Anshul Pande Stanford Childrens This Week in Health IT
March 17, 2020

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March 18, 2020: Today, Bill sits down with another health system executive to understand their organization’s COVID-19 preparedness measures. In this episode, Anshul Pande, CTO of Stanford Children’s Health, talks about what they have done in the face of the pandemic. We learn about the multi-faceted approach they have taken, from partnering with the Stanford Medical Center, their adult counterpart to ensuring they have the right testing facilities as well as new internal communication measures. Anshul sheds light on their command center as well as supporting infrastructure. He also talks about other areas where they have needed to scale like telehealth and the challenges that have come with that. There are not only infrastructural requirements but also training and education demands to get these systems working. We also learn their approach to remote work, collaborating with vendors, and the framework the hospital has put in place to ensure safe and efficient testing. Tune in today!  

Key Points From This Episode:

  • Learn about what Standard Children’s is doing to handle the pandemic in their community.
  • Some of the challenges that come with scaling up telehealth: Infrastructure and education.
  • How Standford Children’s have managed to get their networks to stand up.
  • Find out how Standford Children’s has managed remote working solutions and infrastructure.
  • VPN, VDI, and bandwidth: Some of the challenges that Stanford Children’s faces.
  • Learn how Stanford Children’s is working with vendors who face slower internet.

Health IT Coronavirus Prep with Stanford Children’s

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Health IT Coronavirus Prep with Stanford Children’s

Episode 202: 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.

[00:00:04] BR: Welcome to This Week in Health It News where we look at the news that will impact health IT. My name is Bill Russell, healthcare CIO coach, 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 a series of interviews with health system executives who will share their plans around the coronavirus preparedness that they’re doing. If your system has a best practice to share, please shoot me a note and we will do a 10 to 15-minute Zoom recording. Hopefully that will benefit the industry. 

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

Today’s conversation is with Anshul Pande, the CTO for Stanford Children’s Health. Good morning, Anshul, and welcome to the show. 

[00:01:00] AP: Well, thank you very much for inviting me. It’s great to be here on this show.

[00:01:03] BR: Well, did I get your name correct? You can correct me.

[00:01:07] AP: Yeah, you did.

[00:01:08] BR: Okay. Great.

[00:01:09] AP: You did. You did a great job.

[00:01:12] BR: Hey, thanks for taking some time to meet with us. I know that you’re busy. We’ll get right to it. First question is just a general question, and then we’ll dive into the health IT technology portion, which is what are some of the things that your health system is doing to handle the pandemic in your community, obviously, Children’s Hospital? You guys have some specific cases and different cases that you would be dealing with.

[00:01:38] AP: Right. A big portion of our response to this particular pandemic is multifaceted. One is working with the adult hospital and the school of medicine in terms of ensuring that we have the right kind of testing available. Stanford came up with its own COVID-19 testing frameworks, and that’s available to our system. 

Another big portion in terms of preparing the staff, what is needed in the hospital? What is needed outside to support that staff and making sure we have clear communications at line? For the last week or so, we have a command center running in the hospital, which is handling all the communication, all the potential changes we’ve had to [inaudible 00:02:18] from the surrounding systems just around COVID. At the same time, we have an IS command center running just like it was a Go Live to support the command center as request come into changes into the system.

In parallel, we are looking at more work from whole options, both IS staff as well as support staff, including docs. Then we’re seeing a massive surge in telehealth [inaudible 00:02:46]. In fact, our approach to a lot of this is that you are not coming to a clinic or a hospital. The first triage point is the telehealth [inaudible 00:02:57]. Then based on that, we decide whether you’re coming through a drive-through clinic for a COVID test or we are sending to you an ER to be taken care off, depending on the severity of the situation. 

That’s the framework, and we’ve been working in terms of getting that clinic set up, getting the drive-through tents set up, [inaudible 00:03:19] setting up wireless parking lot as an example, and then we are supporting the technologies to make sure that the pediatric side is handling our HER with our support tools.

[00:03:32] BR: As a CTO, you’re focused in on the technology aspect. Let’s talk about that, because I’ve gotten some questions for people on scaling up and those kinds of things. Your Telehealth is increasing in capacity. Now, did you factor that in when you sort of provisioned your Telehealth to be able to scale to this kind of magnitude, or are you doing a lot more Telehealth right now than you were, say, two months ago?

