what to do. There is still what Pennsylvania considers in the yellow zone, numbers are still high, we expect to be in the green zone probably two or three weeks. So, we are not out of it, but certainly things have stabilized.
[0:05:52.1] BR: Yeah, you know, you guys have so many digital initiatives, so you weren’t caught flat footed by any imagination. But you know, the gains in telehealth are pretty amazing. Digital – you know, remote patient monitoring, chat bots. I mean, there’s so many things that people have put to combat the pandemic and to improve communication.
How do you think those things, I mean, those things have been accelerated, do you think those things will be integrated into our post-pandemic work models?
[0:06:24.8] NN: I think so. Digital is the right word I think for technology folks on technology leader, I mean, future is digital. And I am hearing this not from CIO’s but CFO’s and CEO’s and everyone and this is not just healthcare. This is beyond healthcare.
I think things are going to step now. There are some question marks and the biggest question mark I think is in the reimbursement model for telehealth business, right? Obviously, will insurers with CMS going to roll back some of the rules or they are going to extend and what will be long-term future? That’s a thing we call business of telehealth.
But I think the big win or silver lining out of this pandemic is the cultural shift both on the provider side and the patient side.
The providers we used were pleasantly surprised by the technology and just the processes and so forth and I have to say the processes are still evolving. Same thing on the patient side, you know? Initially, we saw a large number of technical issues you know, backward connections, apps not working, et cetera.
But over time, as our patients are using technologies, they’re all coming in and finding that if technology works. Same things to be said, the things like Zoom, we were piloting remote patient monitoring the day before COVID. But now, you know, the adoption I think is going to just increase en masse, same thing with online learning. I don’t expect to go back to the same levels in any of areas that I mentioned, telehealth, online learning, and remote work. As a matter of fact, we are now considering a pretty significant number of folks to be perhaps permanently working from home.
[0:08:20.1] BR: Right.
[0:08:20.4] NN: A lot of changes I think are going to happen. I think we saw an exponential increase, it’s not going to be back to pre COVID levels is actually going to be somewhere in between. And there are a number of factors that I will decide where we land.
[0:08:34.8] BR: I don’t think I’ve ever asked you this, do you have a peer who is over the medical school or the education side or are you over both the education and the healthcare side?
[0:08:47.4] NN: I’m on both sides.
[0:08:48.5] BR: You’re on both sides? You know, it’s interesting because I just finished an interview with Dr. Mike Pfeffer, who is the CIO for the medical school and the medical center down at UCLA. We were just talking about this is a fundamental shift in the two areas probably, it’s going to be the biggest shift is education and medical as well.
You know, the there things that we’ve always talked about, it’s the – there is the regulatory burden, there’s the cultural change that needed to happen and then there’s the financials around telehealth which really kept it sort of at bay or kept it from really growing. All those things were taken away for a period of time.
But you know, the regulatory will probably snap back, in terms of practicing across state lines. The cultural will never snap back, everyone’s experienced it, right? The patients and the providers have experienced it. But then, there’s the funding and we do have to figure out a way to take care of the funding to continuing it. But generally, if we can figure out those things, do you suspect that – I mean, we are going to see telehealth remote patient monitoring become much more integrated into all of care and that it would start to be taught.
We would start to teach at the medical school, different practices based on that technology?
[0:10:31.3] NN: Absolutely, I think this is the future. We are already talking about what we call Jefferson at home, it’s much more than a telehealth program. It’s about taking care of patients at home not just a chronic care but also acute care. You only need to stretch the boundaries of what we have done up until now, just by telehealth, telehealth is just what you and I are doing, right? Very basic term of video call essentially and it has to be much more than that. Telehealth has to be integrated into EMR and other technology. It has to be integrated with remote patient monitoring. And as I said, you know, the processes and protocols around it.
And you actually mentioned a very important thing. The way we are taught, you know, clinicians are taught, student medical students are taught. I think that there is, in the future, there will be specific I think – I don’t know what to extent. But something forces and feigning for our providers to provide what you need. It’s already happening. There are protocols being developed now, as we speak. But in the future, absolutely, this is the future. I think that you know, the demand from consumers or patients like it’s going to be such.
Surely in the short term because COVID is not gone. It’s still here. We don’t have a vaccine, we don’t’ have any treatment. In the near future, for us to provide care and for our patients to get in a safe environment, all the things that we have been discussing in terms of visual, that will be critical, I mean, there is no need – If we can take – if the patient can take vitals, weight, temperature, even beyond that, right?
