Health IT Coronavirus Prep with Monument Health

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Bill Russell / Stephanie Lahr, MD

Monument Health Stephanie Lahr, MD This Week in Health IT

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March 18, 2020: Our guest for this episode of our series on COVID-19 preparedness is Stephanie Lahr from Monument Health, who has generously agreed to spare some time to share what she and her organization have been doing in the last weeks to combat the outbreak. Stephanie explains how her area of South Dakota has not actually been touched properly by the virus as of yet, which has allowed some time for extra preparation, a luxury that others have not had. We chat about the stringent measures they are taking in regards to the community and providing information and support for staff and the public. The conversation also covers personnel at Monument and how they may bring in some outsourced help in certain fields, especially those in which there might be overflow at the moment. We chat about communication with vendors, the uncertainty of the future and how to go about keeping energy and spirits up with such long and straining hours. 

Key Points From This Episode:

  • The ways that Stephanie and her organization are helping the community around them. 
  • Regions that Monument Health is servicing and the nurse triage line they have set up. 
  • Keeping track of personnel and looking after the healthcare professionals. 
  • The possibility of bringing in outside assistance in areas such as IT.
  • How Stephanie is approaching conversations with vendors currently and her expectations.
  • Dealing with the uncertainty of the current moment; Stephanie’s measures for her staff.  
  • Daily meetings and making sure everyone is on the same page and has the agenda. 
  • Keeping morale and connectedness up in these socially distanced times. 
  • Recording important and helpful information for better access and dissemination. 

Health IT Coronavirus Prep with Monument Health

Episode 204: Transcript – March 18, 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.

[0:00:05.0] BR: Welcome to this week in health IT news where we look at the news in health IT. 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. 

This week, I’m doing, as you know, a series of interviews with health system executives who will share what their plans are for COVID-19 preparedness. If your system has a best practice to share, please shoot me a note at [email protected] and we will do a 10 to 15-minute Zoom video recording that will hopefully benefit the industry.

I want to thank Sirius Healthcare who reached out to me last week and ask me if they could sponsor a series of these conversations to help the industry prepare and I appreciate their foresight in this matter and their commitment to the industry that they serve.

Today’s conversation is with Dr. Stephanie Lahr MD. CIO, CMIO of Monument Health. 

 

[0:00:59.5] BR: Good afternoon Stephanie and welcome to the show.

 

[0:01:01.7] SL: Hi Bill, glad to be here.

 

[0:01:03.8] BR: I appreciate you taking the time, you are one of those distinct people that as the CIO, CMIO titles so it will be interesting got see what your perspective is on this but let’s – I know you’re busy, we’ll get right to the questions. First question is pretty general and that’s you know, what are some of the things your health system is doing to handle the COVID-19 pandemic for your community?

 

[0:01:25.9] SL: I mean, I think we’re doing a lot of the same things other folks are doing, particularly if you’re in the same situation as us. We do have cases in the state of South Dakota but no cases in our local area as yet so we are in the fortunate position to still be able to be thinking about forecasting and planning and making sure we have everything in order and being able to be proactive instead of reactive, some people didn’t get that opportunity so that’s been, we feel fortunate to be in that situation.

 

Really, our focus is on one, being prepared if something really significant comes our way and we start to see a lot of patients and how to manage that high volume, we are also working, you know, as a primary health system, as the only real health system in our community, people are looking to us for guidance on everything from should we close the schools, should we close restaurants to what should we be doing in the rest of the community for social distancing and how do we support that in addition to what are we doing for healthcare.

 

A couple of things, you know, we’re trying to be extremely collaborative across our region and find ways to be able to leverage these skills and resources beyond just what we have as a health system. As we prepare for having a large influx of patients in the acute care setting. In my mind, what has become extremely apparent, particularly if this is going to go on for some time is that we will be very reliant on the other providers in our area who do non-acute care, more ambulatory kind of clinic visits, the primary care providers especially in our community to really be the mainstay of keeping our community, as well as possible, preferably from the safety of their own home.

 

One of the things I am doing from an IT and informatics perspective is really working internally to figure out what are the tools that we can be providing for COVID specific kinds of responses. So I can talk about a few other things we’ve done there, then we also have another focus on what are the elements that we can deliver to the community, so that they can maintain their health while we are going through this problem and then a third element is what kind of collaboration and guidance can I give to smaller healthcare entities and practices across our community, who may not have the technology resources or knowledge or the time to be keeping up to date with all the changes that are happening so that I can help them figure out what tools might work for them.

