Bill Russell Post COVID This Week in Health IT
April 13, 2020

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April 14, 2020: It’s Tuesday Newsday again! We take this opportunity to round up a few topics as we continue our heavy load of coronavirus content. Bill takes a look at the United States of Care’s city-level response to COVID-19 and shares a few interesting think-pieces on the subject as well as asking a few of the top-of-mind questions on what the world may look like after the pandemic. The impact of this disaster is clear but the lasting effects are not yet apparent. So much has been learned and fast-tracked during the last two months, with the healthcare sector being at the center of this. From the explosion of telehealth and other adjacent measures to the need to adapt to the dangers that we have now witnessed, it is hard to imagine institutions returning to certain systems. We are much more likely to witness a new-normal but what that will be remains to be seen! Bill voices some of these questions, raising some of the most pertinent ideas in relation to healthcare and technology, so tune in to catch it all! 

Key Points From This Episode:

  • A quick post-COVID-19 healthcare discussion and what we have learned. 
  • The growth of different areas and applications of telehealth during this pandemic. 
  • Venues, facilities and online resources; so much rapid change so quickly!
  • Improved communications and successful measures that were not thought possible. 
  • What the world of healthcare might look like post-COVID-19.
  • Who might be coming out of this pandemic cash-rich?
  • The playbook and case study of the New York City COVID-19 coalition.  
  • Weighing the pros and cons of staying quarantined and ending the stay-at-home period. 

News Day – City Response Playbook and What’s Next

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News Day – City Response Playbook and What’s Next

Episode 225: Transcript – April 14, 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.

[0:00:04.8] BR: Welcome to This Week in Health IT. It’s Tuesday News Day, where we look at the news which will impact health IT.

Today, we’re going to look at the United States of Care’s city-level COVID-19 rapid response playbook and I’m going to entertain a little post-COVID-19 healthcare discussion, if you’ll allow me the opportunity to do that.

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. 

Shout out to our channel sponsors, Galen Healthcare, VMware, Starbridge Advisors, Pro Talent Advisors, Sirius Healthcare and Health Lyrics, whose investment in This Week in Health IT make our mission to amplify to great thinking, to propel healthcare forward a reality.

This episode never episode since we started the COVID-19 series has been sponsored by Sirius Healthcare. They reached out to me to see how we might partner during this time and that is how we’ve been able to support producing daily shows. Special thanks to Sirius for supporting the show’s efforts during the crisis.

As I said, it’s Tuesday news day. Gosh, there’s always so much to talk about. I’m going to try to keep it to 20 minutes. We have the playbook, the COVID-19 sea level rapid response from United States of Care. I’ll get to that in a minute. If you’ll allow me, I’d like to do a little post COVID-19 health care world discussion. How I’m going to start this is I’m going to talk about the field reports.

Here’s what we’ve learned. We’ve learned telehealth, work from home have just exploded, right? Supply and demand and regulatory all came together to blow the doors off of telehealth. It used to be hard to get physicians to really listen to the discussion, because workflow was so hard. I mean, they had to do in-person visits, they have to do televisits, they have to do messaging through the portal. It was too convoluted too much.

The reimbursement also didn’t support it. Then the offices emptied reimbursement changed and that physicians had time on their hands and they then knocked on our door and said, make this happen. That changed everything in a matter of weeks.

That’s not the only area where we saw really tele take off. I’m going to use the word broadly here and just talk about the area where video really has taken off in the last couple of weeks. Families visiting with their sick patients, with their family members in the hospital via televisits has been one of the things we’ve done. Video use in the care of non-COVID chronic patients, as well as IoT devices and other devices.

Video used to minimize the amount of times that clinicians have to go into the room. Video has been used for huddles, for our teams, it’s been used for collaboration with our work-from-home staff. You see, we have gotten really good at using video over the last six to eight weeks. That’s one of the things we’re learning from these 37 SAMAD interviews I’ve done right now from the frontlines.

A couple other things; new venues, drive-through testing was stood up in most communities, converted whole hospitals. The conversation about the hospital for special surgery changing almost overnight into a COVID hospital and was just incredible. That’s a conversation from Friday. I highly recommend listening to it.

