This Week in Health IT Tuesday Newsday March 23 2020
March 23, 2020

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March 24, 2020: Today Bill Russell brings you the highlights of the latest news in health IT. The global pandemic has put immense pressure on healthcare systems worldwide, and thus news stories are largely centered around the issues of caring for unprecedented numbers of patients. The medical industry is relying heavily on telehealth to mitigate the pressure, but now these systems are breaking down and failing at times due to the number of people phoning in. Bill talks about the three components of telehealth, the relevance of each, and advises health IT workers on keeping these systems running as smoothly as possible. However, now is not the time to implement changes but rather to focus on getting the already-established processes functioning optimally. He also covers the issues with PPE and testing, talks about what EHR vendors are doing to help equip providers, and the steps that big tech companies like Apple and Google have taken to contribute to the solution. 

Key Points From This Episode:

  • A  few helpful resources for those involved in health IT during the COVID-19 crisis. 
  • CNBC’s report about telemedicine companies struggling to serve the volume of patients. 
  • Accepting that your telehealth system is likely to break down at some point. 
  • Advice for CIOs about dealing with the immense burden on their telehealth systems. 
  • The three components of a telehealth system and how important each is likely to be.
  • Why you should avoid implementing anything new to your televisit component at the moment. 
  • Helpful tips on managing and using the queuing system more effectively. 
  • A few examples of health organizations with well-structured websites and online resources. 
  • The importance of having a centralized source where accurate information can be obtained. 
  • Two of the biggest problems currently: The lack of PPE and COVID-19 testing taking too long. 
  • Questions about how EHR vendors are arming providers to handle COVID-19.  
  • How Epic is helping organizations to share information through their network.
  • What Apple, Google, and other big tech companies are doing to elevate the pressure on healthcare systems. 

News Day – Telehealth, EHR response and Field Reports

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News Day – Telehealth, EHR response and Field Reports

Episode 207: Show Notes. March 24, 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] DM: Welcome to This Week in Health IT news where we look at the news which will impact 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.

Before we get going, I want to give you a couple of resources for those in health IT during this crisis. For CIOs, I’m currently helping my coaching clients CIOs as a sounding board and advisor through this time. If you would like to connect with me over the next couple of months and experience coaching at no cost, shoot me a note at [email protected]

For anyone in health IT who finds yourself in uncharted territory and want to crowd source solutions with a team of seasoned professionals, we have set up to ways that you can do that. The first is that we now have a Slack channel that is monitored and supported by our sponsors and I am so excited by the response.

VMware, Galen Healthcare, Sirius Healthcare, Starbridge Advisors, Pro Talent Advisors have all stepped up and provided resources that are going to monitor this channel and it’s a place that you can go and just ask your questions. Pose your question, you know, can my Telehealth scale, this is what I have, this is what I’m thinking, what about my BDI environment, EHR performance is lagging.

Security questions, you know, how to stand up that remote facility. If you want access to this, it’s a great resource, you have former CIOs, CMIOs, you have interim type people as well, you have technologist, you have security experts, all waiting to help you with your problems as well as it’s a platform where you can interact with other health systems.

If you want to access, send me a note, [email protected] and we’ll get you set up immediately. Our sponsors are also some of them push back on me and said hey, people don’t know how to sue Slack, it’s really simple by the way. I’ll send you the link, you get connected, it’s simple but if that’s not how you roll, we are also supporting an email channel, you can send an email to [email protected]

If you shoot that email over it will be routed to the right person or the right group of people to provide you some solutions around whatever your questions happens to be. Again, that’s going to be our sponsors who are manning those lines. I’ll be monitoring those channels as well.

Again, I just want to thank our sponsors for stepping up to provide these services to our listeners. Before we get to the news, I really want to call out and thank Sirius Healthcare for sponsoring all these shows over there last week and this week around COVID-19 preparedness and response to it.

I appreciate their foresight, I appreciate their commitment to the industry.


[0:02:50.3] BR: Okay, now on to the news. As always, I’m going to set my timer because you only have 20 minutes to listen to this and I want to make sure I stay under there. I’m going to focus on health IT and this is going to be fast. Here it goes. First story. Chrissy Far. CNBC, Telemedicine company struggling to meet corona virus demand.


If you haven’t seen it, Chrissy Far was planning to get married over this timeframe and she wrote an article about their decision to postpone the wedding after one year of planning up until that – it’s really interesting and great story, we wish her the best moving forward, she’s obviously a huge contributor to the stories we cover in the news. Here you go.


