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April 6, 2020: Today we bring you another field report where we talk to health system leaders on the front lines, now especially as they have to navigate the COVID-19 crisis. This interview is with Robert Eardley, the CIO of University Hospitals in Cleveland. What emerges strongly from his conversation is that health IT is performing like never before and managing to come up with solutions in record time, which of course has raised the standard and is changing the expectations around what is possible in the future. Robert mentions, in particular, the smooth transition from office to home-based operations and how efficiently they have been able to do screening and set up their call centers. He talks about how they are preparing for the expected surge in COVID-19 patients, the requests they are getting from the health system, how they have been serving by providing telehealth and analytics solutions, and much more. 

Key Points From This Episode:

  • Learn about the University Hospitals health system and the community they serve. 
  • What they are doing to prepare for the surge of COVID-19 patients. 
  • The process of pre-building beds within IT applications. 
  • What the health system requires from health IT, including work-from-home solutions. 
  • How they have been serving the health system by addressing telehealth challenges. 
  • Hear about their analytics journey, how the requests have shifted, and the software they use. 
  • How the outstanding performance of health IT is changing what will be expected in the future. 
  • The aspects of their capabilities and organization that has most surprised Robert. 
  • More about how their call centers are set up and the communication platforms used. 

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

 Welcome to this week in Health IT News, where we take a look at the news that will impact health it. This is another field report where we talk to leaders from health systems on the front lines. 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.

As you know, we've been producing a lot of shows over the last three weeks and series. Healthcare has stepped up to sponsor and support this week in Health It, and I want to thank them for, uh, giving this the opportunity to, to capture and share the experience, stories, and wisdom of the industry during this crisis.

If your system would like to participate in the field reports, it's really easy. Just shoot me an email at Bill at this week in health Now onto today's show. Today's conversation is with the Chief information Officer at for University Hospitals in Cleveland, Robert Ley. Um, Robert, welcome. Welcome to the show.

Alright, thanks for having me. Well, I'm looking forward to our conversation. I know you guys are all real busy right now in preparation and coordination. Uh, so we'll just get right to it. We'll have to, we'll have to do the niceties at at a future time when, when things slow down a little bit. Um, but before we get started, what, uh, give us a little idea of University Hospital.

What's the, what, you know, what's the community you serve at? What's the breadth and and size? Sure. And so we're a, a large health system in northeast Ohio. We largely serve the, uh, greater Cleveland, uh, community extending, uh, down to, uh, some of the cities south of, uh, Cleveland proper. Uh, we have, uh, 14 hospitals, really over about eight different campuses, numerous, uh, health centers and, um, e emergency rooms.

Uh, about, uh, little over, uh, 4 billion of net revenues just to give a sense of size. Yeah. No, that's helpful. Um, so, you know, what, what are the kind of things that are going on at this moment in time, uh, to provide us a little context that you guys are doing for the communities that you're doing for in, in, in preparation for.

Uh, a potential surge in covid patients? Well, you know, with, uh, like many health systems, this, um, coronavirus has really shifted from a couple weeks ago where it was really centered around the screening tents and the, the testing centers, getting those operational to now it really is all about the surge.

So it's a lot of, uh, planning and preparing. Uh, as we sit here now on April 1st, there's predictions somewhere between April 15th. May 15th, somewhere in that window. And so we are working, uh, with our operational partners really to make sure that we are prepared should that surge come or maybe if, um, or when that surge comes from an IT perspective.

Largely what that means is pre-building all of the beds in our . It applications, our EHRs. Uh, and so we wanna be able to be operationally ready that if we have to execute, um, we can be ready within 10 hours or so, you know, half a day to be able to make those beds available. Yeah. So, uh, give us a little idea of the, of the process of, of doing that.

I know that some people have struggled with that. Is, is it as simple as creating a template and then replicating it, or is it a little more complex than that? Um, you know, that's, that's generally, uh, the case. It, it's trying to plan out in certain units that we would have a surge bed, one surge bed, two surge bed, uh, three.

And so at each of our campuses, we've created three different surge units. Uh, I think each of those surge units have 30 beds each. I'm not, uh, exact on that, but that's the spirit of it. And so we have a, a different scheduling and registration system than our hospital-based EMR. Uh, and it's different than our bed tracking system.

So we have, uh, those beds built out in for us. It's Cerner, Sorian, we have those beds. Then flow to, uh, we have an Allscript Sunrise product, and we also have those in our TeleTracking bed management application. So with those as the three primary, uh, we then can connect ventilators. We then can, uh, have documentation, uh, prepared so that we can take care of our community.

Wow. Wow. So you're dealing with a bunch of different EHR, uh, products and, and solutions. Um, you talk to me a little bit about, I'm going off script already, I apologize. Uh, talk to me a little bit about, uh, what is the health system asking of health it right now? So obviously, you know, making sure that prep is ready for the surge.

Uh, are there, and telehealth obviously work from home. Uh, are there other things they're asking you for analytics, other things, other areas? Uh, there is. And so we have, um, in our IT help desk software, uh, we have ServiceNow. So we've created our IT pandemic dashboard. We've got about 75 items that we're tracking on that right now.