We’ve converted stadiums and parks to field hospitals. Mobile units became COVID screening units. All sorts of new venues were rethought in a very rapid timeframe. Community engagement, chatbots received wide adoption. Chatbots were inching along in our industry and all of a sudden, everyone was saying, “I need a chatbot on my website.” Very interesting to see how that has been just wide adoption implemented very rapidly.

Call centers were radically changed to provide outbound information. Not only that, the call centers themselves were just completely dissected and rebuilt as remote units, right? We used to have – I mean, if you’ve ever been into a call center, you know it’s impossible to practice social distancing in a call center.

We took our phone systems, we move people out of their homes and we’re getting the same level of service with people working from their homes. Very interesting. Tat’s some of the stuff we’ve heard.

Reporting data governance. Data governance is something that moves at a glacial pace in health care and we now have it clicking on an hourly pace in some health systems; very amazing work. A reporting moved very rapidly as well to create tracking metrics, new screens. We track constrained resources and other things. Data science took on a new level during the pandemic.

Finally, work from home, I got to come back to this. Work from home at this scale for this industry was just never really thought possible before and now we’re doing it. We’re learning a lot from it. I’m going to get to that in a minute. We thought through succession plans, maybe some of those for the first time. Huddles have become really much more effective communication tools.

Communication from top to bottom has really been thought through. We’ve stood up these command centers and the communication is probably more clear than at any time within our history in recent history anyway. Just the crazy back-and-forth went away. We became very focused on the best care for our community. No one left behind. Let’s get it done.

 

That level of focus provided the much-needed clarity that really enabled us to move this fast. What does post-COVID-19 look like for healthcare and health IT? Now, I realize this might be a little premature. This is not even might be. This is premature to have this conversation. As a leader, I think it’s important to be banging some of these ideas around within your head, even back and forth amongst your leadership team. I’ve heard of organizations actually setting it to a workgroup up of people that are considering what post-COVID is going to look like and I recommend that as well.

 

In that spirit, not to be insensitive, because I’m not going to – I’m not trying to be insensitive. To just start throw out questions that are rolling around in my head that I wanted to capture. I’m going to use this venue to capture it. I’m just going to throw them out to you. I wanted to get the conversation started. If you want to have a conversation with me, shoot me a note, [email protected]. If you want to discuss it further on the air, or even off the air, more than happy to do that.

 

Here’s some of the questions I’m considering. Let me check my time real quick. Okay. That was a long setup for that. Here’s some questions that are rolling around in my head. What’s going to remain from a post-COVID world from a national level/ Will there be a greater demand for public health? Obviously, there’s going to be – about at what level, what are going to be the demands on the health systems? What about research? Is research can become more tightly lengthy to the medical record and where’s that link going to happen? Is it going to happen at the EHR? Is going to happen at the individual health systems?

 

What about pandemic prep? Are we going to be asked to do that at a city-level, at a state-level, at a national level? Are we going to have to prepare plans in conjunction with the other houses in our region? Who’s going to coordinate that? What work is going to be required? That’s at the national level. What’s our president going to do? What are the executive orders that are going to stay in place? What aren’t going to stay in place?

 

Even as important at this point is what are our governors going to do, right? Never let a good disaster go to waste, we’ve heard people say that. I think you’re going to see governor responses be all over the board depending on how they think the government should play a role in this moving forward.

 

I was a CIO in California and I can almost guarantee you that the work that is going to be required from California health systems from the governor is going to probably be more labor intensive than what you’re going to get from the federal level. Just my two cents.

 

I’m sorry, I just want to throw out the questions. I don’t want to be answering this stuff, but what about interoperability? What about it? How about a national? How about national data models? Do you think that’s going to be a thing in order to be able to respond to these things faster? Perhaps genetic testing on a national scale, do you think that’ll be a thing?

 

What about within your system? Work from home. Is it here to stay? How was it for you? I mean, did you experience a productivity drop like we anticipated we would feel, or would the productivity pretty much hold true to what it’s been in the past? If it did hold true, are we going to bring everybody back into the health system? Are we going to put them back into expensive real estate just to get everybody back into the same room?

 

Which should the tele-strategies you think are going to stick? This is the million dollar question, how much of the funding will remain for telehealth? If it does remain, what are we going to do? HIPAA is probably going to be coming back. They ease those restrictions. Does that mean that Zoom is out? Do we have to put something more sustainable in place? Are we ready to put something more sustainable in place? What about physicians practicing across state lines, you think that’s going to stick, or do you think that’s going to snap back?

