Healthcare at the Edge: The convergence of devices, data, patients, providers, and care

With

Bill Russell / Dr. Zafar Chaudry / Rick Allen

Dr. Zafar Chaudry Seattle Children's Hospital Rick Allen Navicent Health This Week in Health IT

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July 8, 2020: Today is an exclusive panel discussion, as part of Aruba’s Atmosphere Digital Conference. Guests are Dr. Zafar Chaudry, SVP and CIO of Seattle Children’s Hospital and Rick Allen the CTO of Navicent Health. They discuss the astounding agility of current technology and consequently the importance of having to pivot quickly to keep up with demands. But what impact does this have on the human factors? Can CIO’s cope with the pressure? And does mobile, cloud and edge technology really compare to traditional face to face care?

Key Points From This Episode:

  • How do you manage the smooth transition of a hundred people working remotely to 3,500 people working remotely almost overnight? [00:02:54]
  • Today’s sophisticated IT can shift very quickly but what mental strain does this put on CIO’s? [00:08:40]
  • Why a CIO in 2020 wins the Oscar for Best Supporting Actor in the delivery of care [00:10:10]
  • Discover 3 creative ways to push people into a network without compromising performance and monitoring [00:11:40]
  • The key to supporting healthcare staff working from home? It’s education. [00:16:00]
  • Let IT departments do what they do best, instead of sitting in some basement regulating the temperature. [00:19:25]
  • How to solve IT’s biggest nightmare … security [00:22:50]

Healthcare at the Edge: The convergence of devices, data, patients, providers, and care

Episode 276: Transcript – July 8, 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.

[00:00:00] Bill Russell: Welcome to this week in health IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creator of this week in health IT. A set of podcast videos and collaborations events dedicated to developing the next generation of health leaders. This episode and every episode, since we started the COVID-19 series has been sponsored by Sirius Healthccare. Now we’re going to be exiting that series and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. [00:00:30] Special thanks to Sirius for supporting the show’s efforts during the crisis and beyond. Don’t forget, we’ve gone to three shows a week now, Tuesday, we cover the news on Tuesday News Day, and we have interviews with industry influencers on Wednesday and friday. 

Alright so Aruba reached out to me to be a part of their atmosphere, digital conference, which is a virtual conference, which I guess all of them are right now. And I did a talk on the state of healthcare, which I’m probably going to share next week on the channel.

They also asked me to host a panel discussion on the [00:01:00] movements that healthcare made during the crisis and its implications with two industry leaders, Dr. Zafar Chaudry, SVP and CIO of Seattle Children’s and Rick Allen. The CTO of Navicent. So here it is. Hope you enjoy. All right. Welcome to the atmosphere digital conference.

My name is Bill Russell, healthcare, CIO, coach, and creator of this week in health IT. I’m going to be the facilitator for a panel discussion. Entitled “Healthcare at the edge of the convergence of devices, data, patients, providers, and [00:01:30] care.” Hopefully you got all that there’s a lot to talk about and it’s healthcare. There is a lot to talk about right now. My two guests are Dr. Zafar Chaudry the SVP and CIO of Seattle Children’s Hospital and Rick Allen the AVP and CTO of Navicent Health. Good morning gentlemen, and welcome to the panel. 

Rick Allen: Good morning

Bill Russell: While I’m looking for this conversation. As you know, as everyone knows, healthcare went through some pretty dramatic, events over, over the last couple of [00:02:00] months.

I did the quick intro. What I’d love for each of you to do is a, his work off of that, introduce your health system to the audience and, you know, tack onto that, how you experienced COVID-19 from a health IT perspective in your community, and Zafar we’ll start with you.

Dr. Zafar Chaudry: Thank you, Bill.

Thank you for having me talk to you today. So Seattle Children’s pediatric health system predominantly in the state of Washington with [00:02:30] 46 sites across four States about a 2.5 Billion dollar turnover. And we take care of kids in the region across the four States. COVID. COVID was interesting. Yeah, I’m sure people will be surprised to hear that there was a massive pivot to virtual in our organization.

We went from a hundred people working remotely to 3,500 people working remotely almost overnight. We had to start [00:03:00] delivering outpatient appointments through telehealth, something we hadn’t really done much work in. And so we went from next to nothing, to thousands of current visits and telehealth that are currently happening in our organization.

So those are some of the areas we’ve been focusing on as we pivoted to respond to COVID. 

