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June 5, 2020: Joining us today is Dr. Andrew Rosenberg, the CIO at Michigan Medicine. When the pandemic first hit the US, Dr. Rosenberg temporarily exchanged his CIO role for working on the frontlines and in the ICUs fighting the virus, but has since resumed him primary responsibility and has learned a great deal in the process. In terms of health IT, he discuses the sudden shift to remote work and how they are thinking about a sustainable solution, suggesting the possibly of a hybrid work model that involves both office and home time in the foreseeable future. There are, he says, certain events, tasks, and services that are best conducted in person and therefore a fully remote solution is not viable. However, the crisis has proven just how many jobs can be done from home and has had surprisingly good results, with productivity improving in some instance. Dr. Rosenberg also talks about the ups and downs of their telehealth systems, how his priorities for health IT has shifted during the crisis, and how they are reopening their services while remaining prepared to deal with a possible second surge. 

Key Points From This Episode:

  • What he has learned on the frontlines about people working together to help patients. 
  • The challenges of rapidly transitioning to remote work and trying operate it sustainably. 
  • Telehealth vendors that we helping versus those trying to take advantage of the situation. 
  • The possibilities of doing more work and delivering more services from remote locations. 
  • Considerations for developing a remote work model and the benefits of such a model.
  • The need for new measures of productivity and what it takes to monitor a remote workforce. 
  • Why a hybrid work model—including time at the office and at home—might be optimal. 
  • The long-term impact of the pandemic on future work models and how it will change society. 
  • Dr. Rosenberg’s priorities for health IT before, during, and coming out of COVID-19. 
  • Reopening certain services while also remaining prepared to manage a second surge. 
  • Dr. Rosenberg’s thoughts on whether colleges and sports events will reopen in the fall. 
Transcript

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. 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 morning we're joined by Andrew Rosenberg, Dr.

Andrew Rosenberg, the CIO for Michigan Medicine. Uh, good morning Andrew. Welcome back to the show. Morning. Thanks for having me. Well, it's, you know, again, thanks for taking the time. I know this remains a very busy time for everyone at, uh, at Michigan Medicine, and you just returned to the role of CIO after spending a few months really on the front lines caring for patients.

Um, what, you know, what, what have we learned in the, in the, in the battle against this virus so far? So I was, uh, I was back in the ICU for about two months, and I was still doing the CIO job. It's just I turned over more the day to day to some other people and, uh, you know, I think what I, what I experienced, what I learned is what you read about in the papers.

Uh, Detroit area was hit pretty hard. Uh, Michigan Medicine had a lot of transfers because of that. Um, I think our health systems, uh, most of your listeners, we tend to do crises very well, and, uh, everything I experienced was a number of, uh, remarkable, um, examples of people coming together from pretty much all parts of the health system to just take care of patients and manage the crisis from that, uh, it and informatics point of view though, the thing that was interesting about this one was that especially as we were trying out new things.

I was one of the people using all of the new tools or trying to new, to use the new tools. We stood up, for example, in ICU in one of our surgery recovery rooms, and, uh, we were trying to bring in new types of phones and we were using some of our very early unified communication platforms. The, uh, phone, we were using the iPhone, but some of the

Directory and some of the, um, patient context linking through Epic. Uh, and that was the first time we were trying these things out. So everything from getting the phones and even still having a lot of people ask for physical pagers at the same time, yet we were doing a new unified communication. It was interesting to be one of the people calling our help desk and asking and getting logged on and all of those things.

So I experienced a lot of that plus some other things we might wanna talk about. Yeah, absolutely. So, you know, give, give us an idea of, you know, just some of the technology. We just started a Zoom call and you had, uh, you guys have implemented some new security. Are, are there things, you know, in a crisis we move very fast to, to stand things up, get 'em going.

Uh, we get really creative on the clinical side. Um, you know, what are, what are some things that, that, you know, we, uh, I don't know. Really reacting to the, to the crisis, to more stabilizing and preparing for a second surge. Well, my, my guess is that we're like most of your other, your, your other viewers, um, we, uh, experienced all the challenges of a very, very fast move to remote work.

