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June 19, 2020: Jefferson Health was busy pre-COVID with various capital-intensive and operational improvement initiatives. While the pandemic has diverted from these projects, the organization has risen to the challenge, adapting to the changing times. Nassar Nizami, today’s guest, and CIO at Jefferson Health, joins us to share how they have dealt with the large-scale shifts COVID-19 has brought. In this episode, we gain insights into what their response has looked like from March until now. While there was an initial rapid adoption and scaling of telehealth, remote work, and online learning systems, there is a steadier rhythm now. We also discuss some of the major cultural shifts Nassar has seen both from providers and patients in terms of telehealth. The uptick has been encouraging on many fronts. Nassar then unpacks how many of these shifts will have long-term impacts on the health system. He believes that the remote work model will endure post-pandemic, so finding a way to balance this will be crucial. Along with this, we explore some of the digital and financial priorities of Jefferson and what the organization is doing to prepare for a potential second surge. For all this and more, tune in today!

Key Points From This Episode:

  • Find out more about Jefferson Health’s COVID response from March until now.
  • Why Nassar believes the digital changes will endure post-pandemic.
  • The major mindset shifts Nassar he seen from patients and providers around telehealth.
  • What needs to happen in order for telehealth to be fully integrated into medical practice.
  • Nassar's experience of working from home and where he sees its future.
  • The surprising finding that came with the increase in remote working.
  • The digital and financial priorities that have changed at Jefferson as a result of COVID-19.
  • Jefferson’s Health IT strategies to prepare for a potential second surge.
  • Nassar’s greatest lesson he has taken away from this time.
Transcript

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 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. Well, we have some, a special request here, the programming team at this weekend Health.

It would like to highlight solutions that deliver hard dollar savings to healthcare in under 12 months. This is in direct response to, uh, comments we're hearing on the show, as well as comments I'm hearing in my consulting practice. Uh, before you drop me an email, I. I need solutions that have successful client stories.

I receive about 10 emails a week from companies that wanna highlight their product on the show. And my first question is always put me in touch with a reference client. And, uh, amazingly about 90% of those requests fall away, which I find really interesting. Um, we wanna see what kinda response we get from you guys and then we will, uh, determine how we're going to.

You know, get this integrated into our programming and get it out there. So, uh, you know, send in your responses, bill at this week in health it.com. Love to hear from you. Love to hear what you guys are doing. That is showing hard dollar savings, uh, real money savings for healthcare. Uh, this episode and every episode since we started the C Ovid 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's how we've been able to produce daily shows. Uh, and, you know, it's just a special thanks to Sirius for supporting the show's efforts during the crisis. Now onto today's show, uh, this morning we're joined by Nasser Zaomi, the CIO for Jefferson Health.

Good morning Nasser, and welcome to the show. Good morning, bill. Good to be back. Yeah, I'm, I'm looking forward to the conversation. Thanks for taking the time. I know this remains an extremely busy time for, uh, for everyone at Jefferson. It was a busy time before Covid at Jefferson. I can only imagine what it's like right now.

You are absolutely right. You know, the, we were extremely busy before Covid with the number of, uh, capital intensive initiatives, number of operational. Uh, improvement initiatives and so forth. Obviously for us, within it, epic implementation or expansion was one of them. Uh, but there were many other, and this, uh, COVID hit us, uh, uh, in March and we had to drop pretty much everything.

And for the last three months, uh, we have been very focused on, uh, everything related to Covid and just now we are. Coming out of it. Barely. Yeah. What, what are some of the things your team was able to do? Uh, uh, give us an idea of how you experienced Covid. Uh, you know, so far from about the March timeframe to now.

Yeah, I mean, it's been a just, I think, rollercoaster ride, uh, as in just, just some, an experience, uh, that is incredibly unique. Uh, so we, uh, obviously we are adjacent to New York, right? So again, in Pennsylvania, the Philadelphia area. So, uh, we were closely monitoring what's happening in, uh, New York, but the things escalated very quickly in New York.

And certainly, you know, even in Pennsylvania, uh, we are a university and a hospital. As you know, we are in academic medical center and in university that, so, uh, start like second and mar week in March. Well, within two days notice we, we went online learning, uh, and we are not, uh, known for online education.

I mean, just give you an idea. Prior to Covid, we had our 50 sessions that were online. Now we are running some 2,700 plus sessions that are online and within a week. Uh, you know, the next big thing that happened was work from home for all our corporate departments. You know, roughly 5,000 people. And again, Jefferson is a very much on-prem face-to-face organization.