Bill Russell: Fantastic. And, and, Rick, give us, give us a little background on, on Navicent and how you guys [00:03:30] experienced COVID-19. 

Rick Allen: So Navicent is a four hospital system based in central Georgia. We are, The Southern most level one trauma center so we take care of from the middle of the state all the way to the Florida line refers back to us. So we’re primarily tertiary care. We do have some small hospitals, outlying hospitals, rural hospitals, that feed into us as well. COVID was really interesting in it. And it kind of on a little bit, a little [00:04:00] bit smaller note kind of echoes what  Dr. Chaudry said was we went from basically no one working offsite to a thousand people offsite in less than two weeks, we had to spin up remote testing sites and virtual visit locations to be able to support some of the virtual visits. We were trying to roll out and put in place. And then we were one of the sites that Jima for the state of Georgia, which is FEMA nationally, [00:04:30] Jima built a field hospital, and we had to spin up a field hospital, built out of shipping containers, just off of our campus to be able to support all the COVID people that were showing up.

Bill Russell: And so here’s what’s interesting. So, you know the, Aruba Atmosphere Digital Conference, we’re going to talk a lot about, you know, what, what really has happened here is we, we saw massive demands on health IT that [00:05:00] we hadn’t experienced before, and we were asked to do them in times that we used to.

But, you know, they, they would say things like, Hey, can you spin that up in a week? And it’s projects that we used to take, you know, a full year, if not two years, to, to spin up. Work from home, almost all of our nonclinical staff went home telehealth, remote patient monitoring, just, just a lot of those kinds of things.

And I think people understand that safety becomes the primary driving force during, during a pandemic. And so we want to reduce the number of touches and we, we stood up all [00:05:30] those different things. But what I want to hear from you guys is, you know, how you give us an idea of what it was like to receive those requests and how dramatic of a change was it from the normal operation, for, for your IT organization.

Rick Allen: Okay, I’ll go first. I I’ll take it back to one story that we, that really jumps out at me as we were going through this as we, we were getting requests to be, to provide virtual family [00:06:00] visits and we had. Put constraints in place on who could come into the hospital. And, you know, people were going into the ICU with no visitors because we were on a no visitation policy.

We didn’t want anybody non-essential in the hospital. So we were approached to within a day. Be able to provide virtual family visits. And we worked up a solution with iPads on our wireless network, right. Connecting them and setting up either zoom meetings or teams [00:06:30] meetings between the family member.

The nurse would go in and, and coordinate, setting it up with a family member and then having the tablet there with the patient, for the family member to be able to interact with the patient. We had one that it was an, was an end of life, situation. And the family actually got to spend time with the patient up until end of life, the nurse leaned over and told the family that, I mean, told the patient that her family loved them and was able to capture all [00:07:00] that on camera.

So even in a bad situation where we couldn’t have anybody in the hospital, we were trying to provide that high touch and do that using technology and turning it around quickly. 

Bill Russell: Yeah, absolutely. Zafar you know, for, for a children’s hospital, you have a lot of acute care situations. How did you continue to care for them when you had the potential for COVID patients right there in front of you?

[00:07:30] Dr. Zafar Chaudry: Well, I think our story is similar, you know, we. We were asked to stand up services that we weren’t used to standing up with a very short timeframe, telehealth being one of those big services. You know, what we sort of found around that space was a large percentage of the IT team was still required to be on site whilst trying to support those services. [00:08:00] So now there’s this mixed model of. Not technical people working from home. And those typically be your IT folks, but there is still a percentage. Of IT people working on site, putting on the PPE, supporting the clinicians with the new equipment, the laptops, iPads, the training that’s required.

And we hadn’t used Zoom before. So we were traditionally a WebEx house. And then our clinicians that are University of Washington clinicians, who’ve been [00:08:30] used to using Zoom. So they wanted us to use zoom. So we had to do all of that training, physical training on site. to support that model. The interesting thing I’ve seen around IT, and the ability to shift very quickly to solve these problems, we’re all very well suited to do that as IT professionals.

But what I’ve seen in my team that they weren’t well suited to do is the strain that it would put on them [00:09:00] mentally from all things happening around them. Plus. Having to support all of these services. And that’s what I’ve taken away as a learning event to say, I think we have great people who can pivot very quickly.