And we all experience not only the challenges of that, but . Probably many of the CIOs and other IT leaders were thinking, how are we going to be sustaining this? Because we knew some of the silver linings of this, uh, crisis were problems that are now eliminated or at least significantly reduced through a lot of remote work.

An example for us that I know has had many other health systems is the patient parking problem. The, uh, difficulty of, uh, uh, parking in, in very, uh, dense. Areas of our health systems now, I believe, has been eliminated because much of the non-patient care, non uh, physical critical work, the, the work that can only be done in person can not only.

Can be, has been demonstrably working and in some cases working even better. So from an IT perspective, what are we gonna need to do to sustain that? Um, how do we create new spaces that allow for hybrid work? Uh, uh, uh, a staff who. Typically either had an office or a cubicle or a set space now will not have that.

But we still want, and we all know as people, we do also want that physical collaborative work. Yet there's some real efficiencies. I mean, here I am, you and I are doing this and I'm, I'm, I'm at home and you're at home and I've been working for six hours already. So I think that there are a number of areas there.

The other one. That's a, a direct correlate of that is telehealth in our case, one of the challenges that we experienced, and I've heard at some other places where some of our big vendors were superb during this crisis. Um, they made licenses free. They really look for opportunities to just help out, uh, others though.

Clearly we're taking advantage of the situation and, and frankly, those, and, and fortunately those were much fewer. But, uh, one of our issues, for example, is right now we have at least three telehealth platforms that we could be using. And ideally we'd like to get to one, and whether it's the integration with our EHR or just to support remote work.

Uh, I think one of the challenges that we're all experiencing is how can we try to get to a limited number of platforms and, uh, enhance those, their feature set, their security, their ability to work in mobile platforms. I. That's one that I think we're all dealing with and it's probably not a bad problem to have, but that's at least one area.

The other one related to telehealth, of course, is not just how the workforce supports telehealth, but I'm thinking about, um, those places that have already some pretty mature telehealth, they're reaping the benefits and good for them for being out in front. We're just. Okay. In some areas our, our ambulatory telehealth blossomed like pretty much everyone else has seen on the inpatient side.

We don't have really rich tele platforms, but we do have several individual ones that could be cobbled together and still be effective. And the challenge I'm working on now, and that's one of the things that I dealt with being in the ICU, several of us got together, we put all of them up into a couple of screens and we practiced with what would.

A tele ICU, for example, looked like with Epic, with homegrown systems like our alert watch with, uh, T three that we use in our pediatric ICUs and how could we gum together secure web-based cameras so that we would have essentially the feature set of a, of a more matured tele ICU platform. We have all the features.

Now we just need to figure out how to take existing systems, cobble them together, a little bit of governance, uh, and move forward with that. Final example, just before Covid hit, we were already talking about more remote radiology viewing, uh, stations at home, and we'd set up about three or six of them. Uh.

Two weeks into Covid, we had 50 up and running. And uh, that's an example of a new workflow that will almost for sure be sustained because in private practice radiology, more radiologists are starting to work from home. So one can imagine not just imaging, but now talk about digital pathology and other types of image related diagnostic and care where people will be able to start doing more and more of that from, if not home, different locations.

And that's gonna be interesting work for our CIOs and other IT leaders to work on and, and I think we could. We could probably come up with a couple dozens of, of those examples. This is what I love about a conversation with you, is you've given me, I don't know, six places to jump off of from here. Uh, what I, I'd, I'd like to talk about telehealth.

I'd like to talk about work from home. I'd like to talk about, uh, setting the priorities moving forward. Those are three things. Um, and I, I, I, I want to talk about second surge, so I, I wanna make sure to, to hit those three things. So, as you know, you talked about work from home. It's interesting. I mean, there are some benefits to it, right?

