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May 14, 2020: Our guest for our Field Report episode is Kristin Darby, Enterprise CIO for Envision Healthcare. We sit down with Kristin to talk about Envision Healthcare, the impact that COVID-19 has had for them, and how they have responded. Technology, especially telehealth services, have been extremely important to a data-driven organization like Envision, as has collaboration with members of the healthcare industry. In this episode, we discuss how Envision addresses their platforms and architecture in order to respond quickly to a rapidly evolving set of use cases, and Kristin gives us some example of specific use cases they have encountered and how Envision has scaled their telehealth systems to respond to unmet needs. We close the episode with a discussion about unique versus out-of-the-box solutions and how the tools Envision has developed are useful not only in acute settings, but in office practices, post-acute, and urgent care centers too. Don’t miss this Field Episode with Kristin Darby!

Key Points From This Episode:

  • Kristin tells listeners about Envision Healthcare.
  • The impact of the COVID-19 pandemic on Envision Healthcare and how they responded.
  • The importance of telemedicine and collaboration for Envision during COVID-19.
  • How Envision addresses their platforms and architecture in order to respond quickly.
  • How Envision scaled their telehealth services and the particular use cases they encountered.
  • The importances of easy-to-use technology for all providers.
  • Kristin gives some examples of the use cases and evolutions of the tech they encountered.
  • How Envision acquires and develops their technology solutions based on evolving need.

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 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 collaboration events dedicated to developing the next generation of health leaders. Have you missed our live show?

It is only available on our YouTube channel. What a fantastic conversation we had with, uh, direct Ford David Mutz. S Shade. Around what's next in health. It, uh, you can view it on our website with our new menu item appropriately named live. Or just jump over to the YouTube channel. And while you're at it, you might as well subscribe to our YouTube channel and click on Get Notifications to get access to a bunch of content only available on our YouTube channel.

Uh, live will be a new monthly feature only available on YouTube. How many times did I say YouTube in that paragraph? Subscribe to YouTube. We're gonna have some great stuff over there. This episode in every episode since we started the Covid 19 series has been sponsored by Sirius Healthcare. Uh, 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. Now on to today's show. Alright, today's conversation is.

Good afternoon, bill. Thank you for having me. Well, I look forward to the conversation. Um, yeah, and, and thanks for taking the time. I know this is really busy time for you guys. Uh, tell, tell, tell us and tell the audience a little bit about Envision Healthcare. So, envision Healthcare is a national medical group.

We have 27,000 clinicians that deliver approximately 35 million annual patient encounters. Our clinical services are provided at approximately 50 locations across over 40 states, and our medical group specialty expertise includes emergency medicine, anesthesia, radiology, women's and children, and surgery.

AM is our ambulatory surgery division where we.



Well, we recognized early that technology helps relieve the covid-19 strain, and it protects clinicians, which is critically important to us in addition to protecting patients. As a result, we quickly mobilized our efforts to deploy telemedicine, but I, I think some of the other observations just about the pandemic in general, collaboration has.

Everyone's recogniz, the public health crisis and the speed of execution is at an all time high, which has really been required in this dynamic situation that has been changing on a daily basis. One area specifically that I've been really, really pleased with is the expeditious data sharing and.

A very robust community-based biosurveillance system that we're augmenting with community-based information. And then the information we're seeing with patients that are presenting on the front line during this crisis envision's very much a data-driven organization. So that's really been critical for us to have the information to be able to respond Most.

And also helping us. Just things like prioritize resources and, and understanding where we need to be focused to respond next in what, et cetera. Yeah. So it's interesting you bring up, well, two things I'd to talk about, talk about Biosurveillance, you talk about Datadriven organization. Um, you know, there's no doubt at this point that

in business agility.

React or respond pretty quickly. Um, give us, give us an idea of, you know, how, how you guys think about the platforms and the architecture in order to give you the ability to respond.

Yeah. So, um, I think when this was evolving, nobody knew what to expect, right? We're all learning, uh. I think just a bias for me has always been, I prefer open architectures. I believe very much in interoperability and, and I think our technology portfolio is reflective of that. But when we started this, we had assumptions as to needs that we were gonna have.