That’s what agility is in technology, but we don’t always look at the human factors when it comes to what is the impact. And what we’ve also seen is when parents realize that COVID was an issue, we actually seen a drop in [00:09:30] utilization in our emergency rooms. So what we were preparing for the worst, but people were only bringing in their kids if they truly needed to bring in their kids.

And therefore we haven’t had the levels of volumes that other hospitals have seen in terms of, Utilization. 

Bill Russell: Yeah. No. And it’s interesting that, you know, both of you go to the heart of healthcare, which is, you know, people serving other people at their, at their time of need. And, [00:10:00] and that’s the gap that we are constantly aware of and constantly, bringing to the forefront that, you know, health IT while we’re not  in the room potentially with the, patients, were the best supporting actor in the, in the delivery of care, because everywhere you look in that room, there’s some aspect of technology that’s supporting, you know, supporting that, that, care event. let me, let me talk to you guys about this.

You know, I know as a CIO, [00:10:30] They’re, you know, they used to the old cliche of, you know, what keeps you up at night? Well, I think what would have kept me up at night. During the pandemic would be that we just shook things up significantly. Right. We sent people home. I heard CIO’s say that, they sent people home and realized they didn’t have a computer at home.

I find that hard to believe in, in 2020 that some of their people didn’t have computers at home, but you know, that’s one way to. Build work, life balance. so some people, they actually send them home when they were working on their kids’ computers. [00:11:00] Some people, you know, were working on a company issued computer somewhere, not you had, just, I mean, again, you had different devices that, you know, Zoom coming in when you used to only have one vacs and whatever, we just changed the environment so dramatically.

So how did you keep a handle on the controls and how did you keep a handle on the performance of the overall network and delivering the quality of service that everyone was looking for. And Rick, I guess we’ll, we’ll start with you.

[00:11:30] Rick Allen: Okay. We had some fairly decent choke points to ensure that we, we pushed everybody in through one of three solutions. Right. We have a very, a fairly small VPN that we brought people in across. We had, some technology from VMware and some technology from Citrix that we leverage to be able to, to enable remote access for the bulk of our users.

So we pushedeverybody in through  that, that one, [00:12:00] those three small pieces, which kept the, the, you know, the attack vector fairly small. We didn’t have to open, open things up too broadly to be able to send people home where we have run into issues is around performance and, you know, network monitoring.

And the network team has worked probably, you know, the desktop and field support team have worked a lot. The network team has worked out as much, if not more to ensure that we have the performance to be able to enable all those people to work from home. That [00:12:30] were working in the office before, you know, the traffic patterns on your internet link, completely shift the traffic patterns on your internal networks, completely shift because now as opposed to anything East, West, or anything, going out, everything is coming back in and making sure that things are architected to be able to support that has been a massive amount of work for, for that team. 

Bill Russell: Yeah. Cause your networks weren’t really designed to function this way [00:13:00] where they, I mean, now you’re, you’re dealing with, Carriers to the home. So you’re dealing with the, I don’t know who they Cox and Comcast and whatever, and you’re trying to manage performance all the way down to that level. I would assume. 

Rick Allen: Right. We’ve you know, we have some people that we’ve sent, you know, we sent. Like a RAP home with just because it was the easiest thing for them to do was send a remote access point, let it plug in, connect back across their internet, just to make it simple. We did have, you know, the way [00:13:30] that you described it earlier, we did have a decent size number of people that didn’t have either internet in their house or had, because a lot of our people live in rural areas had something slower than DSL as their internet links. So it’s not like they had anything high speed. If it was, you know, six down, four up that was excessive speeds for them, that trying to manage through all that, which is why we push people through XenApp. We push people through, you know, some level of VDI to [00:14:00] offload a lot of the demands.

Yet, keep it internal to something that we can control and we can support. 

Bill Russell: So, Dr Chaudry did you guys  have to change things dramatically or was it just moderate changes here and there for your environment? 

Dr. Zafar Chaudry: Well, from a networking perspective, we didn’t really have to change anything. We would, we were already embarking on a journey to increase our bandwidth because we believe that remote working from home was coming [00:14:30] anyway  pre COVID. So we monitor our network on network capacity was good. We have multiple links to the internet, diverse routes, multiple companies. We’d already put that in place. We’d closed our data centers down. We’d moved to private cloud at 90%. We’d already taken steps before this came and where a VDI shop. using Citrix as well. [00:15:00] And so that wasn’t a problem. We were able to have 3,500 BDI connections on our NetScalers. No problem. The challenge came from the home environment from the perspective of end user training. So what was interesting to me was people working in their homes didn’t have the correct setup at home in the first place.

