Rochester Regional This Week in Health IT
May 4, 2020

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May 4, 2020: As we continue our field reports with those on frontlines around the country, today’s guest, Tony Alongi, System Director of clinical engineering at Rochester Regional, joins us to talk about how his organization is handling the crisis. In this episode, we learn about the community they serve, as well as their technical team’s structure. While there has not been an uptick in security threats as a result of COVID-19 at Rochester Regional, they have run into some other issues around ventilators and increasing ICU capacities. Tony shares more about the innovative solutions they have come up that allow doctors to better monitor patients while reducing the use and burn rate of PPE. Along with this, we also discuss the sharing ventilator network Rochester Regional is a part of. It’s always great to hear different perspectives from hospitals across the nation. Be sure to tune in today!

Key Points From This Episode:

  • Find out more about Rochester Regional Health and the community they serve.
  • The structure of Rochester’s technical team and how they handle clinical engineering.
  • At Rochester, COVID-19 has not brought about specific security threats.
  • How Rochester Regional has handled scaling while ensuring security.
  • Learn about Rochester’s ‘tele-ICU’ and other innovative COVID-related solutions.
  • How Rochester has dealt with sourcing ventilators and the network of sharing them.
  • A project Rochester Regional worked on with Xerox and Rochester Institute of Technology.

Field Report: Rochester Regional Health

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Field Report: Rochester Regional Health

Episode 240: Transcript – May 4, 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] DD: 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.

Are you ready for this? We’re going to do something a little different for our Tuesday news day show next week, we’re going to go live at noon Eastern, nine AM Pacific, we will be live on our YouTube channel with myself, Drex DeFord, Sue Schade and David Muntz with StarBridge Advisors to discuss the new normal for health IT. With you supplying the questions with live chat, also, you can send in your questions ahead of time at [email protected] I’m so excited to do this and I hope you will join us. 

Mark your calendar. Noon Eastern, nine AM Pacific on April 28th. If you want to send the questions, feel free to do that and you can get to the show by going to thisweekhealth.com/live. 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. 

[0:01:24.9] DD: Hello everyone and thanks for joining This Week in Health IT. I’m Drex DeFord, CI Security’s Chief Healthcare Strategist and president at drexio innovation network. Today, we welcome Tony Alongi, System Director of clinical engineering at Rochester Regional to This Week in Health IT. 

Thanks for being with us here today Anthony. I know you’re exceptionally busy, and we really appreciate you being here.

[0:01:49.6] TA: My pleasure. Thanks for having me.

[0:01:50.7] DD: Yeah, for sure. Tell us a little bit. Maybe a good way to start us. Tell us a little bit about Rochester Regional and you and your team, and I’m sure everybody really wants to know how it’s going with the COVID outbreak there and the work you guys are doing right now?

[0:02:07.7] TA: Sure.  Rochester Regional Health is a five-system hospital network. The flagship is Rochester General Hospital and Unity Hospital, which are metropolitan areas and we have three others in the rural area. We’re probably 50% of the market in the upstate New York Finger Lakes area. The other is the University of Rochester and they have a similar type of organization, although be it, they are a teaching hospital.

We’ve been together since 2012, we started merging when probably half the country was merging hospitals. We finalized that at the end of ‘12, early ‘13. And been developing and growing our organization since then.

[0:02:56.0] DD: Got it. Tell me a little bit about your team and even a little bit about your background?

[0:03:01.0] TA: Sure. I started with the organization back in 2003 and worked my way up to system director about three years ago. I was a supervisor for maybe, since 2011 before prior to accepting the director’s role. We are organized with our system director, the supervisor and about 20 technicians. And we provide the sourcing for the labor and the clinical engineering work of ensuring the safety, reliability, and effectiveness of the medical equipment for the system.

[0:03:42.2] DD: Got it. You do most of the clinical engineering work in house? You have some contracts. I know every organization sort of organized differently on that.

[0:03:50.7] TA: Yeah, we’re a blended organization. We try to do as much in house as possible. We have an imaging team, although we don’t have a separate category as you would higher up in the ladder, so to speak, you have a technician on senior and you have a senior with imaging.

And so, we do a lot of biomed and imaging work. Some of those technicians have specialized training with our vendors and we have an in-house agreements. We have some OEM contracts, depending on if it’s not worth it to us, from a cost standpoint or manpower standpoint. And we do use some independent source organizations because they might be cost effective and provide similar quality to the OEM’s.

But we just try to maximize our team and our resources to get the best, cost-effective, we have an achieving our goals.