 

Getting to IT a little bit, how did your infrastructure operations really scale? Not the stuff that you’re telling people, not the stuff that sometimes we hear on the podcast, but the stuff that you talk about in your office behind closed doors. It couldn’t have all scaled. I’ve been in the chair. I understand. I’ve been in those meetings, right? We have legacy environments. We have a lot of applications. We have a lot of data silos. We have some latency issues. What scaled? What didn’t scale? Does that change our strategy moving forward? Are you looking at more application rationalization moving forward?

 

I’m curious about your EHR strategy. How did your EHR strategy hold up during this? Do you need your hosted EHR to be closer to you? Was it too far away? Was there too much latency in response as you scaled it up so rapidly? Maybe some of you, do you need your EHR to be hosted period? Maybe you have it in-house and it didn’t scale real well, or maybe you had it in-house and it scaled perfectly. Just some of the questions I’m curious about.

 

Did your work from home scale securely? Keyword being securely, or did it just scale? Did you just throw security to the wind and say, “We’ve got to do this. Let’s get this scaled up.” Now you’re looking at it going, “Well, we cut some corners there.” Let’s talk about the competitive landscape. These again, these are just questions that are passing around in my head. Do you think that competitive landscape changed at all during the COVID-19 pandemic?

 

Well, the if the rest of the economy is any indication, the healthcare economy has been impacted. Let’s talk about it. Which healthcare entities did well during the crisis? If you don’t think any of them did well, then you’re probably not paying attention, because right now the insurance companies are swimming in cash. They collect monthly fees and none of their clients have had to go to the hospital for surgery, or other procedures. They’ve collected two and a half, three months of cash with little to no outlets.

 

That to me means that they’re going to be cash rich coming out of this thing and not many organizations are going to be cash rich coming out of this thing. Who operates the most in that model and how much cash do they have? One of the things I’m thinking is does that create a new opportunity? If who’s going to have cash coming out of this? Who’s not going to have cash coming out of this? How are they going to use that cash?

 

If regulations don’t change, will people be able to launch new services into your market? Are they going to be able to do telehealth into your market? What are they going to be able to do? Will people be more open to telehealth? I don’t know. Just some things that are bouncing around in my head. Will your communities be looking for different services post-COVID? If your doctors say, “Hey, I want to go back to seeing patients in-house,” and people say, “No, no, no. I want to keep doing telehealth.” Are we going to do that? Is that something that – Are they going to say, “Look, I like the drive-through testing.”

 

I want the drive-through testing for flu season. Makes sense to me. Why would I go sit in a flu – People didn’t know what the transfer rates were for the flu and for other conditions. Now they do. They’ve been educated. Well, that’s great that they’ve been educated. Now that they’ve been educated, they might be sitting there going, “Hey, why are we practicing that way? Maybe we should do drive-through testing for flu. Maybe we should do some of that stuff.”

 

Another question, did any of the non-traditional competitors take a hit, right? Our non-traditional competitors were making headway. Walmart was opening up facilities. Did they do well? How about CVS Aetna? CVS really. How did they do during this? How did their care centers do during this? Walgreens, how did they do? How did Amazon do during this? Amazon actually announced some of their financials today. They seem to have done pretty well. I just don’t know what areas, or what sectors that did really well.

 

Just wondering, did any of the non-traditional competitors take a hit? Are there any other service opportunities that are going to bounce back, but they’re going to be short on cash? There are a couple of industries that are related to healthcare that took a major hit. Dentistry being one of them, right? Just like none of us have gone to get haircuts, very few of us have gone to get any dentistry work done in the last two months. If this drags on, there’s going to be a significant shortage of cash within the dentistry space, which is related to healthcare and there’s going to be an opportunity there for organizations with cash.

 

What about 21st century cures and interoperability? Do you think the urgency on that increased or decreased during this COVID season? I think it’s likely increased and I think it’s going to move forward. Just wondering if we’re ready. Well, those are just some of the things that are floating around in my head. I’d love to discuss with you. If you have some ideas, shoot me a note, [email protected].