Telemedicine companies are seeing unprecedented and volumes of patients trying to use their services. That is obvious, hospitals and health insurers are encouraged in patients with suspected corona virus systems to try virtual services first rather than coming in to the doctor where they might infect others. Again, that is a solution we have seen across the board, all the health systems I’m talking to and she goes on to talk about some of these companies say that their IT is breaking down.


Others are frantically hiring hundreds of doctors to meet the demand. All right, here’s my take on this, this is absolutely going to happen, these networks, some of these things are architected for this scale, they weren’t architected for the scale, they didn’t have the equipment in place, no matter how you slice it, even if it’s in the cloud, they have to scale up, there has to be the equipment there, they have to have the bandwidth there, they have to have the ability to scale up.


[0:04:22.6] BR: This will be a test to see who has a good architect and who has architected a good solution. But regardless, the carrier networks weren’t designed for this kind of workload, it wasn’t modeled for this kind of workload, we just send thousands, hundreds of thousands, millions of people home to work from home and they’re scrambling, even if it’s software to find networks, they’re scrambling to model these workloads and make the appropriate changes to their networks. What does this mean?


A lot of moving parts, your telehealth system will go down during this crisis, almost guarantee it, I’m looking forward to talking to somebody after the crisis who said our telehealth system work flawlessly and didn’t have a problem but I doubt that’s going to be the case. If the search continues as anticipated, we are going to have more calls into the telehealth, it is the right approach. 


All right, here’s my take, here’s what I believe I would do if I were sitting in the CIO chair. Telehealth has three main components, teleconsole, telemonitoring and televisit. Consult, physician to physician, telemonitoring monitoring people at home and that’s pretty obvious and then visit with the doctor, that’s the televisit part. I think it’s important to determine what’s the most important for your health system.


I’m going to assume it’s televisit because that’s what I’ve been hearing from health systems but don’t underestimate those other two. Telemonitoring is going to be important, especially for your chronic patients that are non-coronavirus patients, the telemonitoring solutions become a critical link to them as they are in – gosh, I’m going to get the word wrong and I don’t want to. But they’re not allowed to leave their home, telemonitor is going to be important. 


Teleconsult may also be important. They’re going to have doctors thrown across the city potentially with these make shift facilities being stood up and teleconsole may become more important. If we’re going to talk about televisit, my take on this is do not implement anything new unless you have to. A crisis is not a time to implement something new, this is a heavy lift, you’re going to – 


You know, this is what I remember to spend 10 time training people, we had to build templates, we had to change workflow and that was the hardest part of this work. The technology really wasn’t at that time wasn’t really the hardest part. I just want to give you a little perspective here, I’ve spoken to health systems, they are using Facetime.


I really applaud their effort at this point right now. Very resourceful, the HIPAA restrictions have been relaxed, they’re using a technology that their patients are used to and even their clinicians are used to and then they’re augmenting it with other things. I’m going to go into that sort of list of things of how you augment it.


[0:07:01.8] BR: Don’t get caught in the integration trap. Televisit is basically a queueing system that is a waiting room and education platform, that’s while they wait, they’re being educated or self-triaging of some sort, it’s a video conferencing platform and that’s where we spend a lot of our time and documentation platform.


If you’re going to try to integrate this into your EHR and you haven’t started before, the pandemic is going to be over, hopefully it’s going to be way over before you’re even close to a solution on this. Don’t get bogged down in integration so if you don’t integrate, what are you going to do?


We solved these problems before, right? This is not rocket science. Low tech is good in this situation. Get a big screen like the one I’m looking at. One sides the EHR, on the other side is your televisit solution. You just saw the documentation and billing problem, they’re going to be able to see the patient, they’re going to be able to document at the same time.


Work on the templates, work on the training, you’re likely ramping up to almost a 10 fold increase and in fact, in some cases now, I’m seeing an even larger than 10 fold increase. Spend the time on the things that are most important.


[0:08:11.1] BR: The next thing is a queuing system. Again, low tech. Do return phone calls, instead of trying to device a new solution to queue them up and train them as you go, have them call in, get a place in line, have someone call back to initiate a video consult.


Use the admin, use staff to queue up the physician’s time,  low tech for sure but it works and you have some time that just, the staff that their time just got displaced because they are not doing the nonessential surgeries and those kinds of things, use that staff for this. The education, get your web team working on the resources on your website.