[00:04:02] AP: Yeah. We were scaling up Telehealth for the last two years. It was a gradual ramp up. Every year’s target was 2 to 3 times what we did the year before, and it has increased about 7 to 10 fold in the last two years from a Telehealth perspective. There’s a gradual ramp up. 

On the other side in the last week, it has gone up 10X just in terms with the number with this. It’s a different kind of a ramp up which requires a different kind of a framework. It’s not just the infrastructure ramping up to support it, but it’s also how are we going to get the docs who are working from home to get trained on a new way of doing business rapidly. How are you going to support the patient [inaudible 00:04:45] telehealth and they make a call to say, “Hey, I don’t do X or I can’t download something or my video cam was not working.” That framework to support has been an interesting piece besides the technology portions around it. 

Then working very closely with the technology partners to say, “Okay, what is the next scale limit?” Today we are expecting about 300+ visits, and every day the first call is, “Okay, what’s the next hardware limit or software limit that we’re going to have?” Then how do we prepare for it so that we don’t hit in the middle of the day? 

[00:05:21] BR: Do you guys build out your own telehealth or do you have a cloud partner that you’re scaling up with? 

[00:05:26] AP: Well, it’s actually not a cloud solution, but an on-prem solution with the combination of CISCO and a couple of other things integrated with the EHR, which is Epic. 

[00:05:36] BR: Yeah. So you’re keeping a close eye on that as well. Talk about what kind of networks have you had to stand up as a result of this? You talked about the drive-through clinics and whatnot. How did you go about getting wireless to a parking lot or wherever you did stand those up?

[00:05:55] AP: Sure. A good part of that was done by a partner in the adult hospital side and a lot of it is around extending the existing wireless network from the buildings, which are actually pretty close to our hospitals. Then putting external access points, which is new and unique challenge and they did it pretty rapidly in a matter of two to three days. Kudos to them in terms of setting the infrastructure. 

We had worked for a long time in terms of having a common wireless backbone so that our SSID is actually work on their backbone and vice versa so that other devices and providers move back and forth including patients. Their experience is seamless. The moment they put the backbone up, our SSIDs ere up and running and I had to just worry about ensuring that our device was functioning out there. 

[00:06:42] BR: That’s fantastic. Any kind of technology you had – I assume you had a lot of this? Obviously, you had a website and you had probably a plan in place to communicate with the community at large through the website and other things. Were you called in my, say, marketing communications or others to stand certain thing sup as a result of this, or were you guys pretty well established before this?

[00:07:07] AP: Yeah. We were in a good shape, but there was still a lot of work to do in the last minute in terms of scaling it up. Two Fridays ago, one of the big things we decided is, “Hey, we’re going to move a lot of the staff to work from home.” So one of the first things we started looking at is, “Hey, do we have an internet pipe to be able to handle the small need? Do we have enough Citrix capacity to handle the [inaudible 00:07:29]? Do we have enough VPN capacity to handle the [inaudible 00:07:31]?” 

The first task we did was scale up a Citrix environment internally, scale up a VPN capacity and we basically went 10X in the VPN capacity. We went about 2 to 3X on the Citrix capacity. Part of it was planned projects as well as test environments, squish them down and use as much of it as possible to reallocate the Citrix. 

VPN, we basically looked at what our licensing looked like and then expanded it up as quickly as possible. Then internet was again a virtual pipe. We are still not hitting the limits, but we are in a pretty good shape in terms of scaling to the next and the next level after. Those were the first three to look at. Then the next portion was to understand, “Hey, who needs to work from home?” We actually created a form internally to say, “Send us your request. How many devices do you need? What kind of other software do you need?” 

Then we as the leadership team mapped this out, how we’re going to prioritize this across the organization?. We also started calling up vendors to say, “Hey, we need you to drop ship this equipment as quickly as possible.” It’s kind of a first come first serve game out there because they are very depleted in terms of [inaudible 00:08:42] new laptops and hardware. 

We also started looking at whether they could repurpose AAPC that is sitting at your desk to be usable from your home, because the security parameters are completely different. So the engineering teams who worked last week and to just figure out how do we convert on network desktop to your remote workers, that stuff? They came up with a pretty clean solution to doing it. We are trialing that since last night at about half a dozen employee’s homes. Then next week we’re going to expand that program as well. That, if needed, people could take their devices home and work from there.

[00:09:24] BR: Yeah. I’ll you’ll permit me, a couple more questions. VPN, VDI, bandwidth, equipment. It’s interesting. I mean, if you have Lenovo as a standard, and I know a lot of health systems do, it’s good equipment, but their supply chain has been mucked up now for the better part of two to three months, or at least two months. 