Uh, I mean, parking might sound, uh, if you've worked in a hospital, you understand how bad parking is and navigation around a campus and those kind of things. Uh, and this really frees that up. It also, there's a lot of really expensive real estate that gets used in this. Um, I think people anticipated a significant drop in productivity moving people to their homes, but I don't think we've experienced that.

What kind of things are you gonna be looking at to determine. Um, your future model, I, I don't assume you're rushing to get everybody back into the office. You're going to, you know, look at certain aspects in order to determine what makes sense to, to come back and what makes sense to, you know, wait for another day to make a decision on it.

Yeah. You know, one of the great quotes, our deputy CIO said it a year and a half ago, Jack Kufa, he happens to be our CSO also, and we're talking about work from home. And I, I think maybe, um, remote work is probably the more accurate statement because it really is, is just that. Um, and we talked about productivity.

And I love the quote what, what he said. It was one of those off the cuff comments, but it just resonated with me very much. He said, well, how have we been measuring productivity to date? And I think what it really gets to is that one, we don't really measure productivity very objectively, but we have a sense of productivity because we just see people physically around.

And I suppose to some extent, there is something to be said for when you're expected to dress up. Professionally, and by the way, I am wearing clothes right now. This is not me, you know, wearing pajamas at the bottom. But you know when, when people are professionally dressed coming into the office and you kind of walk by, and in general, there's a inhibition to just be watching YouTube videos for three hours and going home.

There's some degree of external constraint for productivity, but. I think the more modern approach, which we were already working on within ITSM in some real sophisticated objective work with one of our other senior directors, Michael Warden, was how do we use uh, our, our ITSM tooling? I. Tickets, um, metrics around response time, metrics around first time, uh, uh, solution, uh, as opposed to just taking a ticket and passing it along to three or four people.

And I do think that when we start looking at measures of a healthy project. Measures of, um, of proper process that we can work on and improve upon. Those kinds of measures. Allow someone to manage a more remote workforce effectively, at the minimum you could say, to make sure you're not getting really bad.

Poor productivity, but ideally that's when people start to say, look, before I had a 45 minute drive to work and home, I just have an extra hour and a half of time now freed up because I don't commute, so I, I can be more productive. And that face validity. Can then be attached to other measures that we wanted to use anyway around our, I'll still call it our ITSM tooling, but really it's a much deeper view around services, metrics, measurable, quantifiable work.

That what I'm hearing in both talking to a lot of people, but seeing in our productivity measures we're better. An example, one of our very large data groups have told their senior director, and they were gonna be one of these groups who might have stayed at one of our old buildings as we're consolidating into one building.

They said, we have no interest in moving back to the old building right now. Let's just wait until we can get into our new consolidated one building for the entire IT staff. And interestingly around that, we, I was having to argue for a fifth floor in this building to move about three quarters of our IT enterprise IT group into this new location.

Now I don't have to that fifth floor, which I thought was gonna be very tough to get from a financial point of view. Completely take it off the table and we can move the additional 200 people into the building because we're gonna have a much more remote workforce. And what it will likely be, and I'm sure others are thinking this way, it's probably not going to be that a large group of people now are completely remote.

Instead, there are people who want to be coming into work, but I think it'll be a more hybrid. Type work. There will be people, whether it's uh, Monday and Tuesday, it's one team, and Thursday and Friday it's another, or, uh, a lot more hoteling space and a lot more collaborative space. And there will be some formal, these are days where teams come together for team meetings, teamwork, joint sessions, but then there's gonna be a lot more work from remote.

And I think that . Overall milieu will overall be a more productive and, and frankly collaborative, uh, uh, milieu for us to work in. Interesting. Uh, alright, so you, you've touched on some of this around telehealth and, you know, we, we've seen significant games, obviously, virtual visits in the ambulatory setting.

Uh, everyone's touting their numbers went from, you know. 500 visits to 5,000 or even more than that. Uh, in, in some cases we've seen, you know, tenfold increase in virtual visits. Um, but you start talking about, you know, some of the other things which I think are important, uh, remote, ICU, remote, patient monitoring, uh, things that can keep.

