VUMC Vanderbilt This Week in Health IT
April 8, 2020

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April 7, 2020: As we continue our field reports, today, Neal Patel, a physician and CIO at Vanderbilt University Medical Center, joins us. In this episode, Neal walks us through some of the incredible technological shifts that have happened at VUMC over the past few weeks. From Zoom calls and virtual town halls to a massive spike in telehealth visits, the changes have been inspiring. Not only have the patients responded incredibly well to the televisits, but the clinical staff has as well. Neal also unpacks the different forms that telehealth can take, from telediagnostics to telemonitoring. While not all of these have been implemented at VUMC, they are becoming a greater possibility as time goes on. Along with this, Neal has been incredibly inspired by the willingness to collaborate across all teams. People who are not usually at the center have been thrown into the fray and the camaraderie has moved Neal. We also talk about the importance of not having heroes during a time of crisis, changes with VUMC’s patient portal, and lessons that Neal has learned from the pandemic so far. Be sure to tune in today!

Key Points From This Episode:

  • Background on Vanderbilt University Medical Center, areas they cover and patients per year.
  • Why Nashville was able to head the warnings of coronavirus early on into the outbreak. 
  • Some of the technology that VUMC has spun out over the past few weeks.
  • Different procedures that fall under the big umbrella of telehealth. 
  • Positive changes with physician-to-physician communication at VUMC.
  • How the VUMC has responded to remote working and details about their virtual town halls.
  • One of the most valuable lessons VUMC has learned regarding telehealth.
  • Changes in the online patient portal since the crisis and how the portal functions.
  • Two things that Neal has found most impressive from his teams during this time.
  • How VUMC has show collaboration and camaraderie in their different command centers.

Field Report: Vanderbilt University Medical Center CIO Neal Patel

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Field Report: Vanderbilt University Medical Center CIO Neal Patel

Episode 221: Transcript – April 7, 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 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.


[0:00:55.4] BR: Today’s conversation is with Neal Patel, physician with and CIO at Vanderbilt University Medical Center. Good afternoon, Neal. Welcome to the show.


[0:01:04.4] NP: Thank you very much for having me.


[0:01:08.0] BR: I know you guys are all very busy so I really do appreciate the time. We’ve been meeting with a bunch of CIO’s and executives, talking about the preparation. And I just like to really just get into it but if you could just give us a little background on the University Medical Center, what area do you guys cover, what geography and a little background, that will be great.


[0:01:34.2] NP: Sure. Vanderbilt University Medical Center is on the campus of Vanderbilt University in Nashville, Tennessee. We really cover the middle Tennessee area. we have patients come again from southern Kentucky as well as northern Alabama, some form Mississippi. Tertiary, ordinary academic medical center. We have a close to a little over a thousand beds with an adult hospital, children’s hospital and a psychiatric hospital on site. We average about 200, sorry, the average about 50,000 discharges a year and about 2.2 million ambulatory visits a year.


[0:02:15.7] BR: Wow. Yeah, Nashville was actually one of the areas that was starting to really escalate, has that continued or is it – 


[0:02:27.9] NP: The good thing that we had was because of our clinical leadership in infectious disease and vaccine development, the worry of coronavirus was actually headed early. We actually started testing for coronavirus fairly early in our city. And so we’ve done a lot of tests and confirmed cases have risen. But the good part has been that thus far, we have not seen the onslaught into our inpatient environment. We’ve been preparing for the past several days weeks in a variety of ways to be ready for it. 


But we initially, our focus was to get rapid assessment centers and testing out there. Now we’re following close to five to 600 patients and as outpatients to follow their symptoms and hopefully keep them at home. And we’re preparing our inpatient facilities to respond as the numbers of inpatient admissions Rise.


[0:03:31.1] BR: Yeah, academic medical center, you probably had a fair amount of technology in place. What new technology have you spun up over the last couple of weeks to address the needs?


[0:03:41.8] NP: Sure. Well several things: while we’ve had technology in place, it wasn’t leveraged as well as it has been in the past several weeks. First and foremost, is what we’re doing now, teleconferencing, using Zoom and every other type of platform has rapidly increased and everybody is saying that around the country.


We have, obviously as many other medical centers, have really transitioned clinical care in our ambulatory environment to telehealth. We had the integration we’re an epic based EHR system here, we’ve had that in place for the past two and a half years. And we had our integration with Zoom and Epic for outpatients to the patient portal. But whereas we average maybe 10, 20 appointments a day now we are averaging about 1,500 to 1,600 telehealth visits a day, direct to patient.


[0:04:41.3] BR: Isn’t that amazing?


[0:04:43.9] NP: It’s amazing how obstacles fall away when it’s the only thing you can do.


[0:04:47.6] BR: Yeah, there’s a lot of different kinds of telehealth and I’ve really been pretty lax on the show to – but there’s obviously the remote visits is important. There’s also remote patient monitoring is another aspect of that. Do you guys have any of that going on at this point?