And what we tried to do is.

What we did is each of those assumptions, we tried to have two to three different ways of addressing it, and we knew some would fall. What we didn't wanna do is be standing there and have to tell our, our clinicians or, or any of our operating units that we couldn't deliver in times that they needed us.

And so.

But you know, I think some of the things that really came through is some of the more robust platforms that we had were scalable. They were able to perform. Luckily we have an incredibly skilled engineering and software development team, and quite frankly, most of what we've done, we built and.

It's not things that, I think with the evolving use cases that have occurred, and, and a lot of this has really been in the virtual health area, so, so we had kind of the remote workforce change that occurred and then there's been kind of the frontline work of really supporting the clinicians and, and the patients that they're serving around the clinical needs that have evolved.

Of those, uh, but more on the telemedicine side. It's really required those advanced technical skillset and also the deep knowledge from, from a clinical informatics perspective and just awareness of how a hospital operates, how office practice operates and, and what is the right technology to address and meet.

For example, telemedicine. We have distributed in 11 states right now, but, but the surge areas were where most of our extensive learning was occurring at a very rapid pace. So, so let's talk about telehealth because that's, you know, given the, the nature of envisioned healthcare, you guys really relied pretty heavily on, on telehealth and monitoring

a result. Give us, and I really wanna get pragmatic here because a lot of systems have come on and said, Hey, we scaled from this to this. And, um, you know, that's, that's really neat. But, you know, how, how, how have we scaled? How have, how have we experienced it from a clinician side and how have we experienced it from a patient side is really the direction.

So as I said, uh, in each of those assumptions, and one is that telemedicine was gonna be needed. I think there was a lot of discussions around that in February, but was it, you know, the traditional urgent care type call or was it an office based call in, in an acute setting? I've had many telemedicine programs over the years, but it was things like tele ICU or very.

In this situation, we didn't know what to expect, and so we, uh, did go down the avenue of some of the telemedicine platforms that you could purchase, and they were dealing with a surge also of demand. And it quickly became clear that the use cases we were being asked for would've been pre covid.

Gonna be, so if we really wanted to meet the needs of our clinicians, and, and I'll tell you that the, the four drivers that, that became really, really clear was, uh, initially was, um, PPE, which the personal protective equipment, we've all heard on the, that the, in the PPE number. How can we use technology to help reduce the need for PPE or, or if somebody was doing something minor that maybe didn't require physical contact, but maybe it's looking at a monitor, right?

Do they really need to get fully dressed in PPE to be able to see what the monitor says, uh, to enter a room? So just real simple needs that really aren't technically, but equipment has to. So the second was alleviating just the capacity strain in the hospital. The third was pre-screening patients that respected covid.

Lots of discussions initially about tens, which is, you know, we started designing for that. And then front of emergency medicine entrances to pre-screen. I would say the front entrances took off. We absolutely had somes, we were supporting. But you know, initially, if would've. That didn't necessarily emerge to the scale that we expected, but what did emerge is the need for specialized treatment consult at a scale that wasn't anticipated initially.

So it was emergency medicine, but the need to be able to see the patients because COVID 19 is something new and everybody's.

The better guidance they're able to provide and the more that they're able to talk to the other providers, especially critical care areas and other areas. We were doing a lot of specialty consults, so a lot of our initial designs were around those concepts. And when we talk about provider adoption, I think there was a lot of discussion about it in, in week one, two, how would we use it, the workflow, and then started some.

The absolute necessity for it, um, became very clear. A lot of those other anticipated challenges were overcome very, very quickly because the need was clear. Uh, our, our providers, we had a few that really, really embraced it from day one, just tech savvy. And we knew when we were designing this.

Is evolving. Right? You know, if you think of the surge area, you might be redeploying people from other facilities. Maybe credentialing hasn't gone through yet. Maybe user accounts are, are aren't provisioned. You know, you have experience with this. It usually takes a little bit of time, right? All those processes with every location weren't necessarily tuned to respond to 10 minute requests, right?