 

[0:04:19.4] BR: This is an interesting conversation because you’re not in the throes of it. I just had a conversation with somebody who is in the market that’s really high volume already and they’re using things like face – they’re just throwing things out now, it’s like, we’re going to do FaceTime, we’re going to do this, whatever it takes to offload some of that stuff, to keep our caregivers safe.

 

But you have some time to plan and it would be logical about it, to build the coalition within your community. You’re not competitors anymore, you’re care for your region and for your state and build out those lines of communication with the state governments. Are you just in North Dakota or are you other states as well?

 

[0:05:06.5] SL: We are all of western South Dakota. We have a little bit in reaching in a few patients and reaching into Wyoming and then some into Nebraska. One of the things that we did do was we have a 1-800 number, a nurse triage line. That was stood up interestingly basically by IT. The organization had a meet and I think this is another thing that you know, as healthcare systems are trying to figure out what do they do, you take the resources you have and the knowledge that you have and you use them wherever you possibly can.

 

We had a need for nurse triage line and I have nurses that work for me. I am a physician so we said, okay, we got this. Not that we did it just by ourselves, it took help from across the organization but within a matter of five days, we stood up a 1-800 number, nurse triage line that’s manned 18 hours a day, mostly by nurses that are in IT and other corporate services, so we weren’t taking them away from patient care. 

 

Now, we can talk to patients from really all across, for sure, western South Dakota, we are talking with patients even in North Dakota and other areas because as patients become worried and they find a number and they think they have a resource, they call it. That’s totally fine. We are partnering also with our health systems on the other side of the state to make sure we have their information because if we see a patient or talk to a patient who is in their territory, then we give them those resources. As you mentioned, right now is not about competition or market share, it’s about community health and protecting the wellbeing of our public and that takes collaboration and we’re seeing a lot of that, it’s fantastic.

 

[0:06:56.3] BR: one of the things we’re seeing and I’m curious how you’re going to handle this is this aspect of the clinicians within the health IT or being reallocated, that’s one aspect, the second is, there is a – you’re trying to create safe environment for your clinicians because if the clinicians end up getting contracting the virus, not only can they not see additional patients, I mean, it just creates a significant problem and we’ve already seen that, we’ve seen that an ER York doc and now two nurses. I’m sure there’s others but those are the ones I read about this morning. 

 

How are you going to stay ahead of who is where because that’s one of the things that happens in a crisis, you just don’t know where everybody’s at and how many resources you have to put towards a problem. Have you thought through that problem?

 

[0:07:48.8] SL: Yeah, we’re working on that to an extent, trying to look at you know, some of our – even our time and attendance system can help a little bit with that, we’ve been looking at some other vendors that are in that space of trying to help us sort of keep track of where people are but it is challenging.

 

One of the things also that we’re sort of thinking about is, do you sort of need a reserve workforce or how do you tier things in, even from an IT perspective. For example, it takes desktop analysts for me to deploy hardware, particularly into clinical areas that we might – we stand up a new ICU if we stand up a new hospital unit, we stand up a new ED, I’m putting those technical team members into clinical space.

 

If they end up sick or quarantined or whatever, how do I make sure the next ED I have to stand up or ICU I have to stand up. I have the people to do that. We’re talking through things like do we have a group of people that you’re sort of tier one and you’re doing this work for this week and the other team members are not a part of that and wouldn’t have those exposures. So that if we saw something happen, we sort of have that second group of people who would be able to take your place while you may be out or being observed. Those are things that you have to think through, not even just in the clinical spaces but in the support spaces as well.

 

[0:09:16.9] BR: Yup, I want to talk to you about vendors but the other thing I’m curious about is, is there a thought in the back of – I mean, clinicians are hard to come by, it’s hard to train a new clinician in those kind of things. But IT people, there could be businesses that are slowing down right now that have IT staff, you could tap into and say look, we need desktop techs, we need those kind of things. Is there a thought of doing that in the community?

 

[0:09:42.1] SL: I would say, we’re looking at that actually very broadly, even including clinical. Because their will for example potentially, be practices who maybe they won’t’ be able to stay open or maybe the physician will do as we talked about earlier Facetime visits or Skype visits with the patient but might not need their full staff.

 

We actually are partnering with other organizations and practices in the community to talk about what it could look like if our hospital needed to temporarily bring their staff on, whether that be clinical staff or things like you mentioned, technical staff from other small businesses and things like that, that may close temporarily. 

 

We’re working then closely with our HR teams to make sure what are those on-boarding process, how do we get that as streamlined as possible because while you can make a lot of the rules, you know, a little more flexible during a time like this, you still have to have a process.

