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June 26, 2020: Welcome to another Field Report. Today Bill speaks with Jeffrey Sturman, CIO of Memorial Healthcare System, who provides context on how Florida has been dealing with COVID-19 and where the healthcare world is headed. Jeff discusses Memorial’s successes within their nursing homes and how this comes down to communications policy and their unique ability to perform their own tests. Bill then asks Jeff about Memorial’s response to the pandemic and how they’ve managed to scale up their telehealth structures. Jeff details the challenges that his organization has faced with telehealth and the need for providers to use non-standard platforms like Zoom to see patients. After emphasizing that telehealth needs a ‘one-click’ solution for accessing providers, Jeff talks about the benefits of virtual care, including the potential for family members to become involved in consultations. Jeff and Bill discuss how Memorial is handling its ‘work-at-home’ situation before focusing on hard-hitting questions about what the future looks like for Memorial Health’s IT priorities. Jeff shares his thoughts on how telehealth fits in with his mobile and social strategy of engaging consumers and about the importance of business intelligence and analytics. Finally, Jeff talks about how he’s preparing for a second surge of patients. Jeff’s insights are valuable in understanding the shifts in the health IT landscape, so tune in now!

Key Points From This Episode:

  • Jeff provides context on COVID-19 in Florida and Memorial Healthcare’s caseload.
  • How Memorial Healthcare has played a leadership role within their county. 
  • Their success in nursing homes is due to a policy of education, communication, and testing.
  • The importance of telehealth to Memorial Healthcare’s pandemic response. 
  • How they scaled-up their existing telehealth structures to deal with the pandemic. 
  • The challenge of having patients adopt standardized telehealth platforms.
  • The need for ‘one-click’ telehealth solutions. 
  • Telehealth’s potential to bring family members into consultations. 
  • How iPads are helping patients communicate with providers.
  • Jeff’s thoughts on work-from-home and how it’s becoming the ‘new-normal’.
  • Memorial’s priorities; customer engagement, virtual care, and analytics. 
  • How Memorial is preparing for a potential second surge of patients.
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. This, this morning we're joined by Jeffrey Sturman, CIO, for Memorial Healthcare System in Hollywood, Florida.

Uh, good morning Jeff, and welcome to the show. Morning Bill. Thanks for having us. Well, I'm, I'm looking forward to the conversation. We've interviewed people from all different types of health systems. Give us a little background and, and idea of, of, uh, Memorial Health Healthcare System in, uh, in Hollywood.

Sure. So memorial's the South Broward Hospital District. Um, we're a county-based, uh, subdivision of, of the state. And so the healthcare system is six hospitals. We have five acute care hospitals and the Joe Diaggio Children's Hospital in Hollywood as well. So about 2000 total beds. Um, about 2000 physicians on our medical staff and the Lion's Share are still community-based providers.

So we don't employ a huge number of providers. Still today we have about 300, uh, of which most are specialists. Um, and we do have a nice footprint on the primary care side, and that's building and growing as, as you can imagine. So I see that our employee base will continue to develop on the physician side.

About two and a half billion dollars in revenue, a little less than that. And for Florida, that's pretty sizable and big. Uh, certainly for Broward County. Um, I won't say that we own the complete market share. Uh, south Broward is a competitive market and, and our sister healthcare system to the north of us, uh, Broward Health.

It's about the same size. Um, I think their, their area of demographics actually is a little bigger. Um, but in terms of revenue, they might be a little bit smaller. Uh, but between North Broward and South Broward, uh, that is really the primary hospital base. Obviously there's others in our market, uh, Cleveland Clinic here in Westin.

Uh, we have some HCA and tenant hospitals in our general area as well. And so, um, really, really happy to be here. It's a very community focused healthcare system. Uh, we span from Hollywood on the east side of, uh, the county all the way to Miramar, uh, which is about a 20 mile area of our six hospitals, and, uh, a terrific healthcare system.