At home and provide a better level of care and monitor them. Um, we chat bots pretty extensively. You, what do you think gonna be the impact of having experienced this pandemic and put these technologies really as intermediaries in a lot of cases? Or as, uh, mechanisms to provide care in different venues.

What do you think the long-term impact of the, of the pandemic's gonna be on future work models? Well, I think the one that we'll most talk about, the one that will get the most money behind it will be all manner of telehealth. We talked about it before Covid. We, um, discussed it from a variety of, um, angles that all made sense.

Uh, patient engagement, uh, patient satisfaction, uh, uh, efficiencies of a healthcare system, uh, like you mentioned, care at home, something that we've been working on with some of our large payer partners to start coming up with mechanisms for . True inpatient type care now being delivered at home. All those things I think are only going to continue to expand.

They had a great interest before Covid. They needed an activation energy, uh, to borrow an old chemistry term and that activation energy was that catalyst actually to overcome the activation energy was covid. So I don't think we're going back in that the. Uh, engine of that will be the financing of telehealth, uh, both professionally, but, but even from a facilities point of view.

Um, I do think some of the benefits are gonna be clear to people. I think some of the downsides might be though, um, the potential . Further centralization of healthcare because of the large health systems being able to afford the infrastructures to do this. I don't know what it means to the smaller, uh, um, vital healthcare providers.

I don't know what it means to, um, the non large medical healthcare providers. So what does it mean to long-term care homes and. Uh, therapy and, and mental health in some other areas, although mental health is a good example of, uh, one of the more, um, amenable to telehealth, uh, uh, programs. My brother's chair of psychiatry at Wayne State, and he said ironically, that, um, during C-O-V-I-D, his department may be the only one that has not seen a significant financial loss because they've been able to do most of their work virtually.

In some ways it's even more effective to get, you know, some of these, uh, types of services out into the community, into rural areas where they're less common. I do think though that, uh, the, the area that we're likely to see a variety of different work will be again, the non-healthcare related remote work, and I'm spending probably as much time thinking about that.

All of its efficiencies. An example you said was we have some very new buildings and we have some very old buildings, and the old buildings have always been an issue because they require a lot more maintenance. We felt we needed them. They typically are where a lot more administrative work is done, and to me that's a win-win where we can start to very quickly move away from

Higher cost areas and use a lot more technical, uh, means to support remote work. Um, there are very few people who desperately wanted to stay in old buildings that cost a lot to maintain them and commute from long distances as opposed to, for example, our hospitals and our clinics. Uh, I do think that there will be, um, new services and new ways of working.

That will be fundamentally changing to society. Uh, we're seeing it in education, both good, but also very bad. Um, I've seen a real mixture in how both, what we have been needing to support for our medical school, for the most part good, but a fact that there's senior classes having to graduate on Zoom. No one wants to do that.

Uh, colloquiums and other meetings where people benefit from all of the pre-meeting and post-meeting discussions and that quick ability to talk to each other and to manage things. No one really wants to only do that remotely, let alone thinking about how are we gonna start the next school year. For our medical students and our graduate students and our nursing students, let alone being part of the university.

It is, that's an example where remote is not ideal. In some cases it is. In other cases it's the exact opposite of ideal. So I, I see us having, uh, much more interesting conversations in some ways around the non telehealth remote work. And what are new tools? You mentioned chat box. So yesterday we had one of our largest network outages.

In fact, probably the largest network outage we've ever had. I had to deal with that, you know, for about 12 hours and it took about 24 hours and it was a power source in one of our data sound. It was a maintenance on power, and we still don't quite know why, but all circuits shut off and we had a full stop of a scale we've never had before.

The impact was that much greater. Because of how many people now are, are working remotely. So one of the interesting correlates of all this remote work is we're even more dependent now on it, on our networks, on our numerous services. And one of those examples that helped out when our, um, when our, uh, call distribution phone platform went out.