 

[0:10:43.4] BR: Yeah, I want to talk about vendors, that kind of couple of call of vendors, saying, what are we supposed to do with this? Part of it, I put my hat on as a CIO and I’m like look, if you’re not already in the health system, they don’t have the bandwidth right now to set you up as a new vendor.

 

All of your existing clients are the ones that could potentially use your services, that’s who you should focus in on. You know, understand that they’re swamped, I mean, I put a call out to many CIO’s saying hey, can you come on the show and at least one or two of them have sent me notes back, “Do you have any idea how many hours I’m working right now?”

 

I’m like, just 10 minutes and they’re like, “No. Not going to happen. I’m working 12 hours a day, my team’s working 12 hours a day, we’re just” – what do you say to vendors? There are some vendors that you’re going to need to have on speed dial to be able to say look, we need to take our VDI environment from here to here and I need you guys to make sure that this is going to work and this is not going to come down.

 

What do you say to vendors?

 

[0:11:49.2] SL: Yeah, we’ve been having. I would compartmentalize it into two, I agree with you, there’s the vendors that we already worked with and then my team, mostly most of those conversations are happening by my team. I don’t need to have conversations with them. We already have a relationship, they know us, we know them. 

 

So I am dependent on my great leaders that work for me, my directors and those kinds of things to be working on those elements of making sure if we need to spin something up, ramp up, get more equipment, do whatever that they’re having those conversations. I will tell you that I have signed two and maybe on the verge of three agreements with new vendors in the last five days. 

 

And I would say this, in most of those instances, I had something I was looking for and so I went out to go find it. I used certainly resources from colleagues, mostly, to say who do you know that lives in this space and what are your thoughts on them, in one instance there really was sort of a, ‘I got an email’. It was targeted and I think that’s super important. When we right now if I had any, the advice I would give to vendors is if you are going to send me something, please make sure that it is targeted and personal. 

 

Sending out broadcast messages about backing up my archive system and things like that right now I am – archive is not on my mind right now and it makes me think that you don’t know what my priority is if you are going to send me something about archive. However, if you have a solution that could help me get something done, I need to get done today in a different way than maybe even I am thinking about it. 

 

I have had a couple of folks reach out to me and say, “For all of our customers we’re offering this. Let us know if you are interested in it, this is how we think it fits into the current pandemic situation that we are dealing with.” I then could take those and if it is in something I understand and I can respond or I can send that onto my directors or whatever and say, “Take a look at this and let’s see where it is.” But it at least tells me you are thinking about what I am going through right now and you are thinking around how you can target solutions for that. 

 

And then the other thing is they just have to be patient. Don’t ping me three times in a week. I saw it the first time, it might take me two to three days to get back to you and more than likely it will be midnight or 1:00 in the morning when you get that email back. But be patient because there are times that I will do that. The other thing I would add and I am seeing this from our vendors, their availability. I am signing contracts at 9:00 at night. 

 

I am sending them back at 9:00 at night and I am getting a response from them at 9:00 at night saying, “We got this, let’s set up a time for tomorrow morning to begin talking about execution.” Eight to five doesn’t exists for me. Seven to seven doesn’t exists for me. I need them at the exact moment I need them and again, I am seeing that from vendors and that is something that’s building that feeling of trust even in people that we haven’t maybe historically worked with or haven’t worked within a particular space. 

 

[0:15:02.8] BR: Yeah, so let us talk about this moment in time, this challenge. So with your staff, your staff is wondering about the work situation, wondering what is coming down the pipe, wondering there’s a lot of unknown and uncertainty and in those times it’s important to have great communication, leadership skills and those kind of things. What are the kind of things you’re doing with your direct reports, who have staff that report to them to assure them to prepare them for a time when things could get a little more crazy and what are you doing to communicate it to the broader staff maybe directly as the CIO?

 

[0:15:41.3] SL: So I’ll start with my own staff first. We are doing a few things here that I think and I am really glad that we’re talking about this because this actually just came up when we made some changes to this today. One of the things that is interesting is I have a staff that has mostly worked from home, most of my analyst have worked from home for the better part of the last year. They work from home three out five days a week. So they’re already somewhat used to a work from home strategy. 

 

However now that they are further in some cases working five days a week from home and things are changing so rapidly I mean hour by hour not even day by day, they are feeling out of touch with what is going on and so it is this balance, what are we going to do to communicate but I can’t spend all the time communicating because we have to get the work done. So a couple of things that we are doing. My leadership team has a huddle every day for 30 minutes. 

 

We go through the new projects that we are working on, the things that IT is involved in. We talk a little bit about what’s happening in the organization and in our community at large. Again, it is a 30 minute call. We are now taking the notes from that and sending it out to everyone in the division. So they all get that information because I can’t assume that the managers are all going to have time to go and have all of those conversations. So we are at least going to send it out in print. 