[0:04:50.7] DD: Totally makes sense, it sounds like you guys have a great strategy, a great plan. I know you’re mostly focused on medical devices and medical equipment. In that space and given the relationships you have with your partners, what are you all seeing in regard to threat activity during the pandemic? What’s got you worried and what have you been sort of really alert on?

[0:05:17.4] TA: Well, I don’t think we’ve changed a whole lot, compared to what pre-COVID life. That team, in the IT team that’s specialized security group, they’ve been working very diligently over the last few years to cover up what they call the penetration points. Looking at all of our policies, as you know, clinical equipment is nowadays tied into a network, whether it’s through your EMR or through your internet or telemedicine et cetera. They’ve been working diligently to ensure that safety and it slowed things down a little bit.

It can be frustrating when you want something done right away, you got to go through this process of BAA and answer all these questions to make sure there’s no chance of personal health information or protected health information. Getting into the wrong hands.

In respect COVID, I haven‘t heard of any particular threats for our organization, that may be because they were keeping it close vested or there really hasn’t been much more activity than normal.

[0:06:24.8] DD: Okay. Generally speaking, too, there’s been sort of this crazy amount of health IT activity over the past month. Tell me about some of your ventures and clinical engineering at Rochester and you know, how you’ve been able to keep security integrated and that whole process because I’m sure you have been juggling a lot of balls?

[0:06:47.3] TA: Yes. Good question. Because it happens fast and there’s no time to wait and do it the ‘right way,’ right? In the old days, things were done very quickly. The term, ‘stat’ comes up. By nature, IT doesn’t work that way in my experience. It’s, “Okay, hold on, let’s scope it out, let’s figure out what’s going on, where are the risks?”

So, we had to do that much quicker. Fortunately, we have a process in place and a network that is easily adaptable to growth. As we manage it, we don’t have outside vendors managing it, even our patient monitoring network, which is where GE house. We use what is known as an EV land, meaning that we own it the architecture and then we manage it. The only areas where I think there was some struggle is in – we wanted to develop a video system for traditionally non-ICU floors. We had to create space, right?

[0:07:55.1] DD: Like a tele-ICU kind of workaround?

[0:07:59.1] TA: Yeah, normal ICUs they’re open or they have glass and you could have one on one’s. So long as we needed to expand the type of care to nontraditional ICU floors. You close the door, keep the COVID in there but you can’t see the patient. You’re monitoring the vital signs. We wanted to be in a leadership – you need to see that. 

We worked with our contractor who provides our security cameras and set up some IP cameras so they can view the patient without going in. Done a lot of that kind of remote interface and maybe longer cables, push the ventilator into the room, closer to the patient and keep the interface degree outside through a cable that’s longer than traditionally available.

[0:08:48.2] DD: So that person there doesn’t have to go into the room? Yeah.

[0:08:51.3] TA: Yes, so we reduced the use and the burn rate on PPE and reduced the exposure risk. 

[0:08:57.6] DD: Makes sense, great innovation. I mean I think everybody has been thinking outside the box this whole time about how to – I mean especially when PPE started to be the challenge, people really got innovative in ways to extend the life of the stuff they had on the shelf and use it all up. 

Have you had to add a bunch of new ventilators or have you gone through that drill and how hard was that and was there any issues around working cyber security parts of that adding new equipment really quickly? 

[0:09:38.9] TA: So, I am not sure how affected cyber security. But to the first part of your question, as we started to see what was happening in New York and the first few cases became public and it went upstate a little bit, in the New Rochelle area and reporting, some reported cases in our general area, which is Rochester, some people came from Italy that they got out and they were healthy might have had exposure.

We started to look at what was going to happen by using those models, how that would work so we immediately reached out to see what we could buy and what the cost was, what kind of funds we had and we looked at renting. And so, we were one of the first people to grab available units that were the similar model that we are used to using. So, we grabbed about 10 of those, we looked at third-party repair shops across the country that have them for sale and we bought a handful of those but it started happening really quick. 

So, we thought we were ahead of it. We were only ahead of it by 24 hours and then it just blew up. So now it became very crowded and very you know – 

[0:10:47.5] DD: Chaotic, right? 

[0:10:48.5] TA: Yeah exactly. 

[0:10:49.2] DD: Yeah like a bidding war. So, you guys just got in right in the nick of time?

