NYU Langone This Week in Health IT
April 2, 2020

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April 1, 2020: All crises are different, but they each reveal the importance of having a good crisis and emergency infrastructure in place. Nader Mherabi, CIO of NYU Langone Health, is our guest today, and he joins us to talk about how they are weathering the current storm. In this episode, we learn more about the community they serve and what’s it’s like being at the epicenter of the nation’s coronavirus crisis. We learn more about how previous crises, like Hurricane Sandy and 9/11, have helped them prepare for the current outbreak. While this one is ongoing, Langone’s ability to be nimble and flexible has benefited them greatly. Naber also sheds light on their telehealth services and its expansion, what their analytics team is working on, and ways that they have helped their staff stay safe and productive. In the end, being prepared for a crisis comes down to long-term preparation and investment, and it is important that the patients’ and staffs’ well-being is integral to these systems. Be sure to tune in today!

Key Points From This Episode:

  • Learn about NYU Langone Health, what they’re doing, their reach and communities served.
  • What Langone Health is doing to serve the community in the face of the coronavirus crisis.
  • Langone’s crisis and emergency infrastructure and what they’ve learned from this crisis.
  • Two ways Langone and Nader are taking care of their staff and ensuring they are safe.
  • Important lessons that Nader has learned from this specific crisis.
  • Find out what’s on the Langone dashboard and other things the analytics team is doing. 
  • Nader’s top tip: Have effective communication channels in place long before a crisis.

Field Report: NYU Langone with CIO Nader Mherabi

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Field Report: NYU Langone with CIO Nader Mherabi

Episode 216: Transcript – April 1, 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] DM: 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.

 

[0:00:55.6] BR: Today’s conversation is with chief information officer for NYU Langone Health, Nader Mherabi. Good afternoon, Nader. Welcome to the show. Appreciate it.

 

[0:01:06.7] NM: Hello. Appreciate you having me on the show.

 

[0:01:09.6] BR: Well, thanks for taking a few minutes to meet with us today. I know you’re really busy so I really – I will have you back on the show because there’s so many things we could talk about, you guys are doing so many creative and fun things in the digital space that I think would be interesting to talk about and we’ll get a chance to do that but I want to do one of our field reports with you.

 

Before we get started though, give our listeners a little idea of NYU Langone, your reach and where you guys are, what communities you’re serving?

 

[0:01:41.6] NM: We are an academic health system, located in metropolitan New York. Our main campuses in Manhattan, 34th and 1st Avenue. And then we have a hospital in Brooklyn, a hospital in Long Island and orthopedic hospital and then of course our main campus made out of three main hospitals. 

 

Then we have a very large ambulatory footprint. About 400 locations, ambulatory location, these are multispecialty locations. You know, over 6,000 in that position, employee’s position and close to 45,000 employees serving metropolitan New York and New Yorkers.

 

And then we have two school of medicine, one main one, one we opened last year in Long Island. Some of you may know about us, that our school of medicine is tuition free and we are the top five best schools in the country. 

 

Then we have a very large medical research portfolio which scientist do that. That’s a sort of our institution in a nutshell.

 

[0:02:57.4] BR: I think everybody knows this and I’m tracking the numbers pretty closely, you guys are in the middle of the surge. You have the Navy ships now off the coast. You’re standing up or not you specifically but in New York, we’re seeing these reports. You know, turning the Javits Center into beds. We’re seeing just unprecedented things. Give us a little context from what your system is doing and what’s going on in the community that you serve right now? 

 

[0:03:26.8] NM: Well, you know, it is a big impact here and we are seeing patients and now ET and we’ll be triaging patients. And you know, one a day, advantage of that is we are open in plenty teams that we have a brand-new hospital which is all private rooms and can be made to be changed.

 

We continue to expand our ICU’s beds. We are you know, seeing a number of patients, triaging across our hospital. And then we got our students and residents and all the health workers, to serve the community in the physicians from multidisciplinary. All engaged to serve the community.

 

[0:04:14.1] BR: We’ll delve into health IT for a second here, so actually, for the rest of the show actually. What’s one thing you discovered in the past few weeks that might benefit others that are maybe a couple of weeks behind where you guys are at?

 

[0:04:29.1] NM: Well, first of all, I’m going to talk about crisis and emergency. I know people ask me, “Well, what did you do?” Fortunately, unfortunately I’ve been through many crises, including September 11th, black outs, Sandy storm and of course this. And part of that is our institution having a good emergency planning since even Sandy and even before that in place and that’s a broader institutional plan about taking a case of emergency and what to do and we plug into that.