Was our chatbots and our ability for people to still, not our bots necessarily, but people to still use chat to get to our service desk. Cellular as a backup spectrum became incredibly important and I think we'll see that really blossom as we get into not just more and more unified communications, more cellular related, but certainly as five G starts to trickle in and emerge.

We'll see even more applications running off of that spectrum now that we're more distributed, now that we're that much more dependent on this kind of work. Where will we see some acceleration in those areas? Those, to me are interesting questions. Yeah. No, this is a fantastic conversation. We're gonna, we're gonna end up going a little long.

I, I, and I'm just gonna keep going 'cause I, I do wanna hit on priorities. How we're gonna set priorities, and I do wanna talk about a potential second surge, where we're going. So, you know, today's, uh, I'm gonna give the date that we're recording. This show will probably not go live until next week, but it's May 28th.

We're recording this show, 2020. Um, you know. How are you thinking about your priorities for health? It, I, you know, you had a set of priorities coming into the pandemic that were well thought out, that had, you know, went through governance, a lot of people talked about, um, and now you have a, a maybe not a whole new set of priorities, but you have, uh, some things that have popped up as a result of the pandemic.

How are you going to prioritize the work? How are you going to, uh, evaluate all the things that are coming at you at this point? Well, I laughed at that because, um, I think like most people, one of the, one of the tough parts of Covid is that we're all going through, uh, cost cutting. And, uh, I'm as much trying to shift that as much as I can to cost optimization type discussions, not just cost cutting.

Those tend to be one time, they tend to be disruptive. We tend to get over it, and then yet we haven't . Really dealt with the underlying issue. So my, my laugh at your question was that all my priorities before Covid essentially got just completely wiped clean. And during Covid and now coming out of it, our priorities are focusing on what really is core to the mission.

Uh, and it's a tough conversation because most institutions have a lot of trouble really prioritizing all the what must be done, what's core versus what's nice to have. It's a. We're, we're probably as, as good and as bad as many other good institutions. But from my point of view, what it has done is it's helping me, um, articulate what really is core to our mission just a little bit more.

And, uh, I've mentioned a few of the examples already, um, where we're duplicating. Where we have three telehealth video platforms, things like that. I'm hoping that this will give us a little bit more clarity to point out what really is core and what we have to focus in on. So that's driving most of our budget discussions right now.

Um, the challenge for me, and it might just be somewhat local, is our dependency on technology is no, uh, has never been greater and yet getting more, um. Um, choices more priority towards technology and it, and data and information services and less from Manda, uh, manual work. That's still a slow process. An example is.

Doubling, tripling down on RPA type efforts that we had already started robotic process automation and frankly, other automating processes. I'm spending a lot of time trying to point that out as a, uh, value, not just to get through the budget crisis of covid, but really set us up into new work going forward.

But the final piece to what you also said is trying to think about some of our priorities, whether it's surges in covid or other disruptions. It's, um, what of the things that we did during Covid can we really demonstrate, made us more nimble? Uh, and we can point to a good half dozen to dozen of those.

And those are the things that we're very, very clearly, uh, emphasizing as we go forward. And one of them are the tooling that we've done that allowed our staff to work very effectively remotely. And make sure that that, uh, only gets more attention and, uh, effort. You know, it's interesting when you say budget crisis in healthcare for, for those of our listeners who said, you know, what budget crisis, I, I would just encourage you to go listen to, we had Rob dhe, the former CFO for UPMC on the show, and he explained it in detail.

So, um, just, you know, if you, if you're not familiar with what's going on, we essentially. You know, had the surge, we shut down, um, elective procedures, and then essentially in a lot of areas, the, the beds did not fill up with covid patients and it created a significant financial gap. Uh, we're not gonna cover that.

What I, what I'd like to do is, you know, we're seeing signs that, uh, you know, just from claims data and other things that are going on from conversations I'm having, health systems are starting to take those, uh. We're starting to see a, um, increase in elective procedures, which is good. It's, it's, that's the financial health of the, uh, of the organization's important.

