University Hospitals This Week in Health IT
April 6, 2020

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April 6, 2020: Today we bring you another field report where we talk to health system leaders on the front lines, now especially as they have to navigate the COVID-19 crisis. This interview is with Robert Eardley, the CIO of University Hospitals in Cleveland. What emerges strongly from his conversation is that health IT is performing like never before and managing to come up with solutions in record time, which of course has raised the standard and is changing the expectations around what is possible in the future. Robert mentions, in particular, the smooth transition from office to home-based operations and how efficiently they have been able to do screening and set up their call centers. He talks about how they are preparing for the expected surge in COVID-19 patients, the requests they are getting from the health system, how they have been serving by providing telehealth and analytics solutions, and much more.

Key Points From This Episode:

  • Learn about the University Hospitals health system and the community they serve. 
  • What they are doing to prepare for the surge of COVID-19 patients. 
  • The process of pre-building beds within IT applications. 
  • What the health system requires from health IT, including work-from-home solutions. 
  • How they have been serving the health system by addressing telehealth challenges. 
  • Hear about their analytics journey, how the requests have shifted, and the software they use. 
  • How the outstanding performance of health IT is changing what will be expected in the future. 
  • The aspects of their capabilities and organization that has most surprised Robert. 
  • More about how their call centers are set up and the communication platforms used. 

Field Report: University Hospitals CIO Robert Eardley

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Field Report: University Hospitals CIO Robert Eardley

Episode 218 : Transcript – April 6, 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 podcast, 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 reports, it’s really easy, just shoot me an email at [email protected] Now, on to today’s show.


[0:00:55.0] BR: Today’s conversation is with the chief information officer for university hospitals in Cleveland, Robert Eardley. Robert, welcome to the show.


[0:01:04.2] RE: All right, thanks for having me.


[0:01:06.7] BR: I’m looking forward to our conversation, I know you guys are all real busy right now in preparation and coordination so we’ll just get right to it, we’ll have to do the niceties at a future time when things slow down a little bit.


But before we get started, give us a little idea of University Hospital, what’s the community you serve and what’s the breath and size.


[0:01:28.7] RE: Sure, we’re a large health system in north east Ohio and we largely serve the greater Cleveland community extending down to some of the city south of Cleveland proper, we have 14 hospitals, really over about eight different campuses and there’s health centers and emergency rooms about little over four billion of net revenue just to give a sense of size.


[0:01:54.3] BR: Yeah, that’s helpful.  What are the kind of things that are going on at this moment in time to provide us a little context that you guys are doing for the communities, that you’re doing for in preparation for a potential surge in COVID patients.


[0:02:10.8] RE: Well, you know, with the like many health systems, this coronavirus is really shifted from a couple of weeks ago where it was really center around the screen tents and the testing centers, getting those operational to now it really is all about the surge. 


It’s a lot of planning and preparing as we sit here now on April 1st, there’s predictions somewhere between April 15th and May 15th, somewhere in that window and so we are working with our operational partners really to make sure that we are prepared, should that surge come or maybe if or when that surge comes. From an IT perspective, largely what that means is prebuilding all of the beds in our IT applications, our EHRs.


We want to be able to be operationally ready that if we have to execute, we could be ready within 10 hours or so, half a day, be able to make those beds available.


[0:03:12.1] BR: Yeah, give us a little idea of the process of doing that. I know that some people have struggled with that.  Is it as simple as creating a template and then replicating it or is it a little more complex than that?


[0:03:25.4] RE: You know, that’s generally the case, it’s trying to plan out in certain units that we would have a surge bed one, surge bed two, surge bed three. Each of our campuses, we’ve created three different surge units. I think each of those surge units have 30 beds each, I’m not exact on that but that’s the spirit of it.


We have a different scheduling and registration system than our hospital based EMR and it’s different than our bed tracking system. We have those beds built out in for us, it’s an assortment, we have those beds can flow to – we have an all script sunrise product and we also have those in our tele tracking that management application. 


With those as the three primary, we then can connect ventilators, we then can have documentation prepared so that we can take care of our community.


[0:04:22.5] BR: Wow. You’re dealing with a bunch of different EHR products and solutions. Talk to me a little bit about going off script already, I apologize. Talk to me a little bit about what is the health system asking of health IT right now, obviously, making sure that the prep is ready for the surge, telehealth obviously, work from home, other things they’re asking you for analytics, other things, other areas?