 

And then, I think we’ve created a structure, for many years about how you deal with crisis. Now, we all know and based on my experience, there’s crisis all different. You never get the same crisis, again when people thought, you know? The question is, how do you setup a structure to deal with a crisis like that and be able to react quickly, improvise different as issue arises?

 

This crisis totally different than what Sandy was. You know, Sandy was an event that happened and you have to deal with the aftermath. This is continuing. In such, you have to prepare your staff to dealing with this on every day basis. It’s a different type of crisis so you got to be very nimble and agile as the need changes, to be able to deliver the technology service, whether that’s expanding ICU, telehealth and various other things.

 

And the other thing is about really having your technology architecture in the way of integrative environment and capabilities, really matters. This is where I chose either is crack or a strength. How you affected your technology infrastructure and that’s the real test here. Both your staff and your structure and your technology capabilities.

 

[0:06:21.7] BR: What are some from a leadership perspective what are some of the things you’re doing for your staff to make sure they’re focused on the right things and to make sure they don’t potentially overwork themselves or get into a situation where they put themselves at risk?

 

[0:06:40.1] NM: Yeah, two things. One, our leadership on top is connected. I’m part of the senior leadership and we meet twice in the morning and in the afternoon to make sure that we are in sync with clinicians, with our staff, what the institution needs are. That’s very aligned that way. 

 

And then I meet with my team, every day at noon time with my leadership to making sure that we are delivering and aligning our resources to deliver the right things and to focus on the right problems. We have a very seasoned team as I said and been through many crises. Everyone knows the playbook.

 

And all part is to have the agility and reaction. Whether that was expanding in telehealth which we invested before and all of a sudden, that really paid the dividends of having thousands of people working from home. And now, we can service them and set up a quick triage and command centers so we can really help people to be productive. 

 

Or you know, making sure that we partner with our vendors to get the need or integration points we need and having them prepare to help us. So, a lot of these again, it requires the structured investment you make a long-term, this is where you see the dividend pay off, the readiness and I always see people that you always have to be ready for a crisis. It’s too late when you try to get yourself ready. That’s the message. 

 

[0:08:08.3] BR: It’s interesting to do your conversation and the conversation with Oschner, on my timeline, I just did them 15 minutes apart. And Oschner, he just sort of looked at me and said, “You know, we have a crisis every year, if not, every two years because there’s a hurricane waiting to hit New Orleans.” He goes, “So, we have capacity, we were ready,” and you just rattled off from 9/11 till today, there’s been a fair number of things. 

 

What specific solutions have you put in place that others may benefit from? Is there a specific solution that you think is relatively created that others could consider?

 

[0:08:48.1] NM: Several things about telehealth. I touch base on our telehealth. We had invested a lot on digital, it’s just not telehealth but digital. Clearly, we pushed a lot of videos as if the boat, we had a virtual urgent care already in place. But the volume went up really crazy and we had to prepare our clinicians. And so, the technology we built is very easy. It’s Uber-like, you know? 

 

That physician can go and take a shift and be virtual and we prepare. So, we would expand, a lot of physicians who can do a virtual session. And then also on ambulatory side, we move a lot of visitors virtual and part of it is because of the reimbursements is feasible and then serving our patients in the community who don’t want to come to the doctor’s office. And we really did booking a lot of video visits and our volume went up thousands fold which is grate for community and our physicians to be serving our patients and their families.

 

On the in-patient side, being able to use telemedicine both between physicians and physician consult and in the room which we deploying. And then, because we have such integrated EHR, we have one EHR across our health system, really making all the protocol changes in that the whole health system against that in one go.

 

You know in that sense we’ve been lucky that we’ve been integrated our EHR across the health system. And it’s not EHR the entire consult platform. It’s one thing, you know, we have one everything, not multiple system and definitely help our hospitals. That allows us to be very nimble and we’ll make a change to that.

 

And the other pieces really, analytics. I’m sure every institution leadership, want the data to be able to decide or how many patient came through, what was tested. So, we quickly developed a dashboard and that team is very season again and analytics of dashboard we delivered to leadership. The dashboard, they need to have information at their fingertips to make decisions. 

 

All of these things I think you’ve got to move in the same cylinder and get every team resources are key to kind of deliver these needs where your leadership meet information leaks data and real time can make decisions.

 

[0:11:10.0] BR: Yeah, I was going to ask you about your build team, your EHR build team and if they’ve been asked to do anything specific. I was going to ask about analytics. But from an analytics standpoint, let’s delve into that a little bit. What kind of things did you put on the dashboard and what kind of things are you being asked for in addition to that dashboard from your analytics team?

