Field Report Mayo Clinic This Week in Health IT
May 19, 2020

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May 20, 2020: On today’s episode of the Field Report, our guest is Cris Ross, Chief Information Officer at Mayo Clinic. In this episode, we sit down with Cris to explore what emerging from the pandemic might look like for Health IT. Cris explains how Mayo has experienced the pandemic thus far, including treatment and research, as well as the transformations their delivery of care is undergoing due to COVID-19, and how these changes will integrate into post-pandemic work. We talk about working from home, the future of remote work, priorities for Health IT both pre- and post-pandemic, and the areas in which Cris believes Mayo has been making important progress. Cris also shares Mayo’s contingency plans as both employees and eventually patients return, as well as the ways in which he believes we will come out the other side of this pandemic stronger, and better prepared.

Key Points From This Episode:

  • How Mayo Clinic has experienced the pandemic thus far, including treatment and research.
  • Transformation of care delivery during COVID, how it will integrate into post-pandemic work.
  • Cris’ experience of work from home and what he anticipates the future of remote work to be.
  • Priorities for Health IT today and what Cris thinks priorities will be post-pandemic.
  • How current circumstances have affected the priorities of Mayo’s pre-pandemic projects.
  • Some areas that Mayo has been making progress in regarding more powerful cures.
  • How Mayo is preparing their health system to start receiving visitors again.
  • Mayo’s contingency plans for a second surge of COVID infections.
  • Cris explains the contact tracing solution that was developed by Dr. Laura Breeher at Mayo.
  • Less perfectionism, ethical data use, and collaboration are the keys to beating COVID-19.

Field Report: Mayo Clinic

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Field Report: Mayo Clinic 

Episode 251: Transcript – May 20, 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.

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. 

[0:01:14.4] BR: This morning we are joined by Cris Ross, the CIO for Mayo Clinic. Good morning Cris and welcome to the show.

[0:01:19.3] CR: Hey Bill, good morning.

[0:01:21.5] BR: I’m looking forward to this conversation, we’ve, you know – this will be episode, I don’t know, 53 in the COVID series but the first one where we’re starting to transition the conversation to really emerging from the crisis. Not to be premature, but that’s where the thinking is of the leadership at this point of, you know, what steps do we have to take to come out of this?

But before we get into that, give us an idea of how your health system has experienced the pandemic so far? 

[0:01:51.1] CR: Well, Bill, it’s been pretty impressive. We’ve been fortunate that in the geographies in which we operate, which is in Minnesota and Wisconsin in Florida and in Arizona, the case loads have not been overwhelming as they have been in some of the areas that have been particularly hard hit.

Mayo’s role, of course, is to treat patients and we’re doing that, but especially because our case load has not been overwhelming, we’ve had a chance to double down on things like research into cures and treatments. You know, a couple of things that have been pretty amazing. One, our commercial lab is large and pretty successful, has introduced tests for detection of the disease and for antibodies and those are in production. We’re doing a lot of work in treatment areas. Dr. Michael Joyner is leading a national program on convalescent plasma, to take plasma donations from sick – COVID patients and use that, injected into other patients to create immunity.

The FDA just last week approved the emergency use of an algorithm to detect heart failure associated with COVID, and that was led by Dr. Paul Friedman and the department of cardiology. Then Dr. Badley, who is a renowned AIDS researcher and physician, is bringing 30, 40 years of talent to bear in leading our combined research activities.

As of last week, we had 109 projects under way. Everything from how to recycle masks to how to provide oxygen better to patients, do research on community response, those kinds of things. While we’re continuing to treat patients as the first thing we do, the research and education shields of Mayo clinic have been on hyperdrive and been doing really incredible stuff.

[0:03:43.9] BR: Wow. When you talk about the stuff, I get so jealous every time, because you – you guys are truly one of the leaders out there, doing some amazing things. I do want to shift a little bit, just to be pragmatic for the majority of our listeners, and really talk about the delivery of care. So as you consider, we saw this spike in telehealth, we saw digital tools, patient monitoring, chat box, those kind of things.

Talk a little bit about that and how you see that stuff integrating into the post-pandemic work?

[0:04:21.3] CR: Sure. We went from a small fraction, like everybody else, of our visits done through virtual means to the majority of them being done by virtual means. Now that we have the capacity to do more inpatient and outpatient visits, we’re continuing to do a lot more virtual care, and it’s been in three areas.

One has been dialogue with a patient. Often by video, but also just by phone. The second has been things to do to support patients and their family when they’re contagious, and maybe under constrained circumstances. So think about the iPads in use to communicate with patients in an ICU, or similar kinds of devices to help support patients who are in long-term care, post-treatment. The third area has been how can we get patients home when surveillance with more intensive kind of treatment? All three of those will continue. Maybe we won’t have a pandemic need to deal with as many patients in isolation. 

But the two areas of trying to keep people from coming into the hospital, and to get them home quicker, is something that we’re working hard on and gaining some great experience. Of course, the telehealth visits will continue to be part of our practice. I don’t think they’ll be exactly the same, a lot of our visits were to maintain patients while they were waiting to come in for care, and a lot of things require physical touch especially things like procedures. 