[0:04:51.7] RE: There is, we have in our IT help desk software, we have service now so we’ve created our IT pandemic dashboard, we’ve got about 75 items that we’re tracking on that right now. It does run the gamut and so early on, it was the screening centers and then the work from home. 


We had to deploy a lot of laptops, we had to connect folks that were not typical remote users and so, as of about two weeks ago, we were able to pull both of those off pretty well, get people situated so they can be effective working remote if their job allows for that. It’s now shifted to making sure that we can manage the call centers and so call centers virtually rather than physically is also kind of a special operational item, different than when you have everybody in the same building so we’re supporting our operational partners from a unified communication perspective.


And then, from the IT applications we mentioned before they kind of the surge planning. Two rather big domains that we focused on is telehealth and analytics and so I’ll come back to those each separately. In telehealth,  we’ve had a long time partner in MD live who is our traditional kind of telehealth provider.


But given the intense needs over the last two weeks, three weeks. We’ve shifted, we’ve leveraged the MD live traditional avenue but we’ve also now set it up so you can use our standard EHR applications and still have a video visit, what that means in our world is we register in Cerner, story in as I mentioned, in our practices as well.


We have 2,700 employee providers that we manage the IT for, they register in Cerner thorium, they schedule an event in that registration system and then they document in an all scripts product called TouchWorks. The care is documented in TouchWorks, its’ a scheduled event that gets built out of the Cerner product and then the uniqueness is that we’re using what we’re calling a visual communication channel that either is MDLIVE itself or its Webex or it’s Zoom or it’s Facetime and we’ve actually offered a lot of flexibility to our practices in that and we’ve offered our support to get those connections in any way possible, taking the guidance the way we got from the CMS that as long as it’s one to one, rather than published publically on the Internet.


Most of those are deemed as sufficient for the moment. That’s where we freed up our practices to conduct a scheduled visit and then they would use one of these products, we also have Cisco Jabber and many of the practices used to create connection to the patient and then they document as if the person’s sitting there with them.


[0:07:59.1] BR: Talk to mea little bit about the analytics journey. I’m sure there’s a lot of request for key metrics and tracking of various things I would imagine.


[0:08:10.5] RE: That’s true, that’s been one of those other, second domain that really has kind of come into its own here and so early on, it was a lot of internal operational items. As far as the metrics on where we have things. The number of screening exams that we’ve tested and the number of employees that we’ve tested, the number of successful or positive COVID test.


Those were a lot of the original request.  Now, the request shifting to a number of the federal governmental agencies have series of request out there, they’re looking for aggregation of number of hospital beds, how many are occupied in the White House CMS and HHS and others have really kind of had a drum beat of request to the healthcare community.


We’re a partner in that either submitting to the state of the federal agency. In our analytics, we have Tableau and Power BI so those are two different visualization programs and so we’ve worked with our operational partners on building out some Power BI dashboards for the purpose of tracking and then lastly in there, we had a special request to use the ArcGIS mapping software, we wanted to understand where in the community are the hotspots for all the tests who are positive tests and so, we have been able to about a few days implement this ArcGIS software. 


We’ve got some folks internally that had some experience using that and so they quickly took the extracts that we supply to them and then put it on a graphic or geographical heat map where all the addresses are for positive and negative screening exams. 


[0:10:02.6] BR: Yeah you know what is interesting as I hear you talk is just there is two thoughts in my head. You know it is like the devil and the angel on each shoulder that on the one side, they angel is saying, “Oh my gosh look at all the things that IT has been able to do in such a short period of time, isn’t this amazing? Isn’t this wonderful?” and the other side is like, “Okay, well that changes our expectation.” 


For all IT projects moving forward, you know it is like people are going to come walk into your office after this is all over and go I want something amazing done and I want it done in three days. You know what are the kind of things that you have been surprised that we have been able to do or your team has really been able to do over the last four or five weeks? 


[0:10:41.9] RE: Yeah, you know I think the shift from work from home on a large scale has been – has occurred without any hitches as I might have expected. I might have expected more of a run on laptops or might have expected more instances where maybe we are offered what people don’t have internet at home. So the fact that that shift occurred really without any large scale hitches, I was pleased with that. It is very natural for us in IT that we work from home or we work remotely. 