We had, uh, you know, remote work, uh, very limited remote work. Uh, and, uh, we were fortunate in, uh, some due to our preparation, some due to lot, uh, we were able to redirect our infrastructure earmark for Epic and really move, uh, within four or five days everyone remotely. Uh, and, uh, uh, I'll, I'll happy to talk about experience, which has been just phenomenal.

I mean. In terms of that. Uh, so, and since then, uh, you know, uh, significant time my team has spent supporting that in parallel, obviously on the clinical side of things, telehealth took off. Um, and again, just an incredible, incredible story. So Jefferson was a leader, uh, in telehealth going, uh, into Covid situation.

We, our leaders, Jefferson is known for telehealth, but we saw 70 times increase. We went. We are now doing more than 3,500 visits a day. Right. Which is just, just incredible. Um, you know, uh, increase and, and, and literally every week we were seeing 203 every day, sorry, two, 300 new. Patient visits on telehealth that continued through April.

So, uh, I would say that through March and April it was an exponential increase on everything. Digital tools like Zoom, Microsoft teams, uh, you know, telehealth only learning, working from home. And in May is when we started seeing basically, you know, uh, what I'm gonna call is not, uh, you know, just a rhythm.

Folks, folks knew what to do. Uh, we are still, uh, what, uh, Pennsylvania, um, considers, uh, in a yellow zone. Uh, so our P code numbers are still high. We expect to be in, uh, green zone in, uh, probably two or three weeks. So we are not out of, uh, out of it, but, uh, certainly, you know, things have stabilized. Yeah. You know, it's, uh, you guys have so many digital initiatives.

So you, you weren't caught flatfooted by any imagination, but you know, the, the gains in telehealth are pretty amazing. Uh, digital, you know, remote patient monitoring, chatbots. I mean, there's so many things that people have put in, uh, uh, to combat the pandemic and to improve communication. How do you think those things.

I mean, those things have been accelerated. Do you think those things will be integrated into our post pandemic work models? I think so. Look, I mean, digital is the right word, I think for technology, uh, folks and technology leader, I mean, uh, future is digital and I. Uh, I, I am hearing this not from CIOs, but CFOs and CEOs and everyone, and this is not just healthcare.

This is beyond healthcare. Uh, and I think, uh, things prob are going to expect. Now, there are some question marks, and the biggest question mark, I think is, uh, in the reimbursement model for, uh, telehealth business, right? So obviously. Will insurers with CMS, uh, going to roll back some of the rules, uh, or they are going to extend and what will be long-term future?

That's, I think, probably the business driver of telehealth, but the, I think the big win or silver lining out of this, uh, dynamic is, uh, the cultural, uh, shift both on the provider side and the patient side. And the, the providers, uh, who have used were pleasantly surprised. By the technology and just the processes and so forth.

And I have to say, the processes are still evolving. Uh, same thing on the patient side. You know, I mean, initially we saw a large number of, uh, technical issues, you know, that were connections, uh, you know, app not working, et cetera. But over time, as our patients are, uh, you know, using technology, they're overcoming and they're finding that it works.

Technology works. Same things to be, can be set for things like Zoom. Uh, we are, we were piloting remote patient monitoring day before Covid, but now, you know, the, the, the, the adoption I think is going to just increase in that same thing is true for online learning. We don't, I don't expect, uh, to go back to the same levels in any of the areas that I mentioned, telehealth, online learning, remote work.

Uh, as a matter of fact for, uh, you know, we, we are now . Considering a pretty significant number of folks to be perhaps permanently working from home. Right. A lot of changes I think are gonna happen. I think we, we saw an exponential increase. It's, uh, it's not gonna be back to pre covid levels. It's going to be somewhere in between.

There are a number of factors that will decide where we land. Do you, um, I don't, I don't think I've ever asked you this. So do you have a peer who's over the medical school or the education side, or are you over both the education and the, uh, in the, uh, healthcare side? I'm over both sides. You're over both sides.

Well, this you. It's interesting, um, because I just finished a interview with um, uh, Dr. Mike, who's the C for the medical school and uh, the medical center down in at CL and we were just talking about how, you know, this. This is a fundamental shift in the two areas. Probably it's gonna be the biggest shift is education and, uh, and, uh, and medical, uh, as well.