[0:10:53.6] TA: Yeah, so some of us were a little bit ahead of it. Some of the leadership is lagging a little bit because they were trying to figure out how we were going to manage this through an incident command, should we do it by the local hospitals? Should we do it centralized? And as that few days went by, you went from, “We can get you these items in a couple of weeks,” to six weeks, eight weeks, 10 weeks, 15 weeks, 31 weeks. And so, we got behind the eight ball. 

And understandably so, New York City needed this stuff probably more so than we did. We are prepping, they are buried, they are underwater. And as you can – everyone knows if they are watching the news what have happened since in the area, whether you are watching the Governor was talking about sharing and developing a network of sharing healthcare equipment and so forth.

And even the vendors stepped up and said, “Look, even though you may have had this order in for a project down the road, we are not going to ship you that stuff and send it to them and we will take care of you after this is over.” 

[0:11:59.8] DD: Are you part of that network? Have you all had conversations about how you would wind up ultimately shipping and sharing devices with another organization down the road? 

[0:12:12.6] TA: Sure. So, we are working with the leadership, the executive leadership and the Chief Medical Officer. We identified what we are using currently. Our current rate of infection went from doubling every four days to eight days, which was good. Some of the distancing and mitigation strategies may be working or the virus is slowing down for whatever reason. We have identified what the percentage of units we could give to the state to be used along with anything else that we have that was in surplus at the moment with the understanding that when it dies down on that area or they get a handle on it and if it were to peak in our area, we would then be afforded to be same courtesies. 

[0:12:56.5] DD: Right, yeah. Tony, thank you so much for your time. I always try to give everybody that we interview the opportunity to tell us anything else that I didn’t ask because I don’t always ask all the right questions. I try to just put it out there. Is there anything that you want to tell your peers across the country, healthcare across the country, stuff that you have done that you think they would find useful or interesting or anything else that you want to share?

[0:13:25.6] TA: Well, first, just to apologize, I didn’t have a whole lot to contribute to the cyber security world. 

[0:13:32.8] DD: Oh no, you’re great. 

[0:13:33.6] TA: Because we are collaborators with that group. With respect to some of your other questions right at the end, one of the things I’d like to share is the idea of collaborating and innovating with your local universities. We have done that with Rochester Institute of Technology and Xerox. Xerox, their headquarters and factory is here in Rochester, New York. 

So, the three of us got together, it is the University of Rochester, Rochester Regional Health, RIT and Xerox to modify what is known as the Go Vent. It is a portable vent used in emergency situations. It is kind of the one you put on to wean you off of a more sophisticated critical care event or a step to that. So, we are going to be increase it so that it can be used, we are going to increase the peep on it with using their design capabilities at RIT and the manufacturing capabilities at Xerox to manufacture an improvement to that Go Vent. 

[0:14:35.5] DD: That’s amazing. You guys have done this in a pretty short order then, right? 

[0:14:38.2] TA: Oh yeah, we were super-fast with a two to three-week turnaround. 

[0:14:41.7] DD: That is incredible. So how hard or how easy was that? I mean it sounds like everybody was just all hands-on deck. 

[0:14:47.3] TA: Yeah, exactly. So, we from the medical community provided the medical input, the RIT reversed engineered using and then did the prototypes using 3D printing. And then the manufacturing people, when you told them to come with the manufacturer and that’s what they do so. And it is not a big blown electronic device. It is pieces of plastic but they have to be constructed in such a way that it allows the flow of air to act.

[0:15:19.7] DD: It seems like 3D printing has blown up in all of this too. Have you done any other 3D printing for other uses or other components that you had to sort of invent?

[0:15:29.7] TA: Yes, so it is hard to source the part especially when it’s at end of life sunsetted and you can’t get parts for. We have done some of the things like that mostly covers because you don’t want to get into violate – 

[0:15:42.5] DD: Oh right.

[0:15:42.7] TA: FDA 510(k) issues and so and we have dealt with shields for a short period of time because our capacity is low. So, until other manufactures could pick up the slack, we helped out here and there. 

[0:15:57.4] DD: Got it. Hey again, I know your time is exceptionally valuable. I really appreciate you taking the time to share observations and best practices with us, Tony. Thanks again very much and thanks for being on the show. 

[0:16:12.2] TA: Well thank you too and thank you to everyone out there. I appreciate you having me on. And I tell this to everyone during this time period is to endeavor to persevere. 

[0:16:21.8] DD: Endeavor to persevere. Thanks, I’ll talk to you later. 

[0:16:28.2] TA: All right, take care. 

[0:16:30.4] 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, DM whatever you do, however you do it. Go ahead and do that and that would benefit us greatly, we appreciate your support. 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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