But for large users of folks that normally come to the office to man the call center and answer billing questions or to schedule appointments you know they don’t always have the same technology capabilities that we might at our house and so I was pleased with that. The other item that was a surprise to me and it was a positive surprise is the efficiency and the way that we chose to do our screening process. So for us here at University Hospitals we chose to set up a call center. 


A hotline for COVID, a physician when they wanted to order a COVID screening exam, they would actually call the hotline, walk through the patient system symptoms and then the hotline would enter that screening exam as an order in our laboratory product. At first that sounded inefficient to me but overtime, over about three days I started to see the wisdom of it because they were able to match a bit the demand with the capacity that was available for these screening exams. 


So what we were able to stir away from was having everybody order the screening exam and us not having enough supplies and then you have patients out there with open orders. They can’t get the screening exam in a timely manner and then there would be missed expectations. So we try to balance that like a lot of health systems. The first priority is the intensive patients inside the acute care setting most notably the ICU and then it gets triaged to the folks that are highest risk. 


And then the elders and so having this phone-based line and the efficiency of it was admittedly a surprise and then in our screening process, the other efficient surprise for me was with that phone based hotline for our screening process as a patient or as a person drives up to one of our drive through centers they need to have a physician order and this is common with most health systems. But what we do is we have a person on the front that’s on the phone with the call center. 


And once they see the patient’s or that person’s license or information they merely have a phone line back to the call center to the same agent once they read off that patient’s information. The call center actually hits the print routine to the label printer that is sitting in the specimen collection area. 


So it is interesting, we don’t really have any computers at our screening centers. We just have connected label printers and those label printers are for the purpose of attaching to the lab specimen. 


[0:14:10.0] BR: It is interesting because one of the things that I have been hearing and I have been talking about it on the show is just to be creative and use whatever tech is available and that is a really great idea because I heard people trying to stand up wireless and doing all sorts of crazy things for some of these remote locations but that gave you a lot of flexibility in terms of where you could place all of these things doesn’t it? 


[0:14:35.0] RE: Well it does and so it gives us a lot of flexibility because we really nearly need a phone up at the front, you know consider it two stations. One is the verification that the person has a physician order on file and then the second is the actual screening location where they are going to swab your naval cavity and so because we had it designed in this way up at the first station they really just need a phone and they hold a constant phone connection to the call center agent, the hotline. 


They read off the patient’s information, the hotline can either confirm there is an outstanding order. Every once in a while there is not, right? People wait in line and they hope to get an order once they are inline but if the hotline validates they have an order then they push a print routine. We happen to use soft lab where they push a print routine out to a network connected printer that sits at the specimen collection tent and so the caregivers and the specimen collection area just pick off the label and await for that patient to drive up. 


[0:15:51.0] BR: So let me close out with this. I want to talk a little bit about your call center. So are any of your call centers still operational with people like sitting six feet apart from each other or have you pretty much dispersed most of those to be geographically dispersed? People working out of their homes and your call routing to them specifically? 


[0:16:13.2] RE: Yeah, I think largely dispersed. We do still have our buildings open. So I think on some cases where an individual might not have connectivity at home, we still have our buildings open and in those cases we do take daily temperatures of the folks entering the building and do a screening for everybody who enters the building. In our state that is a governor’s request to do that if you are continuing to operate the building. 


But to my understanding the capacity or the attendance in that building is quite low now, most people have gone virtual. 


[0:16:49.2] BR: So how are you able to do that? I assume you had some voip solution that you could redirect these calls and still utilize your call center software to track things? 


[0:17:00.5] RE: That’s right. So in our case it is largely a Cisco based unified communication platform. So we have Cisco call manager, we have collaborator of call recording and so we largely have continued that operation without too much disruption because we have a soft phone that works on a computer. So we have a Cisco soft phone that rings and so as long as the agent has a headset with the microphone they have access through their phone. 


They have access through their same phone number that they normally call into and because it is a call center there is this concept of agent on and agent off and so they are using the same software as if they were sitting in our office building. They’re just using it at home. 


[0:17:55.9] BR: Yeah that is fantastic. I know we have gone over and I appreciate your time and thanks again Robert. We will have to connect again at a later time, we’ll touch base. I love to hear some of the stuff you guys are doing. 


[0:18:08.3] RE: Okay Bill, thanks for connecting. 


[0:18:10.6] BR: Thank you. 




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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.




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