[0:05:06.9] NP: Not yet. I kind of – I agree with you. We have been playing with the telehealth wheel for a while and telehealth is the big umbrella. And there’s really televisit, where you’re interacting with a patient face-to-face. And so, it’s kind of like an ambulatory visit. There’s also things like telediagnostics which go forward, whether it’s EEG’s or pictures of retinas for diabetic retinopathy and those sorts of things.


And then as you said, telemonitoring. We haven’t really got into that space as much. We have other tools that we have access to be able to visualize the monitors remotely and we wouldn’t really classify that in terms of changing our apparatus, where we’re moving the provider from the bedside. It’s more of a surveillance and an oversight aspect by supervising attendee.


[0:06:05.6] BR: How much does physician to physician communication gone up via things like teleconferencing?


[0:06:12.5] NP: It actually has gone up remarkably well. We have been on the journey to do that initially with secure chat or secure texting to comply with the CMS regulations but now we have also are beginning to leverage and see if Microsoft Teams can be used to do virtual rounding and bring desperate people to the same location but also, promote social distancing or we should actually call it physical distancing, where individuals still need to collaborate on the care of patients.


[0:06:50.9] BR: You know, I love working from home. You’re giving me the full experience, I’m getting some background noise. Some things going on back there. You’re also using Zoom to its full capacity. People are just listening to this on the podcast, you have the background going as well.


People are taking to this pretty well. I mean, obviously it’s hard. We used to work in the office. We’d interact with each other. But are the staff taking to this pretty well? Are we figuring out ways to bring everybody together and sort of break up the monotony and help them to stay focused in talking with each other?


[0:07:24.1] NP: We have been and we’re learning as we go obviously. One of the big pieces that has been important for our health IT team. We have about 450 FTE’s that very quickly had to transition to working from home when they were in the office. And I’ve been impressed with how professional and diligent they have been. 


We have really utilized the communication platform and Microsoft Teams to keep people communicating with each other, keep statuses up to date. And really, it’s been interesting, whereas before, when we would have “Skype” calls where everybody would just dial in and was a glorified teleconference with the old telephone, it’s amazing how many more people are turning on their video because they want to see the physical interaction whereas we didn’t do it as much when we’re in the office but still, it was still a call with a bunch of remote people. That transition has been interesting. 


The other piece that we’ve done is we’ve held virtual town halls.


[0:08:30.2] BR: Yeah, tell me about that.


[0:08:33.2] NP: We held the two of them, the first one was right as we started to work from home the week after where everybody was kind of naïve to all of the actions that were taking place in the command center at the Medical Center and how do you get that sort of information to the front lines.


Emails or just giving updates into written form just doesn’t – isn’t enough. And so we were able to leverage our Zoom capability and the first kind of did an update with what was happening nationally as well as locally and in our medical center, providing the clinical background to our IT staff. We have 450 people on that town hall, virtual and it was amazing.


And we also use it for a little bit of fun. We had people submit pictures of their home work environment that they had to throw together and so with that amazing community, building out of that process as well. 


And then the post survey of that town hall, people actually begged for more and they said, “Gosh, it would be great if we had this weekly or every two weeks.” And so, we did another one this week which was two weeks later. And again, on this 460 people dialed in at 8AM which I found pretty impressive that there is a thirst for being together in some format and hearing a common message.


And so it’s been gratifying to know that our team could come together and people could share and despite all of us dealing with all of the various things that we have to deal with home life and worry about safety. 


[0:10:16.3] BR: Yeah, so over the last couple of weeks a lot has changed. What is one of the things that you have discovered that you were like, “This is a real good finding,” that might help others or just something that you might want to carry forward? 


[0:10:31.8] NP: Sure. I think most institutions are finding the fact that our frontline clinicians have transitioned to do telehealth visits where in the past they have never considered such an option. Now, obviously it is easier to do now because there is no other option and you are not having to switch back and forth between live patient visits and telehealth visits. But the fact that there has been very rapid up take and adoption of the technology with very little “teaching” or educating has been rather impressive to us. 


And it gives us the confidence that we can move quickly on certain things. And not to just let the enemy of good be perfect, which often times we get in trouble with in terms of trying to perfect something or perfect the solution before getting it out. 


[0:11:27.6] BR: Yeah you know I’ll say an acting CIO doesn’t have to say, “But there is a lot of barriers to telehealth before this.” I meant the compensation model that barrier came down. Even the security restrictions. We had  to go with very specific technology platforms the physicians quite frankly push back significantly, at least when I was trying to roll it out, they pushed back significantly on the fact that they had to do televisits, they had to do in person visits. Their workload was so – it wasn’t designed to really take digital into account. 


Well, all of those things happen to fall away over the course of what a week, two weeks? 


[0:12:09.1] NP: Exactly. And I think that is a start. If there are going to be silver linings around this horrible, horrible cloud that is one of them. All the factors fell into place to actually get over that activation energy that is required for people to at least try it. As some of these obstacles or barriers rise up, we are going to need to now but at least think about how to overcome them as we move forward. 