We're seeing upwards of 85% capacity now, uh, even, even pushing, uh, 90% capacity, which is great. Um, but as we do that, my two, my two part question here is how are we gonna do that safely? And then the second is, how are we, how are we, uh, returning to that work? While also keeping an eye on a potential second surge.

Well, I think again, probably we're like many, we had had these ideas around, uh, 24 7 hospitals and significant more efficiency. So one of the silver linings for us is that as we had built some more capacity over the last few years, we weren't using it really as efficiently as we could. Um, particularly in some of our ambulatory areas.

Now, I. We're reopening our ambulatory sites with full efficiency, and only when we've achieved that do we then open up further sites and. Probably will allow us to sustain, um, a, a, a lower cost per unit service, which we've been trying to do before Covid, and I would suspect other viewers are finding those opportunities.

And if not, that's something that we're doing actually very well. And I think, uh, it gets broad support, uh, as opposed to our hospital, which, like others, we were running at 97% capacity. Almost inefficiently full now, we actually might be able to find some mechanism plus some of our new analytics to try to just take a bit of that edge off and stay more efficient, for example, to accept more transfers to shorten wait times for patients.

So I think there's some silver linings in terms of capacity bed management, transfer management that this. Crisis, if we emerge out of it effectively may, uh, help. A similar example that I mentioned before around the 24 7 hospital, while we're not running 24 7, we have expanded services into Saturday and somewhat later hours.

And I think, uh, maybe people just want to be getting back to work and feeling secure in their work. I don't know how long it will sustain, but if we do it properly, we might sustain it. That should take down some of those longer wait times and engagement. Those are examples of silver linings that I hope, uh, we, uh, uh, maintain after the crisis.

That will also, with some of the technology points I made before, allow us to not close down as completely as we did before. Better. Screening, of course, is absolutely critical to anything we talk about at all. Better identification. We've worked with our ehr, as I'm sure others have to do a much better, um, uh, colla, uh, uh, collation of data so that a more accurate signal that a patient either has, has high risk or had.

Allow us to maintain operations as opposed to shut everything down and only be a covid hospital. I think those are the kinds of things that we're gonna see during the emergence, during any types of surges and spikes, because I don't think the economy is gonna allow us to shut down as much as we did before.

But it's also, I think, gonna help us for some next future, uh, um, uh, items, whether they're infectious diseases or other surges, and be able to manage those more robustly in the future as well. All right. The million dollar question my daughter goes to, uh, Baylor, and she has been studying this semester, obviously from home.

And, uh, you know, one of the reasons you choose to send a student to Michigan or Baylor is that experience, I guess, you know, as we look to, to the fall. This is my closing question, so that, you know, there's part of this that's, I'm just curious, you know, are we gonna see football in the fall? Are we gonna see college campuses open?

Do I mean, do you think that's gonna happen? Well, my daughter's a fresh, was a freshman at Michigan and she's in music theater and, uh, it's difficult to do music, theater, all the acting and the dancing remotely, and it's been very, very tough on that small and elite class. So, uh, I like you feel this very, uh, viscerally.

Um, my best guess. Uh. My best guess is that schools that have, uh, uh, uh, not announced that they're not gonna open in the fall. So, so those schools that I think are still trying to stay open will try to figure out a way to stay open. Um, and, uh, and it's gonna be very, very difficult from the dorms and the, uh, eating halls to the large classrooms.

And it's not just for the students, it's for the faculty. Uh, I can't imagine how large football stadiums would be able to handle those kinds of crowds. Uh, and so my best guess is that schools will try to reopen with, um, public health, uh, uh, supported practices, but that the large sport venues, particularly football, will not go forward this fall, which is very tough for so many people.

Not to mention the, uh. The athletes, especially in their senior year. But that's, you know, what else do I know? I have no other insight than that. Yeah. I mean, we're just speculating at this point. Yeah. Um, uh, a Andrew, again, thank you for your time. I really appreciate you sharing, uh, your experience with the community.

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