 

The other thing that we are then doing, our organization has a daily huddle that is more disease state specific, what is happening in our community, we are sending that out to our folks and we are offering an opportunity for them to reach out to managers and ask questions and get their answers because they are not just our caregivers they lives in our community and they have some of those kinds of questions as well. 

 

My team is also working on what are tools that can be used and I mean like games and other kinds of things that are out there for in work from home environments, there are tools that exists to build culture and to build relationships and connectedness. So we are looking at things like, “Hey, this is a marathon, this is not a sprint.” So we got to be able to keep some balance here. What is an online work related but fun game or interactive something that we can all do that keeps people connected? 

 

Let us have a virtual coffee, let’s get together for a virtual lunch so people can just talk about things but they are staying distant. So that is another thing that we are working on and then the final thing is we have a Facebook group that is a private Facebook group just for our IT caregivers. About two thirds of our team is already on it, we are working on seeing if we can expand that further and every Friday I am going to do a Facebook live video.

 

They can log on, ask questions, we’ll do it during the day when most of them are working but then obviously it will stay on the site. I will talk about it will kind of be a state of the state for where we are, right? So what have we been working on this week, shout outs, great job, here are our successes, here is what is going on, here is what is happening in the organization from a healthcare perspective, here is what we’re thinking is going to happen next week to try and keep people again, connected. And then we use that Facebook site for other kind of those similar fun things of just trying to keep the teams positive. 

 

[0:19:08.6] BR: Yeah and that is so crucial in these times and I appreciate you really focusing in on some of these stuff that people call the soft stuff and I would always laugh every time I hear somebody say the soft stuff and I think it’s a lot harder than what people think to keep people engaged, to keep people smiling from time to time, hopeful, just energized. I mean if you are going to keep putting in 12, 14, even 16 hour days, people have to smile every now and then. They have to let off steam every now and then and that is not a soft skill for leaders, I don’t think. 

 

[0:19:46.3] SL: I completely agree with you. The organization I will admit is harder and we’re still working on what those things are because again, everybody is so busy we don’t want to bombard them email is not going to work. We have a lot of calls for certain groups of people but one thing that we are looking at doing for example for our providers is starting next week doing a daily 30 minute again mostly report out, probably a phone call kind of thing. 

 

Where people could call in but maybe the first 20 minutes is a report out and the last 10 minutes is for questions, helping them understand where are we with tele-health, when there might be clinic be, having an opportunity to do things like that, how they might be helping in other areas, what is our current testing procedures that is such a moving target right now. People have lots of questions about that so what are those things that are clinically relevant to them. 

 

But then recording it, so that those who can’t make it to that time, we could put it onto our internal share point site. We could send it out to people and they’d be able to come in and get some of that more medical staff related education and information every day. 

 

[0:20:59.6] BR: Well thanks for your time, just one last quick question. I just want to give people perspective. On a normal day, you get so many emails how much has that increased during this time? 

 

[0:21:10.5] SL: Well my phone did tell me, my screen time has gone up by 40% in the last week. It’s a lot, there are – I mean I probably on average get a 100 to a 150 emails a day and I am probably twice that at this point and you know it is what it is and we’re all managing but one thing that I think is really great in a situation like this is typically you see the best in people come out, people give each other grace. People give each other help, seeing so much opportunity for collaboration out there. 

 

People saying, “Here is something we did that went great, take it and run with it.” You know some of those kinds of things. Providence did something on their website, I work with my team we recreated something very similar. You know those are things that we could all be doing and people are really open to that and so I think that sort of keeping everything going. It is very, very busy but at the same time, it’s pretty – it feels like you’re doing important valuable work and so it is gratifying to be doing it. 

 

[0:22:21.5] BR: Absolutely, thanks again Stephanie. I really appreciate you taking this time today and you know I just really appreciate all of the stuff that you guys are doing

 

[0:22:31.4] SL: Thanks so much. 

 

[END OF INTERVIEW]

 

[0:22:32.1] BR: That is all for this week. Special thanks to our channel sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics and Pro-Talent Advisors for choosing to invest in developing the next generation of health leaders. This show is a production of This Week in Health IT. For more great content, you can check out the website at thisweekhealth.com or the YouTube channel. If you want to support the show, the best way to do that is to share with a peer, however you do that go ahead and do it, share it with somebody and let them know that you benefit from the show. 

 

We’re going to be back again with more of this episodes this week and probably into next week if I thought about it. So please check back often. Thanks for listening. That is all for now.

 

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