Yeah, I, you know, it's, um, I, I just moved from California to Florida for people who don't know, I moved into Naples. I moved on in March 1st is when we moved in. Couldn't have been a more odd time to move in, but I'm, I'm looking forward to, I. Uh, getting to know the people in, in Florida, and it's interesting be because, uh, you know, the, the Florida healthcare systems, I, for whatever reason, Florida and California, obviously geographically pretty dis uh, you know, dispersed.

But, um, I didn't interact with a lot of people from Florida Healthcare. Being in California. I, I I, I don't know why that is. It's just, um, we, we always say it's a bubble here. I mean, it's a bubble where I live in my very small community. It's a bubble in South Florida. Um, and, and I don't know if that's how we are geographically placed or, or why that is.

Um, and, you know, the opportunity to do both consulting in my past and bring some of those lessons learned to a place like Memorial, which has such a long and rich history of people working here for a very, very long time is, is been terrific and, and fun. So, but it is a bubble. Yeah, it's, it's interesting.

Alright, well let's, let's, let's get into it a little bit 'cause I, um, you know, it's, it's interesting as I'm interviewing you guys now, a lot of, you're like, Hey, what can I talk about that we haven't talked about before? Um, and I think each market has a little different bent and, uh, it, it's interesting to me the feedback I get from different CIOs and different people within healthcare that they appreciate the fact that we're interviewing people from different markets and different sizes.

Because even though. Yes, we're all doing telehealth. Yes, we're all doing, uh, work from home. Uh, we, we took a little different approach to it and, uh, and that's helping others to really think through where they're at. So give us an idea. Let's start with just give us an idea of where your health system or, or how your health system experienced the pandemic thus far.

Well, well, maybe I should start just with some high level statistics for you and, and give you a sense of Florida and, and Broward County and Memorial. 'cause I think it'll give you a little bit of context for. What we've done and what maybe we haven't done compared to some others. Um, I'll just rattle off some statistics as I look at them.

So, for the state of Florida, um, and I think we have been hit by covid, just like everybody, uh, the the volumes are high and, and maybe not as high as some other areas in the country. So in context. We have just about 53,000 cases in the state of Florida in Broward County. We have just, uh, under 7,000. So between Broward and Dave County, we really, unfortunately, it's where the, uh, majority of the population of the state of Florida really is.

Um, and, and we are seeing obviously the, the number of cases to be highest in those two counties. So just about 7,000 cases in Broward, uh, about 307. Uh, deaths we've had in Broward, of which 1500, uh, people have been hospitalized. I can put that in context for Memorial now. And, uh, Memorial has had about half of the total cases in Broward County, hospitalized at one of our five acute care hospitals.

Uh, we've had 84 total deaths. And we run a census right now of about 110 covid patients ranging between a hundred and 120 on any given day. And that's down from about, uh, four or five weeks ago at the height, uh, and peak of this, where we were close to 200 in patients, uh, across our five hospitals. On the acute care side, we've had very limited, uh, thankfully on the Joe Diaggio Children's Hospital.

So, um, it's a big number and, and we've been doing a lot of the same things that so many others have done. Um, early, early on with regard to testing and working with the state of Florida and the governor's office. I think we were the first ones to open up a testing center and automate that testing center with our technology.

So really creating the throughput and the volume of patients that, uh, we could manage. And, um, upwards of 800 patients a, a day. Wow. What did, did you guys take some of the, um, some of the cruise ship passengers? So we did in, in a very limited fashion. Uh, the port in, in port of Everglades is in Fort Lauderdale, closer to Broward Health.

Um, I know they did take some, we took very limited, um, but we did certainly, um, play a role in both cruise ships and some of the long-term care facilities. Some of the nursing. Uh, we've been continuing, uh, to play a leadership role really, not just for memorials own what we call manner, our long-term care facility, um, but, but long-term care facilities across the.