So people had bought. Massive bandwidth connections with Xfinity century link, you know, 200 [00:15:30] m, one gig connections into their home, but the equipment that they placed on top of that, was terrible. You know, people, people had bought the $30 roots from Amazon, popped it on there. One time it connection.

And then they had 17 people in that house trying to do a Zoom connection at the same time. And the feedback we got was it’s all children’s fault because we have an internet problem. And so we very quickly pivoted to [00:16:00] education. We created a website for our staff where we produced. Quick cheap, quick guides to how to correctly set up your home wives by how to actually put a password on your home, wifi, how to buy the right route for your home wifi.

And when we started to do that, we saw massive improvements with people’s experience at home just by shifting router equipment. We didn’t send, [00:16:30] you know, we thought about sending the one box to connect, but at the time, the, the ability to deliver goods in Seattle. Wasn’t great. So it would have been a huge delay trying to get that equipment to people.

Bill Russell: Yeah. That makes sense. I’m going to shift this to talk about the future in healthcare. If you guys are up for it, you know, we’ve, I think how I’m gonna frame this is, you know, we, we had a move to mobile. You know, we’ve, [00:17:00] we’ve put all these mobile devices she’s in the nurse’s hands and the doctor’s hands.

We have the moving around and whatnot. Then we had this conversation around cloud and I want to give people a picture of where we’re at on each of these mobile, cloud and how we’re thinking about Edge, if we can. Right. So, how mobile is healthcare today? You know, dr. Chaudhry, we’ll start with you. How mobile are, how mobile are you at Seattle Children’s?

Dr. Zafar Chaudry: So I think we’ve started our mobility journey, in terms of [00:17:30] on the units using solutions, handheld devices, whether it’s tablet based or mobile based is definitely something we’re already doing with our clinical information systems. And we’re doing the same on the patient side, but there’s definitely more work to be done currently.

We’re in a model of, we provide equipment, people utilize it, but. You want to be able to shift to more of a, bring your own device type of environment. And that’s in the hospital space [00:18:00] in terms of connecting up remotely, what we’ve learned through COVID is the future of delivering what I call ancillary back office services is remote.

You know, there’s no need to build new office buildings. In downtown Seattle and fit them out. Actually people can work from anywhere in the country, as long as we have solid networks in place. So we’re looking at our networking partners to figure out how [00:18:30] can we do this in the box? What solutions can we give those employees to enable that to happen?

Whether they’re clinical or not? That’s certainly what we’re doing. 

Bill Russell: All right. So, you know, Rick, give us an idea of where we’re at on the cloud conversation for healthcare. Are we, you know, we’re, where is healthcare today? 

Rick Allen: we’re moving that way, I guess is the, is the, probably the easiest way to describe it.

You know, Dr. Chaudry said earlier that they were at 90% private cloud, [00:19:00] and closed their data centers. We’re working toward that. We’re not even close to that level of being into the cloud, but, I see that there’ll be that hybrid cloud look across the board. That there’ll be some things that we consume from a public cloud provider.

Some things that we build into the pro in as a private cloud and move all of those things off site. I think that, you know, most IT organizations really want to get out of the real estate business and out of the [00:19:30] facilities, business of managing power and cooling. Well, let’s let somebody else do that and let us do what we do best, which is manage the infrastructure and applications that run that run there.

So I think that over the next, and this is going to be a driver. I think covert has been a driver, I think over the next 18 to 24 months, you’ll see some really huge steps and some huge organizations moving from on prem into the cloud because of the experiences they’ve been able to hit over the past three months that we’ve been doing [00:20:00] this.

Bill Russell: All right. So let’s, let’s talk about, you know, cause we said in the title, we were going to talk about the Edge. So, you know, the, the biggest Edge cases for us are going to be, you know, the, the, the home as a place of care, the home as a place for aging in place, the home as a place. For, you know, for following up on the visit, you know, maybe built into the television where you’re doing physical therapy with somebody and those kinds of things we’re seeing all sorts of use cases be talked about, [00:20:30] but I want you guys to be really honest.