Um, and, uh, you know, the, the three things we've, we've always talked about, it's. The, uh, there was a regulatory burden. There's a cultural, uh, change that needed to happen. And then there's the financials around telehealth, which really kept it, uh, sort of at bay or, or kept it from really growing. All those things were taken away for a period of time.

Mm-Hmm, . Um, but you know, that the, the regulatory will probably snap back in terms of practicing across.

The cultural will never snap back. Everyone's experienced it, right? So now the patients and the providers have experienced it. Um, but then there, there's the funding and we, we, we do have to figure out a way to take care of the funding to, uh, continuing it, uh, continue it. But generally if, if we can figure out those things.

Um, do you, do you suspect that, I mean, we are going to see, uh, telehealth remote patient monitoring become much more integrated into all of care and that it would start to be taught, uh, we would start to teach at the medical school different practices based on that technology? Absolutely. I think that's the, this is the future.

We are already talking what we call Jefferson at home, so it's, it's much more than a telehealth program. It's about taking care of. Um, patients at home, not just, uh, chronic care, but also acute care. I mean, so we really need to, uh, stretch the boundaries of what we have done up until now. You know, just by telehealth, telehealth is just what you and I are doing, right?

I mean, in a very, very basic term, a video call, essentially. And it has to be much more than that. Telehealth has to be integrated into, uh, EMRs and other technologies. It has to be integrated with. Uh, remote patient monitoring, and as I said, you know, the processes and, and, and protocols around it. Uh, and you, you actually mentioned a very important thing the way we are taught where, where we, uh, you know, uh, clinicians are taught where student medical students are taught.

And I think that there is, uh, in the future there will be, uh, specific, I think, uh, uh. . I don't know to what extent, but certainly, you know, courses and, and training for our providers to provide care virtually. It's already happening with our protocols being developed now as we, as we speak. But in the future, absolutely, this is the future.

It's not going away. And frankly, I think that, you know, uh, the, the demand from consumers or patients right, is going to be such. Uh, strongly in the short term term because covid is not gone, right? I mean, it's still, uh, still here. We don't have a vaccine. We don't have any treatment. So in the near future for us to provide care and, and for our patients to get here in a safe environment, I.

All the things that we, we've been discussing in terms of visual. That's, that would be critical. I mean, there is no need for if, if, if, if we can take, uh, if a patient can take vitals, weight, temperature, even beyond that, right? Enter or provide automated in, in real time. We are real time and just talk to a physician.

You know, look, I have had a couple of instances just during this, uh, where I was able to leverage telehealth and it just works. Unless you have to show up in the hospital. It just works. So, I, I think it's, it's, it's here. So Nassar, how, how have you experienced work from home and, uh, you know, what do you anticipate the future to be for the health system?

Do you. Do you expect, you know, work from home models to continue after you post covid? That's an interesting question that we are, uh, you know, dealing with. So I'll, I'll, I'll answer you in two parts. First of all, you know, I never had doubt that it can work from home like pre covid, right? I mean, uh, except for a, probably what I would say, 20 to 30% of our workforce that provide

Uh, onsite support like desktop, mobile, uh, folks, our biome team, uh, nature of their work is such that, that that's not possible. Remote is not possible. Uh, rest of the teams, our analysts, EMR analysts or financial analyst or analytics team, uh, good portion of our security team, et cetera, they can all work virtually.

I.

What Covid changed is, uh, that our entire corporate, uh, so anyone who could work from home, which is our hr, whether finance or revenue cycle or seamless access marketing department, it, these are the departments, uh, that went remote. Um, I'm talking about healthcare side of things, right? Certainly in the university, everyone is, uh, for the most part remote.

Um, and that. I think the change is very important because the reason, at least I was not a proponent of, um, remote work just in it is because of cultural reasons, right? If, if, if you are, you're supporting a department and that department is all in a conference room, uh, it to be on the phone, just one person to be on the phone just doesn't work, right?

And that has changed. Now when I'm in a meeting. Most people are working from home. Right. And, and I think the biggest, um, uh, thing, learning, not necessarily for me, I think, but for a number of our leaders, I would say, including me, is that our productivity did not decrease. Actually, we have seen improved productivity in our revenue cycle in our finance.