This will probably change how we think about things going forward. How do we line up alternative   equipment vendors going forward? But I do want to talk about VPN, VDI and bandwidth. VPN, it sounds like was more of a licensing challenge than an equipment challenge. You had enough horse power already in the data center to handle the VPN. Is that pretty accurate?

[00:10:16] AP: Correct. VPN hardware is right now not an issue. We just have to make sure that our licensing is adequately set up and the hardware will actually scale up to our needs. We aren’t always on VPN. So the moment you take any of our laptops anywhere in the world, the first thing it will do is home-in to the VPN connection so that all the communication is private. 

But in order to handle that, we have to make sure that as we scale this up, the problem doesn’t again that people are working from home feel like the experience is super slow. That was more of a test and a check to say, “Hey, yeah, this is done. We’ll be fine.” 

[00:10:52] BR: This will be interesting. This will take us back to – Sometime in the future, I’d love to have you back on the podcast to talk about what, as a result of this, changed the way we look at architecture or those kinds of things. VPN, though, a little more challenging. A lot more moving parts in VDI environment. But I would imagine same kind of thing. I mean, you already have the build and the applications packaged up so you can deliver them, really, anywhere remotely. It was just a matter of making sure you didn’t outstrip the capacity of the system that you had. 

[00:11:28] AP: Absolutely. You have to stay ahead of that, right? On a steady state, you have an understanding which environment. If you’re growing it 10% or 5%, you know what that’s going to look like over the year. But this is like a sudden ramp up. I mean, sudden ramp up means you have to have that additional capacity, plus you’ll find new problems which you hadn’t thought off or understood. Scalability, you’d assume, is a straight line game, but it’s not. At some point it just drops pretty dramatically. So you have to stay ahead of all of those problems. Luckily for us, we have stayed ahead of it till now.

[00:12:05] BR: How do you – This will be my last question, I promise. I’m just more curious than anything. If I’m sitting in that chair and I just send everybody home, one of the problems is not going to be my pipes and bandwidth, because I’m Stanford Children’s and we’ve put in a really great infrastructure. But now all of a sudden you have all these endpoints coming in from vendors that you don’t have a relationship with, potentially. You could have all sorts of bandwidth challenges as people move into their homes. Not necessarily because of you on your side, but on their side. Are you working with those vendors and trying to help the staff to sort of navigate that bandwidth challenge?

[00:12:48] AP: Yeah, totally. I mean, this is the running joke in Silicon Valley, is that the highways have speed it up because there’s nobody on the highways. But the internet highway have slowed down because there are so many people working from home. Part of it is to have those conversations with a bigger partners like Comcast and Verizon and AT&T to say, “Hey, how are going to support this?” This is not just a healthcare challenge, but the entire Valley’s challenge where a big chunk of the tech workforce is working from home to say, “Hey, are you going to manage this? By the way, how can you prioritize us on top of everything else so that we can actually provide the critical stuff that are needed to support the community overall?” It’s definitely a discussion.

[00:13:35] BR: Can they prioritize –

[00:13:36] AP: They don’t today.

[00:13:37] BR: They don’t. Yeah.

[00:13:38] AP: Yeah. They don’t today. They don’t today and we’ve been talking to them to figure out, “Hey, can you prioritize these specific endpoints considering it’s a VPN traffic? It looks slightly different from everything else,” to see if they can do. We’ve been in interesting conversations with them to see how that will work.

[00:13:58] BR: Well, again, thank you for taking the time. I really appreciate it, and we definitely will have to have another conversation if you’re open for it at a later date just talking about how we’re rethinking architecture as a result of this moving forward. I think it will be interesting. Thanks again. 

[00:14:18] AP: Absolutely. Nice talking with you, Bill.


[00:14:20] BR: That’s all for this episode. Special thanks to our sponsors, VMWare, Starbridge Advisors, Galen Healthcare, Health Lyrics and Pro Talent Advisors for choosing to invest and developing the next generation of health leaders. This show is a production of This Week in Health IT. For more great content, check out the website or the YouTube channel. If you want to support the show, best way to do it, share it with a peer, share it on social media. However you share things with people, do that. We’ll be back again for more of these interviews as well as our Tuesday News Day episode and our Friday Influencer episodes as well. 

Thanks for listening. That’s all for now. 


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