But the reaction from the patients has been the most impressive thing. The positive feedback that we are getting from patients has been absolutely tremendous and that sort of validation that the clinicians are hearing they are pretty profound.


[0:12:48.1] BR: Yeah, it is amazing. I just got off the phone with my mom. She is 80 something years old. She’s like, “I just had a televisit.” She was so happy because she listens to the show and she’s like, “I now know what you are talking about that was really good.”


 Yeah and I think that is what’s going to happen. The Net Promoters Score on this stuff is so high that people are going to go, they’re not going to want to go back so we have to pick up with that. 


[0:13:09.1] NP: Between the televisit and also, we had a significant up take of our patient portal, which is we had developed a home grown one before with the Epic. And just transitioned it but branding it the same. Just called My Health At Vanderbilt that is utilizing My Chart functionality in Epic. We are signing up 7,000 patients a week now. We are already closing in on 500,000 patients and now we’re skyrocketing because the thing we get each of our rapid assessment centers is that patients wouldn’t have to call in for their results if they signed in for the patient portal because their result show up as soon as it was resulted and that was incredible and people again found a reason to connect. 


[0:13:55.4] BR: Yes so it is more than just a record. You are giving them their results back pretty quickly. Can you schedule televisits through there and actually instantiate them through there? 


[0:14:05.8] NP: Yeah it is instantiated through the portal that is how we do all of the televisits using the platform. 


[0:14:11.9] BR: Yeah I know that at least back when I was a CIO one of my compensation goals was to get more people on the portal. This would be a great time telehealth and getting more people on the portal were two of the things I was compensated on. This could have been the perfect year for that. 


[0:14:28.9] NP: Exactly. 


[0:14:31.0] BR: But I think people are going to find that those tools that we have been talking about our Amazon moment or whatever, people are going to experience those tools and realize that the health systems have the capabilities. They have the digital chops to make this stuff happen. We just have to and I hope that is the message that get across the state and federal government is, if we get out of the way, if we move some of these things out of the way and now that people have experienced it, it will be interesting.


 You know I have framed some of these questions I think a little differently but talk to me about your team. What is one thing that your team has done that’s really just been amazing? 


[0:15:10.4] NP: Well, I will actually focus on two things. [0:15:17.7 inaudible] but we basically had to use the structure of our inpatient beds in ways to create core specific units in such. And the agility of our team to coalesce and partner with operations and be flexible because decisions would change from morning to afternoon depending on new findings or new understandings. And often times IT teams can complain bitterly when operations or somebody changes requirements after they already been down a specific path. 


But knowing that we all had to come together and be responsive, that level of collaboration has been just tremendous to see. And creating new reproducible models so that we just didn’t create a hero mentality of knocking it out just this one time, but everybody realizing that they are going to need to have this for the long-haul as we evolve and creating what I have always [0:16:18.3 inaudible] create a systematic approach dularity so we can do this and we can small fashion it without having to go through the same one path over and over again and reel on things and so it’s been tremendous to see the teams just embrace that. 


[0:16:35.5] BR: Yeah, you know this is the last question here but I saw Stanley McChrystal talk about what are the things you want to avoid in a crisis is heroes. And it is interesting because you would think the opposite because when we were growing up, we saw these stories of the crisis hits and the hero. But you know what he started communicating is you want more like NASA, a team of people solving problems, coming together. Operations, IT and whatnot.


And I am glad you brought that up because I think that is a key point to really getting through this and one of the things I mean if you could talk a little bit about that how the entire system has really come together around the needs of the community?


[0:17:17.4] NP: Oh absolutely. From our operation, from our enterprise leadership on down, everybody has command centers in every one of their institutions so it is a well-known term. But the key is how is the camaraderie and the collaboration within the command centers. But also the willingness to have robust discussions of what is the right path forward. And that is what I’ve been most impressed with between our leadership, between different leaders and experts. Because this pandemic bought together different types of individuals that usually aren’t in the center of the fray. 


Usually when you have a command center is because of the natural disaster or some sort of other issue. But in this to have our supply chain leader addressing things, to have our HR leader trying to figure out how to support staff and augment staff to have our infectious disease individuals having to rewrite policies on the fly and provide recommendations and get them communicated out.


But to see all of those individuals come together and just be in harmony in many ways, instead of each struggling to figure out how to work together has been just something to take pride in. 


[0:18:48.4] BR: Yeah, absolutely. 


Neal, I really appreciate your time. We will have to have you back on the show at another time you know maybe in a couple of months and we will see how much of this stuff stuck, you know? How many televisits are doing six months from now I think will be an interesting conversation. 


[0:19:04.8] NP: Well I’ll be glad to be back and report out and promise to be bluntly honest. 


[0:19:10.9] BR: I appreciate it. Take care. 




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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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