And I think one of the wins for me was our CFO saying, uh, that wow. He did not see any loss in productivity and he was not the only one. He was in a meeting with a number of regional CIOs and they looked at, they all looked at each other and said, Hey, we have not seen any in productivity. So we, as I mentioned before, we are actually actively looking at, uh, uh, keeping some.

Significant portion of our workforce remote. I don't know the number. We don't know the number. Uh, I would say that, you know, uh, we have to culturally balance it though. Uh, for instance, we still have providers and we'll continue to have providers and clinicians who are gonna show up, uh, at the hospital.

And, uh, uh, I think from at least IT perspective, it's going to be a balance. If the teams that we are supporting are going to show up in the hospital, then do we. How do we balance the remote work, which we know we can do and we can do productively, right? I mean, is there a cultural disconnect or not? We are, right now, immediate safety is.

First we gonna do everything, uh, to keep our workforce safe and secure. That's, that's . So, so number one, that comes everything. But certainly in the long term, we are considering and there are different models, you know, alternate days, alternate weeks. Permanent remote. I mean, everything is, uh, on the table.

We are discussing it, but I can, I can tell you that, uh, it, our workforce returning back is not going to be the same numbers and same numbers as, as pre covid. Well, I will tell you this, having been, having been, uh, someone who parked in one of the garages by your location and, uh, tried to get back to 95 during a snow storm, um, you know, sometimes that can take 45 minutes just to, just to travel.

You know, four, four miles to get to the main highway and, and get pretty backed up. So, I, I, it, it, it's interesting just to play around with the concept of how, uh, you know, how city traffic, how parking, how navigating hospitals. 'cause we're freeing up parking spots. All that stuff changes if, if we adopt some of these mod.

It's, I dunno, just stuff that's, uh, tooling around in my mind. Alright. Today's May, uh, May 29th, actually. And the reason I ask that is because I wanna ask, you know, what are your priorities today? And have they, have they changed much? Obviously there's gonna be some post work this.

But generally speaking, have the priorities changed, uh, dramatically since, since the start of this? I think, uh, the understatement to say that priorities have drawn dramatically, of course it has have changed dramatically, I guess. Uh, so look, uh, one thing that I think we have not discussed, uh, is the financial impact, right?

Of everything. So while digital is. I'll come back to digital and how our priorities have changed there. I would say that, uh, financial impact on provider side of healthcare is very significant, right? So, um, as a result, uh, uh, I expect, uh, significant scaling back of capital intensive initiatives. Uh, so including, you know, both on operating side and capital side of things.

So, um. What that essentially means is for at least Jefferson, uh, and you know, us, uh, we have been in this implementation mode, uh, E-M-R-E-R-P, student Information System facts, you name it, for the last four or five years. Uh, and frankly, our mindset for the next 12 to 18 months is going to be more of an optimization.

In, uh, operational excellence, improvement, then implementation. That's just one thing. We, we, we, we are moving forward with a pretty significant implementation of EMR that was pre covid plan and we need to get to, to conclusion. So that has not changed. So significant portion of our time will be just that.

It's just that beyond that, or in addition to that, typically there was always five things happening. I think it's. Or more, uh, happening. So financial distress is going to force us, or, or in a, in, in a good way, I guess. You know, there is this positive side of just looking at some, you know, uh, work. That we were not able to prioritize pre covid work.

Secondly, the three things in terms of digital that I've mentioned is online, uh, uh, for us, the telehealth work and remote work. So in near future, I think remote work will resolve in the next few months. Uh, policies and I, I, I say remote work as digital, but really I, I consider it as an hr, uh, first and foremost, an HR initiative, and that's how Jefferson is.

You know, tackling it. Our HR is leading and we are partnering with our HR to make sure that, uh, we are coming with the right policies, procedures, you know, and certainly supporting technologies for that. Uh, but in the next six, six months or so, I think, uh. Uh, end of this calendar year, uh, I think we will be in a good place for remote work position, but then everything that has to do with digitally, you know, how do we help our clinicians, uh, you know, uh, with perhaps pre-registering.

I mentioned Jefferson at home, that is picking up already at, at Jefferson. Uh, how do we keep patients at home and provide them, uh, educate or better care than, than they arrive at the hospital? Uh, things like, you know, can we register patients before they show up? Right? How do we do digital technology? The concept of digital door, right?

I mean, which we already have things like apps and, uh, you know, uh, alerts, et cetera. We just, you know, new ways to use them. Some new predict, use of predictive analytics to. To look at patient populations, at risk populations, and how do we, uh, uh, how do we encourage patients who need to come to the hospital?