But it’s clear, it’s never going away. It will be an important part of our song going forward.

[0:05:57.5] BR: Yeah, for you guys, it was an important part of your arsenal before. I mean, this was pretty much baked into a lot of the things you’re doing because you guys end up being a destination facility. You’re communicating a lot remotely with patients, even prior to this I would assume.

[0:06:14.7] CR: Yeah, thanks for mentioning that Bill. I mean, many patients travel a long ways to come visit us at Mayo, so if there’s ways that we can have a pre-visit, incorporate it more into our screening and scheduling processes. We had a lot in the works to try and rev up our digital practice, to create more of a consumer experience, to create a more clinically relevant experience for people, without having to come to one of our destination medical centers.

This is an opportunity to just prove out the effect that that works and we’re just going to go faster.

[0:06:49.4] BR: Yup. All right, you’re working from your house. I love the artwork in the background. How have you experienced work from home and what do you anticipate the future to be within your health system?

[0:07:03.7] CR: We had very much a face-to-face culture, as a lot of organizations do. We certainly had teleworkers, especially people who could work remote in task-based kind of work, like revenue cycle or those kinds of things. But we’ve really tested it. You know, personally, I have a 90-mile commute from my home in Saint Paul to Rochester, Minnesota, so it’s been nice to not spend quite so many hours on the road. That’s helped with my productivity a lot.

I think a lot of people now have this experience of rev and running from conference room to conference room across the campus. Now you just jump from one virtual meeting to another virtual meeting. The productivity isn’t bad, the fact that we all are working at home has been sort of a shock to the system to force us to have to address our culture. 

We’re not in a hurry to bring people back on campus. I’m telling my team and the rest of the administrative areas are hearing the same thing that they should plan to work from home, through the end of the summer and maybe into September.

We’re going to have to do some things to make physical space better to deal with, social distancing and those kinds of things. We’re not in a hurry, we’re working well in a virtual way and you know, I think that’s going to shape our future.

[0:08:18.4] BR: That’s fantastic, it’ll be interesting to see,  I know that somehow systems are creating surveys to gather a lot of feedback and those kind of things. It was great to hear you mention Saint Paul, Minnesota. Growing up as a kid, my dad worked his entire career at 3 AM and he used to have to travel to Saint Paul for – I remember as a kid, waiting at the airport for my dad to get back from Saint Paul, from training, and he would tell me these stories of, they have underground tunnels in Saint Paul because it’s so cold outside.

[0:08:46.3] CR: That is true but you know, you’re in Florida. There’s advantages of being in Minnesota too. Right now, it’s gorgeous outside.

[0:08:55.0] BR: Yeah, I would imagine. All right. Today is – we’re recording on May 18th and, for this question, I just want to capture the date, so it’s May 18th 2020. What are the priorities for Health IT today and what do you think they’re going to be post pandemic?

[0:09:11.1] CR: We haven’t finished the job of responding to this corona virus – crisis, for sure. That means that we still need to be on our toes and improve our capability to do testing, to do tracking, to help with containment, with, along – in partnership with public health agencies and other officials, to create more treatments, and, of course, to accelerate vaccine wherever we can.

My data team for example has really pivoted in supplying a lot more flexible deeper, richer data to help those areas. We’ve had to shelve a couple of other things that our data team would otherwise work on those exactly the right thing to do. I would also say Bill is, you know, the triple aim goals didn’t go away. Cost of healthcare in the US is still too expensive. It’s still too inaccessible. It is not affordable, and we can improve quality and outcomes. Those don’t go away.

Hopefully we will take some of this hyper-charged learning form this public health event and apply it to other diseases, to move on them with the same level of urgency and immediacy. We are excited about that and believe that we really can use this as an inflection point. 

[0:10:25.1] BR: But will there be a re-evaluation of some of the projects? Because you are talking about – we set these projects probably nine months ago, a year ago, when the conversations were happening. Has the world changed enough to reconsider some of the projects that we prioritized back then? 

[0:10:41.5] CR: Well, for sure. So our clinical practice cancelled right off the bat about 80% of the keep-the-practice-advancing projects. We expect to restart most of them, maybe all of them, but you know I bet that some will be sidelined. The good news, and I don’t want to brag too much about Mayo, but we had been making some areas and some movement in some important areas, like the improvement of digital care. 

We also launched a platform business, where the intention is to use data and technology to work with partners to bring more powerful cures to a broader population, that maybe could be treated again by coming into one of our destination medical centers. We have already started partnerships in discovery with data to look for new cures and new pharmaceutical cures. We have been working on home hospital initiatives, and we’ve been working on remote diagnostic and disease management capabilities, all within this platform idea. 