Yeah. So what's distinct? And so there's been a lot of talk about, about nursing homes, and I'm gonna go off script here a little bit. Just the, so from a nursing home standpoint, Florida's sort of being lauded, uh, as in terms of some of the, some of the, uh, approaches they've taken versus, versus other states.

What are some of the things we, we did with regards to nursing homes? You know, I think, I think our instruction of education, communication. Testing. So Memorial's one of the only organizations that I'm aware of that actually has their own ability to do the test. So do testing early on and have all the reagents and have the testing equipment is something that we, um, help significantly with our nursing homes.

And, uh, and continue to provide that education with regard to PPE, uh, with regard to, as I said, um, just equipment in general. So I think that education, that communication has really, um, helped. It certainly hasn't, um, mitigated totally all the, all the issues of our nursing homes. Um, but we've seen a significant decrease actually just in the last couple of days, so we're happy with that, obviously.

All right, so the, the shows this week in health it, let's start talking about technology. We. You know, we, we've, we've done, we've done a lot of different things. What are some of the things you guys did with regard to, to technology and feel free to be repetitive. We'll, we'll, I'll, I'll break it down and, and go, because I'm sure you did some things in telehealth.

I'm sure you did some things work from home. Uh, love to hear about those and, and maybe some other things that you did. Yeah, I mean, I think we've done so many things like, like you said, with that is similar to others. Um, obviously telehealth has been, uh, front and center for all of us. Um, you know, bill before, before Covid on an annual basis, and the penetration for telehealth here and virtual was really, really small.

And I'm gonna go off a number that may be not completely right, but 2000 to 3000 telehealth visits a year before Covid. And in the, in the last . Two and a half, three months. We've had 42,000 telehealth visits. Um, most of which have been through Epic. So Epic is our EHR and, uh, and through the, uh, MyChart and scheduled visits and the way in which we are conducting telehealth, uh, we do that through, through MyChart and, uh, over 35,000 of those visits, um, have been through our actual integration with Epic and MyChart.

So you, you, you had that in place beforehand and you just scaled it up. We did. So we had it in a, in a limited fashion. So our primary care group has really been out in front of this a lot. Um, and some of our, what we call memorial physician groups, so some of our employee based of physicians. In limited fashion.

And so in the last two and a half months, almost all of our specialists and certainly all of our primary care providers have been trained, have been marketing and communicating with their patients, uh, that this is an opportunity and an option, uh, that, that we wanna encourage. So we did have the technology already in place.

Uh, and so that was an easy lift. The hard lift has been how do we make the easier transition for all the patients that don't have MyChart and don't wanna use Epic? And so we're still investigating and we've used a lot of different technologies to facilitate telehealth that we didn't have in place.

Things like FaceTime and Doximity and doxy.me, and WebEx and Zoom even. We haven't wanted to get in the way of our providers providing care to patients as effectively as they choose right now. Now we know that's not consistent, that's not standard. That's not even where we want to be. The long term. So we are looking at very simple solutions.

In fact, we're piloting two right now. Uh, one is a partner of Cisco and one is Tiger, which is a application we have here for texting capabilities, for secure messaging. And both of them have very simplified. Telehealth capabilities, one click telehealth visits, and, uh, and we think that'll take off even further.

So that's for people without MyChart, you're, I mean, you're talking obvious. You know, this is something people don't really recognize. Not everybody has, even if they're in your community, not everybody has a, a, a medical record at your system, but they still in a time of pandemic, might need to get a test, might need to be, you know, those kind of things.

And they're first . Hit their first, uh, interaction with the health system could be through telehealth. While they don't have a a record, you have to have a way to sort of instantiate them into the system. Um, is that what you're talking about? It is. So we're, we're thinking about it in, in kind of two ways.

We're thinking about, for those patients that don't have a MyChart account and a provider wants to initiate a telehealth visit at, on an ad hoc basis with that patient, um, even if they're not scheduled per se. The other thing that we think there's an opportunity here is we're telling. Patients and their family members not to come into the hospital unless they absolutely have to.