This is an important thing and I think it’s being overlooked by too many. Baptist Health has a great site, great design, easy to understand, answers questions, simple URL, Mayo Clinic has a great FAQ multi care, great example of a home page, Intermountain has a nice simple and direct way, it goes straight to – gives you the ability to do a bot, a chat bot if you will to go through the symptom as symptom checker, that’s the word I was looking for.


If you haven’t, set up a chat bot, CDC has a self-checker bot for information for patients, we’ll talk about that later, a bunch of health systems is headed in that direction, there’s a free COVID-19 chat bot from Orbita and we’ve talked to their leadership before on the show.


[0:09:45.3] BR: They do great solutions, Charles Boise sent me one and it’s also highlighted in all our resource page. If you haven’t hit our resource page, the team continues and those of you who provided the links, thank you. Team continues to look through those links, make sure they are related to health IT and is creating a resource just for health IT around COVID-19.


A lot of links in there, we’ll touch on that a little bit more but most of the stuff I’m talking about is referenced there. Then finally, for video conference, again, a lot of moving parts, be ready for outages, have a backup, Zoom, Webex, Skype, Facetime, you name it, you understand that is going to be one of the easier things to set up.


With that being said, get your licensing setup correctly and be ready with a backup. All right, that’s all for Telehealth at this point. The reason I spent so much time on it is because we’re hearing a lot about it.


Next news story. His talk is a – that’s a great resource with frontline reports. I read large Midwest health system with a medical school, again, these are just stories from each one of these, kind of we have command structures statistic show that 30% absent rates could be realized. We even ask the document our command structure at least three levels deep. Director Ford and I covered that in some detail. It is very important to know that especially if you are a clinician CIO-clinician whatever, you might be called back into a much more important role of being a clinician, in which case you’re going to want to know what the command structure is going to be when that happens. 


A boss analysis on the patient does not exists in Epic until they have a visit or a bed. This has been a problem with every EHR for a very long time. We only think about patients. It is about patient documentation. This is why we overlay things like Salesforce on top of it and hopefully this will change things. Hopefully we will figure out a way to monitor people in our community and consumers within the EHR again, a heavy lift but something we should consider. 


With new, a patient does not exists in Epic until they had a visit or a bed with new tents being added. The lobby is being bedded and new ICU beds being planned, Epic builders and managers, physician and leadership are working overtime getting it all built. The command center has been fully operational for nearly two weeks. Telemedicine visits were built and rolled out in record time. Hundreds and hundreds of them on Monday. 


I am not sure everyone outside of Epic world understands how much work this takes. It takes a lot of work. So we do recognize that on the show, anyone in health IT understands that that’s a heavy lift. Small rule health system in the Pacific Northwest. I like this one, agility matters. Stay hyper informed about what is going on locally and nationally. Keep it simple, quickly deploy at 60 to 70% solution is better than nothing at all. 


[0:12:44.9] That is why we talked about our telehealth solutions being fit together just for this, focus on telehealth is your next thing, expect and plan for big support overhead with telehealth and work from home for IT. Expect all of your technology partners to be fairly overwhelmed if you are looking for hardware essentially be prepared to be disappointed. Stay engaged with your clinical and operational leadership. Dust off your disaster plans and business continuity plans. 


They can be a great guide for remote workforce management. Keep your CISO and compliance officer close at hand. That is all great feedback. North Carolina health system expanding urban and rural by investment, big investment in telehealth capacity, capability network upgrades, training investments and telework for non-essential personnel. Dashboards to track cases, in house, pending test, supply projections, vent availability. 


Again, all of those things are things that we have been talking about. I think the problem said is becoming quite known. So we have done a lot of these preparedness episodes. To date, we were hearing the same things from the various health systems and what they are doing to plan for a surge in their marketplace and so what we are going to do on the show is we are going to start focusing in on solutions. 


I want to be talking to people about scaling up VDI. I want to talk to people about scaling up your Citrix platform, scaling up your work from home, scaling up your telehealth and those kind of things. I am going to start focusing on solutions. Let’s see and then I received this email. I think it is worth noting Northeast Health System. We have been literally going non-stop working with Epic, modifying our systems rapidly adding televisit capacity. 


[0:14:28.5] Both Epic video and teledoc again primary backup adding drive through sites, modifying our lab systems, there is morning meeting who just tracked the COVID-19 related IT projects and leadership has minimum two calls per day everything is being put on a website to ensure that everybody has access to it. The single point of truth within the health system is so important to set up so that people know where can I go to find the latest and most accurate information about what is going on. 