Enter and provide automatic and real time and just talk to a physician. And I have had a couple of instances just doing this that I was able to leverage telehealth and it just works. Unless you have to show up in the hospital, it just works. I think it’s serious.
[0:12:36.7] BR: Nassar, how have you experienced work from home? And you know, what do you anticipate the future to be for the health system? Do you expect work from home models to continue after post COVID?
[0:12:51.3] NN: That’s an interesting question that we are already dealing with. I’ll answer you in two parts. First of all, you know, I never had doubt that IT can work from home, like pre-COVID, right? I mean, except for probably what I would say, 20 to 30% of our workforce that provide on-site support, like desktop, mobile, folks, our biomed team. The nature of their work is that that’s not possible, remote is not possible.
The rest of the teams, our analyst EMR analyst or financial analyst or analytics teams, good portion of our security team, et cetera, they can all work virtually, COVID or no COVID. I think what COVID changed is that our entire corporate, anyone who could work from home which is our HR or finance or revenue cycle or seamless access, marketing department, IT, these are the departments that can work remote.
I’m talking about healthcare side of things, right? So, many in the university, everyone has for the most part remote. That, I think the change is very important because the reason that, I was at least, not proponent of remote work just in IT is because of cultural reasons, all right. If you are supporting a department and that department is all in a conference room, IT to be on the phone is one person to be on the phone and just doesn’t work right. And that has changed. Now that I am in a meeting, most people are working from home and I think the biggest thing learning not necessarily for me, I think, but for a number of our leaders including me is that our productivity did not decrease.
Actually, we have seen improved productivity. You know our revenue cycle, in our finance and in one of the events for me was our CFO saying that, “Wow, we did not see any loss in productivity,” and he was not the only one. He was in a meeting with a number of regional CIO’s and they all looked at each other and said, “Hey, we have not seen a decrease in productivity.”
So, we as I mentioned before, we are actually looking at keeping some significant portion of our workforce remote. I don’t the number, we don’t know the number. I would say that we have to culturally balance it though. For instance, we still have providers and we continue to have providers and clinicians who are going to I show up at the hospital. And I think from at least an IT perspective, it is going to be a balance if the team that you are supporting are going to show up in the hospital then how do we balance that remote work which we know we can do and we can do productively? I mean is there going to be a cultural disconnect or not?
These are the things are grappling. Actually right, now the immediate safety is first, right? We are going to do everything to keep our workforce safe and secure. That is absolute so number one that comes everything. But it is not only in the long-term, we are considering, and there are different models you know. Alternate days, alternate weeks, permanent remote and everything is on the table. We are discussing it.
But I can tell you that you know our workforce returning back is not going to be the same numbers and same numbers as pre-COVID.
[0:16:04.4] BR: Well, I will tell you this, having been someone who parked in one of the garages by your location and tried to get back to 95 during a snow storm, you know sometimes that could take 45 minutes just to travel four miles to get to the main highway and get pretty back down.
So, it is interesting just to play around the concept of how city traffic, how parking, how navigating hospitals because we are freeing up parking spots, how all of that stuff changes if we adopt some of these models. I don’t know, it is just stuff that is tooling around in my mind.
All right, today is May 29th actually and the reason I ask that is because I want to ask what are your priorities today, have they changed much? Obviously, there is going to be some post-pandemic type work that comes out of this. We’re going to have improve safety, maybe some new communication things and those kind of things. But generally speaking, have the priorities changed dramatically since the start of this?
[0:17:11.0] NN: I think it would be an understatement to say that priorities have not changed. Of course, it has changed dramatically, I guess. So, look, one thing that I think we have not discussed is the financial impact, right? After everything. So, while digital is great and I think we will come back to digital and how our priority have changed there, I would say that financial impact on the wider side of healthcare it is very significant.
So as a result, I expect significant scaling back off capital intensive initiatives. So, including both on operating side and capital side of things. So, what that essentially means is or for at least Jefferson and you know us, we have been in this implementation mode, EMR, ERP, student information system, PACKS, you name it for the last four or five years.
And frankly, our mindset for the next 12 to 18 months is going to be more up in optimization, in operational excellence, improvement than implementation. That is just one thing. We are moving forward with a pretty significant implementation of EMR. That was pre-COVID plan and we need to get to it if we can improve it. So, that has not changed, a significant portion of our time building just that. It’s just that beyond that or in addition to that, typically there is always five things happening at this time we haven’t had or more happening.
So financial stress is going to force this in a good way I guess, you know there is a positive side of just looking at some work that we are not able to part as pre-COVID.