There's a patient population that should be coming to hospital, but they're not coming to the hospital because of fear of covid. Uh, and, and I think, uh, we need to, uh, assure them that, uh, we, we are. One of the safest places to be, right, which Jefferson is, I mean, if you look very well from a safety perspective, uh, so use using digital tools to help on the academic side.

Healthcare side of things, uh, to, to do as much possible as possible digitally without the need of a, in-person presence. And that is a very broad spectrum of things. So those, those are going to be priorities. I just want also would mention, you know, as an example, cybersecurity has changed because of cybersecurity have changed for us.

Uh. It was always important. Pre covid, it's still important, but within cybersecurity domain, we look at the initiatives that have changed. We never have this much remote folks, uh, remote users. So our priorities on endpoint protection, uh, in remote access, uh, the way we collect log information, everything, everything changes within cybersecurity, right?

Uh, so, so I think, uh, the, our priorities in one word, digital. Yeah, so, so let, I mean, let's talk about that a little bit. So you have, um. You know, we, we have to restore people's trust in coming back to the hospitals. We told 'em not to come to . It's interesting, we're the one who told not to come to the, to the er.

Um, but now we're we're, uh, doing those initiatives around this city, uh, around our regions to. Uh, reassure them. We have procedures. We're testing patients, we're testing our staff. We're, you know, monitoring, uh, we're doing a just a, a ton of things. Um, I, I, I'm, I'm curious, what, what are, are you doing anything from a health IT standpoint?

With regard to a potential second surge. So you guys will go from yellow to to green here shortly. Um, and you know, I know there's a lot of people that are concerned about a second surge potentially in the fall or something to that effect. Are there any health IT projects per se that, that, uh, help you to, to respond maybe quicker than we did the last time around?

Yeah, so, so I think our strategy is we already, uh, in this first phase of Covid, we already stood up, uh, infrastructure for everything like telehealth. And our strategy is, and our thinking is that for foreseeable future, we are not going to scale back. We are going to leave that infrastructure in place. We are actually beefing in some areas, right?

Uh, because again, remote work is, was great when we did, you know, initially everyone want remote work, but then. Things like second monitor, things like, you know, uh, better connectivity at home, et cetera. I need a phone, I need some other equipment team. And we are all now working towards providing from a technology perspective what are the policies and, you know, uh, software, hardware that is needed.

So our strategy really is that we already set up infrastructure in a pretty significant way. We are beefing it up. We are gonna leave it on. Uh, so, and frankly in our case, we had to redirect from other projects to support covid related activities. And they will, the, that the, the equipment and infrastructure that we borrowed, is going to be long-term borrowing, I guess.

Uh, so. Uh, there's not, um, you know, significant, at least from a health IT perspective initiatives that we are undertaking at this point. I'm sure that as time passes, as fall comes near, I think, uh, we'll be more, more and more focused, uh, on that timeframe on this. All right. Last question. What do you consider the greatest learning so far?

Look, I think the greatest learning for me is that, uh, I, that we are an incredibly resilient organization. Okay. I'm, uh, incredibly proud to be working at Jefferson. We, we used to call ourselves 200 old year old startup, and I think we proved it to ourselves. Uh, the decision making from senior, senior leadership, uh, leader, uh, to, you know, really an analyst level have been incredibly agile.

Uh, people have been just making decisions and implementing things at a pace, uh, that was unthinkable before Covid. I mean, just no concept that you would be able to do things at this pace. Um, and, uh, and, and, and really with, with our, uh, we improve lives, every decision that we have made, literally in every meeting that I've went, we, we said, Hey, we improve life.

Uh, you know, we do the right thing and we, we, we, we, we think differently. I mean, our, uh, uh, guiding principles of re mission have, have really guided us, but I'm incredibly impressed by the folks, my colleagues, uh, the folks who I work for, who, you know, I serve, uh, my team. Uh, by the agility, by the resilience, by their integrity and just the drive to serve the community and not just something that, uh, we have to somehow, Jefferson has to figure out a way of preserving that, that that's just, just been an incredible experience as, as difficult as the experience have been.

Uh, just, uh, just uh, being around the folks on just fortunate, uh, to call them, uh, colleagues. It's just been amazing. Fantastic. Na sir. Thank you again for taking the time. I really appreciate it. Always good catch up with you. Both. Thank you. 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.

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