Um, and obviously we're safe and we can do this for patients, but family members are used to being waiting in the waiting room for their family member. Or when a patient's having a procedure in the operating room and outpatient procedure, they're used to waiting there. So now we're having our providers actually initiate these very simplified telehealth visits.

And they're not patients of ours. These are family members where they can actually communicate with a family member, the status of their patient or their, their family member who just had a procedure. They're able to communicate with them real time and face-to-face, which we think is more valuable. Yeah, that's, that's interesting.

Any, any, uh, remote patient monitoring or, uh, I mean, let's, let's just go there. Any kind of expansion of the remote patient monitoring, uh, capabilities that you had? Yeah, so this is something we were looking at, um, actually before the pandemic. Uh, and we've been looking at tools that we can utilize. We've done this for the last number of years on the value-based care and population health side.

Um, so we're gonna continue to leverage the tools that we have at our fingertips, uh, for further chronic disease and even follow up on some of the home health long-term care. Um, some of the, the patients that, that, you know, we, we wanna make sure we're having the right follow up on. And so, um, I think this will take off more.

Uh, we are talking about it more and more, um, and we're doing some pilots. A vendor on even our ECMO patients right now. So some level of virtual, remote patient monitoring of ecmo. And then finally, we've put in over 300 iPads in our facilities. One so that we can continue to communicate for, for patients with their family members.

And two, we can communicate from a nursing station, for example, and not burn PPE unnecessarily. So the patient can actually communicate with a provider who's not in the room, who's covid positive and have the ability to ask for something as simple as ice chips if they need it, and, and not necessarily, um, have a provider come in the patient room without, um, without unnecessary risk.

You know, I love, I love, uh, I love interviewing CIOs and especially when they have their mail open in the background. 'cause it gives, gives people a picture of how busy they are and how many , how many things keep popping up on your, uh, on your computer. Um, let's talk work from home and actually let's just, let's just project into the future on work, from home.

How are you gonna make the determination of what. Uh, what the new work environment looks like. Uh, you know, how quickly people come back. Do people all come back? Is it a hybrid environment? How are you gonna make those decisions? How are you gonna determine what, uh, what the future of work looks like at, uh, Memorial?

I. Yeah, so we're, we're about 15,000 employees and about 2000 people at any given time right now working from home. Um, we've been talking about this a lot lately. In fact, I'm, I'm going to my, you can see I'm home right now, but I'm going to my office this afternoon for a, a tour with my chief nursing executive and, and some of my facilities people to actually look at the layout of the building to determine where we have risk areas and how we need to shore things up from a safety standpoint.

And so, um, we are looking at June 15th from a corporate services standpoint to open things up in a very, um, staggered means. So we're gonna say not everyone come back to work right away. I. And certainly we have some other project going on in it that allow us to be very productive right now and, and capable to work from home.

So my intention is, uh, certainly for the month of June and July to keep people working more remotely than not. Uh, and, and I think we're gonna take this in two week increments and, and just see where things are. But from a corporate services standpoint, June 15th is the date we're targeting to have a phased in approach.

We're leaving it at the discretion of leaders of various corporate departments to tell us whether or not their people can be productive or whether they need to be back in the office. But there's gonna be an element of, of this new normal, of working from home for I think, the foreseeable future. Yeah. Do you anticipate any people sending you an email saying, Hey, I don't wanna come back?

Oh, I, I think I do. I anticipate it. I I get it about 10 times a day already. , um, so, so yeah. It's, it's, I, I can't believe my team of about 300 people in it are clamoring to get back into, into our corporate building. Um, nor do I think they need to. I think I. I think one of the biggest lessons learned we all have, and we were really fearful of is would this work at home experiment that we were forced into work and, and can we create the productivity that we all, um, that we all really need right today?