Secondly, the three things in terms of digital that I had mentioned is online for us, the telehealth work, and remote work. And in the near future I think remote work will resolve in the next few months, policies to it. And I say remote work as digital but really, I consider it as an HR first and foremost an HR initiative and that is how Jefferson is tackling it. Our HR is leading and we are partnering with our HR team to make sure that we are coming to the right policies and procedures and supporting technologies for that.
But in the next six months or so, I think at the end of this calendar year, I think we will be in a good place for remote work position. And everything that has to do with digital, you know how do we help our patients with registering. Well, I mentioned Jefferson at home, that is picking up already at Jefferson. Now how do we keep patients at home and provide them educate or better care and before they arrive at the hospital?
Things like can we register patients before they show up? How do we use digital technology, the concept of digital door, right? I mean we already have things like apps and you know alerts, et cetera. We just need this to use them, some use predictive analytics to look at populations at risk and how do we encourage patients that need to come to the hospital? There is a patient population that should be coming to the hospital, but they’re not coming to the hospital because of fear of COVID. And then, I think we need to assure them that we are one of the safest places to be, I mean Jefferson is. I mean if you look at our stats, we have very well on the safety perspective.
So, using digital tools to help both on the academic side and the healthcare side of things to do ask much possible as possible digitally without the need of an in-person presence and that is a very broad spectrum of things. So are going to be priorities.
I just also would mention you know as an example cybersecurity has changed. Because the cyber security have changed for us. It was always important pre-COVID, it is still important but within cybersecurity domain, we look at the initiatives that have changed. We never had this much remote folks and remote uses. So, our priorities is on end point protection in remote access. The way that we collect log information, everything. Everything changes within cybersecurity right? So, I think – we found our priorities in one word, digital.
[0:21:40.9] BR: Yep. And so, let us talk about that a little bit. So, you have – you know we have to restore people’s trust in coming back to the hospitals. We told them not to come. It is interesting, we’re the ones who told them not to come to the ER but we are doing those initiatives around this city, around our regions to reassure them. We have procedures, we are testing patients. We are testing our staff. We are monitoring. We are doing just a ton of things.
I am curious, are you doing anything from a health IT standpoint with regard to a potential second surge? So, you guys will go from yellow to green here shortly and I know that there is a lot of people that are concerned about a second surge potentially in the fall or something to that effect. Are there any health IT projects per se that help you to respond maybe quicker than we did the last time around?
[0:22:39.8] NN: Yes. So, I think our strategy is we already in this first phase of COVID, we already stood up infrastructure for everything with telehealth and our strategy is and our thinking is that for the foreseeable future, we are not going to scale back, all right? We are going to leave that infrastructure in place. We are actually relieving in some areas because, again, remote work was great when we did initially everyone wanted remote work.
But then things like second mark or things like better connectivity at home etcetera. “I need a phone. I need some other equipment.” And we are all now working towards providing from a technology perspective what are the policies and software, hardware that is needed. So, our spectrum really is we already stood up infrastructure in a pretty significant way. We are beefing it up, we are going to leave it on, all right? And frankly in our case, we had to redirect from other projects to support COVID-related activities.
And they will, the equipment there, the infrastructure that we bought is going to be long-term borrowing, I guess. So, there is not significant things from an IT perspective, initiatives that we are undertaking at this point. I am sure that as time passes as fall comes near, I think we will be more and more focused on that timeframe on this.
[0:24:07.6] BR: All right last question, what do you consider the greatest learning so far?
[0:24:11.8] NN: Look, I think the greatest learning for me is that we are an incredibly resilient organization. I am incredibly proud to be working at Jefferson. We use to call ourselves 200-year-old startup and I think we proved it to ourselves. The decision-making from senior leadership to really an analyst level have been incredibly agile. People have been just making decisions and implementing things, at a pace that was unthinkable before COVID.
I mean just no concept that you would be able to do things at this pace. And really with our – we improve lives. Every decision that we have made literally in every meeting that I have been, we said, “Hey, we improve lives.” You know we do the right thing, differently. I mean our guiding principles, our mission have really guided us. But I am incredibly impressed by the folks, my colleagues, the folks who I work for, who I serve, my team, by their agility, by their resilience, by their integrity and just the [inaudible 0:25:21]. That’s just something that we have to somehow Jefferson has to figure out a way of preserving that. It has just been an incredible experience, as difficult as the experience has been, just being on the folks, I am just fortunate to call them colleagues. It has just been amazing.
[0:25:40.1] BR: Fantastic. Nassar, thank you again for taking the time. I really appreciate it, always good to catch up with you.
[0:25:45.9] NN: Bill, thank you.
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