How is this? Are we talking futures? Are we talking? You know, there’s, there’s definite movement here. Where, where are we at in healthcare? Are we going to see a lot more devices in the home and a lot more care being done out of the home? I mean, COVID would indicate that, you know, telehealth is a possibility, but it’s more than tele-health it’s it’s it goes beyond that.

Dr. Chaudry we’ll start with you. 

Dr. Zafar Chaudry: Well, I think it starts from, there needs to be a shift in reimbursement [00:21:00] for the shift in services. Right. So I do believe that we will be moving towards more use of equipment in the home and, you know, care in the home, but where you sort of see the blockers is. And I can deploy 15 devices in someone’s home, but if I’m not going to get any reimbursement for that, how am I supposed to run my health system?

And we’ve, we’ve only seen a slight shift in COVID where health insurance companies have allowed us to do [00:21:30] telehealth visits and actually pay for them, but they still won’t pay for the facilities fees. They just pay for that actual visit. So is that level of investment you have to make, and you need to know that you’re going to get some sort of return on that investment.

And therefore, I think it’s still a slow journey. And then secondly, if we do put devices equipment in people’s homes, how do we actually make sure they’re secure and they’re not hackable, et cetera. And that’s a piece of work, certainly us as an [00:22:00] organization. Are thinking about, but haven’t really figured out how we’re actually going to do that when that, when that takes off.

Bill Russell: Yeah. That’s interesting. Rick, what are your thoughts on, on. 

Rick Allen: I agree with both of those, and add one more and it’s around workflow. You know, the physician practice workflow has been honed over forever that you go in, you see a receptionist, you move to a tech. Then the physician comes in, [00:22:30] which most of the work has been done to bring his expertise to it.

And then he moves on and somebody else steps in and takes over until we can get workflows built. That can leverage a lot of the telehealth technologies. I think that you’ll see that you’ll still see some slow adoption and, you know, you throw the workflows, the reimbursement and then say, you know, for me, security is the biggest nightmare of the bunch because I can’t necessarily fix the workflow.

And, I can’t necessarily [00:23:00] fix the way that the payers are going to address it. I can address the security of it. And that’s where most of the work that we’re doing today. Lives in, how do we put something into a patient’s home that we can keep secure and ensure that the data is private in the end and immutable from end to end?

Bill Russell: Yeah. You know, so this is going to be my closing question for you and it’s going to be around, how does your mindset change having gone through a pandemic? [00:23:30] I know, I’ve talked to some people who went through a hurricane Sandy in New York and they told the stories and they said, this will forever change how I think about disaster recovery.

And, and I followed up with some of those people and it really has changed how they think about disaster recovery, and how they, how they function. What do you think the mindset shift will be for you as a, as a health IT leader coming out of this pandemic?

[00:24:00] Rick Allen: No. I was going to say, I think To to me, the biggest thing is around, is around the ability to pivot, to be flexible. you know, cause like we talked, when we first started, there were projects that normally would take, you know, two or three weeks to kick off and then take several months to implement that.

The expectation was that you’ve got a week. To make it all happen. And I do think that that’s going to be the biggest shift in my mindset is we have to become much more flexible and be able to move on something much more quickly [00:24:30] than we have in the past.

Dr. Zafar Chaudry: And from my perspective, I think what we’ve learned is that as IT professionals, we must work in multidisciplinary teams and we must work at a pace that is a lot more agile than we’ve ever seen. So for the very first time, my people have experienced that we are in true partnership with clinical staff, with nonclinical [00:25:00] staff.

The fact that patients need us to pivot. Very very quickly is something we weren’t used to before. So I agree with Rick, you know, we were used to this model of let’s spin up, let’s do a PM, let’s do this, let’s define the project and then let’s have a timeline and a roadmap. And what I’m seeing now is that people are more multitasking.

You know, if you are jumping into this Musk, the disciplinary team, and a clinician needs you to be the [00:25:30] project manager too, to herd the cats around the technical pieces, then you’ll just do that. And we weren’t doing that before, before we were trying to define pieces and work with those pieces. And I think.

We don’t want to go back to the old ways of work and want to continue to learn and pivot with this agility, this new founded agility, which I think is exciting. 

Bill Russell: Yeah. It really is exciting. I, you know, gentlemen, I really, you know, [00:26:00] I want to thank you for your time today. I know this is a really busy time for you guys.

This was a fantastic conversation and I always enjoy learning from people who have experienced the things that you’ve experienced. So close to the front lines. Thanks again for your time.