The communications team here is super, it matches the community or comprehensive. Started 25% remote work about two weeks ago and they have ramped up to a 100% work from home in most areas and they do twice daily scrums with their teams. Zoom is being stretched to capacity with occasional connection issues and we are using MS Teams in Skype. I am hearing MS Teams a lot in the conversations being ramped up. They contracted for augmenting their support center. 


And there is contingency planning in place for upcoming go lives and they post this question, which we are not going to answer today but we will come back to and that is it will be interesting to see how much this impacts future delivery of both health care and technology and I believe that is true. The most common problems that we’re not going to touch on obviously are PPE. It is hard to care for people when you can’t protect yourself. 


You are worried about being protected yourself. So PPEs one of the bigger issues and then testing, I am hearing all sorts of things about testing taking way too long. You have some academic medical centers coming up with their own test. So if they can reduce that timeframe significantly, we are hearing like seven days to get reports back. So anyway, those are the two biggest and we are not going to cover that just because we are about This Week in Health IT and I am not a clinician. 


[0:16:20.6] Next new story, how EHR vendors are arming providers to handle COVID-19. I have links to each one of these on the resource page as well. This is from Healthcare IT news website, all scripts are focusing in on virtual health solutions, virtual triage and those kinds of things. Athena health is updated, order set, social history questions based on CDC best practices. Also virtual care solutions. Cerner, they have screening. 


And monitoring solutions, update to Millenium, Telehealth as well, E-click works, Virtual Care, Epic. So Epic has done a lot of things as you would have expect given their scale and scope. The company is encouraging organizations to share COVID-19 information through Epic Center operability network. They can share that through Care Everywhere and also outside of non-Epic organizations through their inner operability network. 


So many Epic has advised provider customers that is my chart portal can be used to handle questions, complete screening for COVID-19 or communicate through e-visits video, visits or secure messages to precluded unnecessary visits. Several weeks ago, Epic issued an update to their travel screen criteria to identity patients who travelled to affected regions, great work. Using analytics with Epic suite of products, clinicians can’t create and run reports to potentially find things. 


Like physicians might be able to map positive COVID-19 patients by zip code to discover potential hotspots. So they are doing an awful lot in this area and then Meditech. Meditech offers expanse inventory and patient portal, user’s complimentary deployment of scheduled visits, virtual visits, functionality for a six month period. 


Everybody’s really focusing on that virtual side. Epic’s response is a little more comprehensive and you could check all those out in our research page, click the link, it will take you to the page that from the various vendors and what they’re doing.


All right. I’m going to close by, what’s big tech doing, right? Apple has updated Siri, to help people to ask if they have corona virus so let’s try this out. Hey Siri, do I have the coronavirus?


[0:18:35.1] Siri: If you’re worried you might have coronavirus, a few questions can help you understand your situation. Ready to begin?


[0:18:42.2] BR: No, there you go. Apple has updated the coronavirus to be a symptom checker of sorts and that is fantastic. Google’s coronavirus search hub is making COVID-19 information easier to find if you haven’t been out to Google lately and type COVID-19 in there, you’re going to see that Dr. Google is ready to go and I played around with it a little bit today, it is really well done as you would imagine from Google and they have a great set of clinicians behind them as well. The Microsoft healthcare chat bot symptom checker is being used by the CDC as well as Providence and as well as let me read this a little bit.


Nine other health systems, it has taken 40,000 sessions and 6,000 hand offs to video consult so far. That’s according to The Wall Street Journal and next gov notes that it is not collecting any personal information from users. Again, great work from Microsoft as well.


I’ve seen a lot of other things, I’m just not going to cover, I’ve seen 3D printing of ventilators which I think is fascinating and if we had more time, I would go into that. Elon Musk is talking to Medtronic. I don’t know what he’s talking to them about but they’re doubling their production of ventilators as well so we have that going.


That is 20 minutes and I’m going to honor the 20 minutes because I know you guys are busy so that’s all for this week, special thanks to our sponsors, VMware, Starbridge advisors, Galen Healthcare, Health Lyrics, 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, check out our website and the YouTube channel. If you want to support the show, the best way to do this is to share with peer, however you do that, go ahead and do that. We’ll be back again with more episodes this week, we’re going to start focusing on solutions to the problems that we’ve heard over the last week, talking to health systems. We’re going to put a couple of other shows out where we’re talking about insular type things like leading in a crisis.


I have a really good episode for that that I record last week and I’m going to see if I can’t talk to somebody about some of the mental health ramifications of this situation. Look forward to t hose episodes, we’re going to be dropping one a day so keep an eye out. Thanks for listening. That’s all for now.



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