 

[0:11:32.7] NM: Well, it’s clearly that you know, how many patient come through the door and, who is in ICU bed and who is recovering, who has been tested. The condition of every patient, volume across each hospital, number of visits, you know. Ventilator counts, so a slew of things that leadership is going to look at it real time every day and every moment and to be able to have that information. Those are the main things.

 

And then we also trending the data, seeing every day, how things trends across different emergency rooms. And then the inpatient, clearly telehealth volume and various other aspects that we are measuring.

 

We are at that, one interesting now is tell people that advice as you’re developing these dashboards quickly deliver the metrics and add the next one. You don’t have to build all of them at once and deliver. Just as much as you can deliver and let it validate it and let – clearly partner with hospital operations and leadership and conditions to make sure that the data is validated quickly and make sense. 

 

And then you know, deliver these metrics very – you know, every day because in leadership on metrics. Will be happy and so, don’t wait to do everything, get to the main things and then keep iterating.

 

[0:12:58.9] BR: Yeah absolutely. Your build team and your build team around EHR there is a whole bunch of codes being thrown at us. There is a whole bunch of potentially different screens tracking for OMC, CMS and others and CDC who want information. Has your team been busy trying to incorporate that? What kind of work are they doing right now? 

 

[0:13:26.3] NM: The team is very busy. First of all, we most focus on how we serve our patients and listen to our clinician, their needs, what kind information they need on our EHR screen console we deliver that integrated screen that has a good level of information. One of the things we good preview that our informatician physician also work on the smaller now they are doing shifts. 

 

So, it is getting good information inside about what is happening.  And how people are looking into our information and what are some of the things that we can adjust? So that has been very helpful because these are our informatician and the information part of the IT actually also doing shifts on the floor. So that – and also doing some telemedicine visits. So, we’re adjusting.

 

And then we continue to again work with state and federal government and making sure that we are providing the data with either also our EHR vendor as well. 

 

[0:14:25.5] BR: Yeah. I mean when you are in the thick of it, it is important to be focused on the clinicians, on the patients and serving them well.  Last question and I appreciate all the time you have given us. What is one thing in the prep process that you wish you had done earlier on some systems that are getting ready for a search and maybe they have a little bit of time to do something at this point. So, is there one thing you wish that you would have done maybe earlier in the process? 

 

[0:14:53.9] NM: I will be very honest. And it all sounds strange but no as I said we have been having this structure in place so we exactly know when we are connected how to start organizing, team reacting and making sure that people understand. And then also taking care of the employees themselves and making sure that they have access to the system and they’re safe. 

 

So, I think that you have to be prepared. You have to have a structure. So, if you not have a structure in place about communications, you know have that structure in place so you can communicate rapidly with your team and there is a structure. 

 

So, one thing I would advise to give is if they not have that in place and they don’t know how “People could get engage, how do information get this to me and how do you communicate?” So, for example when we prepare for people working from home some of our non-essential stuff work from home, of course our clinicians working in the hospital but you know we needed to get people information about, “Hey, if you are using your computer from home this are helpful hints and tips and how do you use WebEx effectively.” We got it as the lead information very quickly to people so that you know some people may not have used WebEX or Zoom technology in a while and we have to send them quick tips and also a lot of these get very large and people have a different way to manage and how do you meet people quickly so that you get people can hear it?

 

Little of things that people really appreciate that you give them a hint before so to have those things information prepared so that you can make people stay productive. So those are some of the advice I would have.

 

But you have to have a structure in place. You know if you don’t have an emergency call number that everyone could get on and then in second notice then you’d have a bigger problem. So, for us it is if I wanted to get my leadership on a call there is no “Oh here is a number,” People know it is an emergency call, P1 they call it and everybody gets on the call. 

 

[0:17:04.2] BR: Yeah. 

 

[0:17:05.2] NM: It is in everyone’s program, everyone’s phone or calender. 

 

[0:17:08.1] BR: You know again, I think you guys have benefited from – I mean it is hard to say you have benefited from going through disasters but you do benefit from going through them and learning things and being prepared for these kinds of things and I appreciate you bringing that experience into this crisis and being a part of sharing that with our audience I really appreciate it. 

 

Thanks again, I really appreciate your time. 

 

[0:17:40.0] NM: My pleasure. Thank you. 

 

[END OF INTERVIEW]

 

[0:17:40.9] BR: That is all for this show. Special thanks to our sponsors, VMware, StarBridge Advisers, Galen Healthcare, Health Lyrics 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 an email, DM whatever you do. You could also follow us on social media, subscribe to our YouTube channel. 

 

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

 

[END]

 

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