 

All right, let me hit. I want to hit this playbook. Hey, this is a great playbook. If you get a chance to take a look at it, it’s at the United States of Care and it’s the – it’s called the playbook, city-level COVID-19 rapid response to serve at-risk populations. Case study, New York City COVID-19 rapid response coalition, April 2020 launch.

 

The New York City COVID-19 rapid response coalition is called CRRC. Hard to say, I will try not to mess it up. The United States Of Care target audience for this is people in cities that are looking with a patchwork system that are looking to put something in place rapidly to serve the underserved populations.

 

The scope, actually first of all, it’s a really well-done presentation. Has their guiding principles, has their goals and then it talks about their product. Their products really is about – the CRRC product is about providing the information to that vulnerable – that information to the vulnerable population, so that they can receive care. What they’re doing is they’re stitching together this this patchwork of organizations in order to provide the best care to that population. They have a dynamic texting platform that allows simple script writing to connect patients with support, draws from analysis tools and pre-existing data sources, contacts high need individuals identified through patient risk assessments and connects them with telehealth and teleservices.

 

Then it goes on to say, a network of relationships that weave together a care provision and support from a coalition of 60 plus social and clinical services data and analytics from a variety of sources, including healthcare payers and navigators. I’ll have a link to this presentation.

 

I think again, really well done. The CRRC process and tech overview has a flowchart, which I think again is it’s high level, but it’s really well thought through. Starts with the data, they create the analytics, they end up creating the registries, which they call rosters. Then they have a coordinating center, which makes the right contact, connects people with the right care at the right setting.

 

The partnerships are providers and some significant providers within New York payers, social services, alternate care providers, legal capital and project management, technology providers, delivery, Uber, Lyft, CVS, you get the idea, as well as others. Then they go on and talk about their tactics. I like this presentation. I think we’re going to be giving a bunch of presentations in the not-too-distant future around our plans around COVID-19 and what we’ve learned and what our strategy is going to be moving forward.

 

I’m looking forward to seeing some of those presentations and seeing how we frame up what we’ve learned and what we think the world post-COVID is going to look like. Anyway, great presentation.

 

I really wanted to hit this last story. Two weeks in a row, I really haven’t been able to – national coronavirus response roadmap to reopening. It’s interesting. The idea of reopening is something we all are – where we really want to get there, but it’s a lot more complex. We don’t have enough information right now to really understand. I think there’s people on one side that say, “Hey, let’s just open and see what happens.” There’s others, “Let’s stay self-isolation for another six months.”

 

Clearly, if we stayed self-isolated for another six months, the economic catastrophe would be beyond measure. On the other side, if we all started going out, I think all the experts would say that we’re going to potentially overwhelm the system and have a second wave of – second spike, if you will.

 

This article is actually really well thought out, I thought. Dr. Scott Gottlieb. It’s on the American Enterprise Institute. Once again, I just don’t have enough time to really go through it. Here’s what I like about it, executive summary, starts talking about four phases, slow the spread, state-by-state reopening, establish immune, protection and lift physical distancing during phase three and rebuild our readiness for in phase four.

 

The reason I like this is it’s so well thought-out. Has a set of goals, has the triggers to begin each phase and the trigger to move to the next phase. If you’re wondering how the epidemiologists are thinking about this and how they’re going to protect, you have a really clear roadmap in this article. I’ll share this link to this article there as well.

 

I think it’s a lot more complex than this. I think the doctors and the epidemiologists are absolutely at the table and should have a very strong say in what’s going on. I don’t think it’s wrong to be talking about the economy, because more people could die quite frankly from a economy where you have double-digit unemployment.

 

We’ve already talked to people on the show about the mental health crisis that’s going on right now with people losing their jobs, being stuck at home, not having the opportunity to pursue employment, or feed their families. These are difficult, difficult and complex decisions that people are going to be having to make.

 

Well, that’s all for this week. Special thanks to our 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 check out our website, thisweekhealth.com, or the YouTube channel. If you want to support the show, the best way to do that is to share it with a peer. Send them an e-mail, shoot them a DM, however you do it. Go ahead and share with – share it with somebody. That is the best way to support the show.

 

We’re going to be back again with more shows this week. Really thank my friend, Drex DeFord for interviewing the security professionals and that’s giving me a chance to catch up on my life and get some things done. I really appreciate that.

 

Thanks for listening. That’s all for now.

 

[END]

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