So we were trying to figure out how do we fit in there and make sure that this continues to be secure, which throughout this process, we've never compromised on any of the security standards or HIPAA requirements because those are absolutely critical to us. And, and we feel as a responsibility to our patients and, and the health systems that, that we, the patients on.

I certainly wouldn't have anticipated that initially. So we had a, a mother that was in, I, I believe, uh, late fifties, sixties, admitted adult children brought her to the hospital, not in good condition, and they had to leave her at the emergency department during the crisis, the visit.


Very critical condition ended up being intubated. But normally in a situation like this, a physician is talking to a patient, but also their family surrounding them about these are the options you have available to you. These are the courses of care we could take. And there's a, uh, an there's.

Discussions with patients that, that weren't necessarily prepared to be making those types of decisions, right, typical decisions and may not have been able to. What we were called about is how do we get the patients, us, you know, the providers, which might have been more than one, and family together, where the family discussion.

So we ended up designing a multi-point secure video conferencing solution. And initially it was for those meetings, right? Uh, uh, discussions about how to, how to make critical decisions around, uh, patient care needs. But then it evolved to the physician said, why disconnect the.

Make sure they know they're safe. They can't be there physically to hold their hands, so why not be on video right there with them? Absolutely makes sense. Don't hang the connection up, right? It's a secure connection and, and so those types of things, just replacing what is so just critical from a human perspective really was important for us.

Critical care patient that was in the ICU but was conscious, awake and intubated. The, there's a, a very advanced bed called a rob bed that is often used for patients that have acute pulmonary complications. And this patient covid positive, but having complications, uh, with.

It's the best course of action. So if, if you just think about being scared that your covid-19 positive, right? You know, a patient, and this is, uh, a few weeks ago, still not a lot, no, right, lots of uncertainty. You're away, you know, you've been intubated and now you're in a bed upside down at.

The challenge is, he said to me on the phone, how am I gonna get a nurse down there to talk to the patient, right? Even if they laid on the floor and crawl vendor, they're not gonna be able to give those personal updates that are so critical just to be able to say, we're here for you. This is the status, this is what we're seeing.

You know, this is the, the path to recovery, and this is where you are on it. So what they did is they used the solution to put a tablet under the patient, and they were able to come on and say, we're here. Good. Right. Checking in on you, you're not alone. Right. And those are things that, um, are so incredibly valuable for patients trying to get through what is probably the most vulnerable point in their life.

But in addition to that, just the, the fact that technology can help with that, I would've.

Those because, you know, Father-in-Law into the hospital, probably about three, four, be been in hospital times most of the time.

I mean, he involved in conversation with us and see that as a really real need, uh, for I just experience and. You know, the last thing, because I've up a fair amount of your time, but the last thing I, you, you seem to be an organization that leans more on, uh, creating your own solutions as opposed to relying on out of the box.

Is that, is that accurate? And then how has that played out through this pandemic? Yeah, so I would say that we probably, the majority of what we, we would always. Unless there's a specific reason around some type of proprietary activity we're doing or something that is a differentiator that we're developing that otherwise we would always look to buy.

Especially, it's something, it's, I think what what drove us from a development perspective here was clearly.

In the way our clinicians really needed it to respond, to be able to meet these on me. If we gave them a traditional structured, you know, station or heart or you know, just these things that were created for other types of use cases, we wouldn't have been able to have the flexibility that we've been able to have and, and truly benefit not.

We certainly, I described the acute setting, but we've been using this in our office practices, uh, also in post-acute and urgent care centers. It's really been valuable tools to help us navigate this crisis. Fantastic. Well, I really appreciate, I really appreciate you sharing and I, the thing that really has come through is.

Thank you. I appreciate it. That's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, Sirius Healthcare and Pro Talent Advisors for choosing to invest in developing the next generation of health leaders. If you wanna support the fastest growing podcast in the health IT space, the best way to do that is to share it with the peer.

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