And is it sustainable? And so many people, uh, from a leadership standpoint, um, we're very fearful of that. And I think we've proven out, certainly for my team, um, we are productive, if not more productive. I working at home right now, so I don't think it's a bad thing. Yeah. Um, it's May 28th, 2020. I, I say the date because I'm gonna ask you, you know, for, uh, something that I want people to understand the timeline.

We're asking this. So what are the priorities for health it today on May 28th? Um, and, and what do you think they will be post pandemic? Yeah, it's a good, it's a great question. I, I think, you know, so much of what we were doing before pandemic and, and now, during and after, um, have shifted and reprioritizing everything.

In fact, we're on a fiscal year that ends in, at the end of April. So we just concluded our fiscal year, which is really odd. Um, and, and we had our budgets fairly well secured in February. And so now we've been taking a look back and saying where are, where and how do our priorities need to shift?

Certainly virtual care. Uh, we had a fairly good strategic meeting with even physicians yesterday about virtual. You talked about remote patient monitoring earlier, and obviously telehealth. That is gonna be first and foremost and really I think continued, um, in terms of, of where we need to be looking. I, I put that in the category of virtual, but if I look at our strategic priorities in it, it fits in the world of mobile and social as well.

I. Those are two of our major priorities before pandemic and will certainly continue beyond pandemic. So the whole idea of engaging our consumers in the most effective way. Has always been something in our mind for this last year, and it's even more front and center. Uh, so consumer engagement. What are the tools we need to create and, and develop and partner with, uh, to, to make that all happen?

Uh, is still under evaluation. Uh, obviously analytics and data is something that also is very important post and pandemic and certainly has helped us make decisions during the pandemic. Uh, so I think business intelligence and analytics will be a strategy that we continue have to build out. We don't have the best governance around analytics.

Um, so we need to get that resolved. Um, but I think that'll be a, a big to do for this coming year as well. All right, so two closing questions. The first one's really around, we're seeing claims data showing that, uh, we're seeing an uptick in volumes, uh, across the board and I, and actually we're seeing it in, in all markets.

So I'm assuming that's true for you as well. Um, what specific. Health IT projects, um, are either you're putting in place to, uh, augment the safety procedures or, uh, putting in place to prepare for a potential second surge. Uh, if that does come about. I talked a little bit about this already, but I'll, I'll reiterate.

You know, I think, I think if a second surge were to come, we're doing a lot of things to, again, look at the data, make sure we have the, the dashboards and tools accessible and make sure they're tuned in a, in a manner that's sustainable and, and right not just for today, but for the future. Um. Texting and, and you know, the way in which we're communicating to patients and our consumers from, um, not just a one-way text, but a a two-way text that we've all gotten used to in other industries.

And for whatever reason, Memorial and maybe other healthcare systems. Are a bit behind here. I think we need to continue to look at how we engage our, our consumers on, on the texting front, um, and make sure that we're getting information out to 'em as real time as possible. Um, memorial's looked at because of our size and because of I think, who we are to the community.

As really an agent for information and education. And so we'll continue to look, um, at ways in which we can, um, provide that information to them. Uh, really, I, I talk about it from a, a MarTech, so marketing and technology and collaboration, and so there will be so much more to be done there. And, and then finally, um, this easy solution for telehealth, making this as seamless and simple for our end users that sure, epic is terrific and MyChart has a great capability for scheduled appointments, but there's so much more we can be doing to make an ease our, our population from consuming information and getting the right care at the right time.

Jeff, thanks. Thanks again for taking the time. I really do appreciate it. And, uh, after this is, you know, we've progressed through this a little bit, I'd love to come over there and visit with you guys since it's only a couple hour drive, I guess. You know, I love Naples. Uh, I, I'll even come over there to visit you.

It is, it's not even a couple hours. It's for, for me, I live in Weston. It's like an hour and 10 minutes. Um, and it is, uh, it's terrific just to come right across Alligator alley. So yeah, make your way over here for sure. Absolutely. Thanks. Thanks, bill. 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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