So to some degree, it is an affirmation that the vision that our CEO, Dr. Gianrico Farrugia, brought into office a year and a half ago is just as current if not more current. So what we have to do is to deal with the financial consequences of this crisis, to keep our eye on the ball in treating patients as we get through to the pandemic. But then I think to some degree, Bill, we are just going to put more logs on the fire on some of the initiatives that we had already started. 

[0:12:12.4] BR: Yeah, that makes sense. You know we are seeing signs that claim state is growing which means that the volumes are starting to tick up, really across the country. What kind of things is your health system doing, as you expand procedures, in the way of safety, in the way of just preparing the health system to receive visitors again? 

[0:12:34.1] CR: Yeah, it is a great question and job one, obviously, is safety. Making sure that our patients and our staff are protected from COVID-19 if they come into our clinic. So health care is a very human-intensive kind of endeavor. So we have the capability to use or registration and our nursing staff to screen patients, to give them clear indications, to do COVID testing on everyone who needs it before they come to the clinic, and then provide wall-to-wall support throughout our operation. 

So I am working with my colleagues in facility, and safety, and security, to help the practice with things like how do we route people around our facility and get people to use less crowded waiting areas? How do we do more touch-less things and, fortunately, we have a completely touch free payment environment. So if someone wants to pay using Google pay or Apple pay, they can do that in our environment without having to touch anything. 

We are looking at things like signature pads and we have taking iPads out of circulation. We’d like to figure out how to get those used safely again. So it is kind of a thousand little things I think Bill as oppose to one big thing. So once we get the safety right, then it is reassuring people that they can come to get care, safely. We know that across the US, people are delaying care and that is really a bad thing. You know, you have to worry about the people with chronic diseases who are not getting timely treatment. 

So we need to reassure folks and then, again, because a lot of people travel to come to Mayo, we have to work with airlines and hotels and hospitality to create a great community environment when people come to see us. 

[0:14:25.2] BR: Yeah, so as we start to receive patients again, are you planning or – actually, I know you are planning. So what kind of planning are you putting in place for a potential second surge if that happens? 

[0:14:39.7] CR: So we certainly have contingency plans in place. As I said, in most of the geographies in which we operate, the curve got bent pretty well. Although there is certainly things to worry about in all of our geographies and of course nationwide, as we treat patients nationwide. I think we had a lot on the shelf that is ready to go. There is some of it that was the best we could do in the moment, that we are going to want to refresh and make sure it is as good as possible. 

We have done some things around contact tracing within our environment. One of our occupational health physicians, Dr. Laura Breeher, worked with a tech team to create a very rapid and effective contact tracing tool. So we can assure that our staff is going to be safe when they are treating our patients. I think we are ready to go. We certainly hope that the second surge is insignificant, but all of the data suggests that this is the first chapter in the long book. 

[0:15:43.9] BR: The contact tracing solution you talked about is that something other health systems can implement? 

[0:15:49.0] CR: So Dr. Breeher wrote it up as a white paper, and it will be published in Mayo proceedings. It may have already been published actually, this week, but it is considered a blueprint as opposed to the tool we can share with other people. It combines some lab results data and our Epic data and some HR data and kind of glued it together in an agile fashion. So hopefully some other people can use that as a blueprint, but unfortunately it is not something we can just give away as is, but we are giving away the IP. 

[0:16:19.6] BR: Interesting. Thanks again for your time. Here is my last question, what do you consider the greatest learning to date from this experience? 

[0:16:28.0] CR: So you know one of the clichés that’s not a cliché is we learned how to do ten years’ worth of change in a couple of months, and that is true. The cultural requirements were true. We have battle-tested a bunch of things, and we found that sometimes good-enough is good enough. You know we always want things to be perfect, especially at a place that is as demanding as Mayo, but we found that simple, lightweight, good-enough is probably okay. 

The second big thing that I hope will have legs, Bill, is we have been struggling to communicate broadly about our mission to use data ethically and responsibly to drive new cures. People see that as a trade up between their privacy rights and the ability to create cures, and I just don’t believe that. I think it is a case of and, not or. I think we can protect people’s privacy and still use data to advance medicine.

My hope is that people will come out of this understanding that, by sharing the data, and by working together in big collaboratives, not just in the country but around the world, we were able to address this illness. Hopefully that will make people understand that, even while their privacy is sacrosanct, we are absolutely committed to patient privacy and the security of their data, that there value in that use of data. My hope is that that will unlock unbelievable potential.

There is incredible cures that are just waiting to happen if we can use data in more progressive, interoperable, immediate, right-now kinds of ways. So I am excited about that too. 

[0:18:15.5] BR: Cris, that is a fantastic way to end, which is a segue to we’re going to have to have you back on to have that conversation. 21st century curers, we have just your work with Google, there is so much talk about but for another time. Thanks again for your time and coming on the show today. 

[0:18:33.8] CR: You bet Bill, thanks for doing these shows. They help us all learn from each other and they help us advance. It’s really been a service to the country and our industry. Thanks very much and I am honored to have been here. 

[0:18:43.6] BR: Thanks Cris. Take care. 

[0:18:45.2] BR: That is 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. 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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