Um, it does run the gamut and so early on it was the screening centers and then the work from home. So we had to deploy a lot of laptops. We had to connect folks that were not typical remote users. And so yeah, as of about two weeks ago, we were able to pull both of those off pretty well, get people situated so they can be effective working, uh, remote if their.

Job allows for that. It's now shifted, uh, to making sure that, um, we can manage the call centers. And so call centers virtually, uh, rather than physically is also kind of a special operational item, different than when you have everybody in the same building. So we're supporting our operational partners from a unified communication perspective.

Um, and then from a. IT applications we mentioned before, the kind of the surge planning, um, but two other big domains that we focused on is telehealth and analytics. And so I'll come back to, to each of those separately. So in telehealth, um, we've had a long time partner in MD Live who is our traditional kind of telehealth provider.

Uh, but given the intense needs over the last. Two weeks, three weeks. Um, we've, we've shifted, we've leveraged the MD live, uh, traditional avenue, but we've also now set it up. So, um, you can use our standard, um, EHR applications and still have a video visit. So what that means in our world is, uh, we register in, in Cerner, Sorian, as I mentioned, uh, in our practices as well.

So we. 2,700 employed providers that we manage the IT for. So they register in cer. Um, they schedule an event in, in that registration system, and then they document in an Allscripts product called touchworks. Uh, and so the care is documented in touchworks. Uh, it's a scheduled event that gets billed out of the Cerner product.

And then the uniqueness is that we're using what we're calling a visual communication channel that either is MD live itself or it's. Uh, WebEx or it's Zoom or it's FaceTime, and we've actually offered a lot of flexibility to our practices in that. And we've, we've offered our support to get those connections, um, in, in any way possible.

Taking the guidance, the latest guidance from the CMS that as long as it's one-to-one rather than published. Publicly on the internet, most of those are, uh, deemed as, uh, sufficient for, for the moment. And so that's really freed up our practices to conduct a scheduled visit. Uh, and then they would use, uh, one of these products.

We also have Cisco Jabber that many of the practices used to create a connection to the patient. And then they document as if the person's, uh, sitting there with them. Yeah. So talk to me a little bit about the analytics journey. I'm sure there's a lot of requests for, uh, you know, key metrics and, uh, tracking of, of various things, I would imagine.

Uh, and that's true. And so that's been, uh, one of those other, the second domain domain that really has kind of come into its own here. And so early on it was a lot of internal operational items. Um, as far as the metrics on where we have . Have things, um, the number of screening exams that we've tested, the number of employees that we've tested, the number of successful or positive covid tests.

So those were, uh, a lot of the original requests. Um, now the requests shifting to a number of the federal governmental agencies have a series of requests out there. They're looking for aggregation of number of hospital beds, how many are occupied, um. The White House CMS and HHS and others have really kind of had a drumbeat of, um, request to the healthcare community.

And so we're a partner in that either submitting to the state or the federal agency. In our analytics, we have, uh, Tableau and Power bi. So those are two different visualization programs. And so we've worked with our operational partners on building out some Power BI dashboards, uh, for the purpose of, of tracking.

And then lastly in there we had a special request to use the ARC GIS mapping software. And so we wanted to. Understand where in the community are the hotspots for, uh, all the tests or positive tests. And so, uh, we've been able to, in about a few days, implement this arc, GIS software. We've got some folks internally that had some experience using that, and so they quickly took the extracts that we to them and then put it on a, um, graphic or geographical, uh, heat map where all the, um.

Uh, all the addresses are for, um, uh, positive and negative screening exams. Yeah. You know what's interesting? As I hear you talk and there's just, there's two thoughts in my head. You know, there's, it's like the devil and the angel on each shoulder that on the one side, the angel's saying, oh my gosh, look at all the things that it's been able to do in such a short period of time.

Isn't this amazing? Isn't this wonderful? On the other side, it's like. Okay, well that changes our expectation for all IT projects moving forward. You know, it's like people are gonna come walk into your office after this is all over and go, you know, I want something amazing done and I want it done in three days.

Um, you know, what are the, what are the kind of things that you've been surprised that we've been able to do or your team has really been able to do, uh, over the last, I don't know, four or five weeks? Yeah. You know, I, I think the shift, um, from work, from home on a large scale, uh, has been, um, ha, has, has occurred without any hitches, as I might've expected.

I might've expected more of a run on laptops or might've expected more, uh. Instances where maybe we're offered where people don't have internet at home. So the fact that that shift occurred really without any large scale hitches, uh, I was pleased with that. It's very natural for us in it that we work from home or we work remotely.

But for large users of folks that normally come into the office to man the, the call center and answer billing questions or to schedule appointments, you know, they don't always have the same technology capabilities that, that we might, uh, at our house. And so I was pleased with that. The other item that was a surprise to me, and it was a, a positive surprise, is the efficiency in the way that we chose to do our screening process.

So for us here at University Hospitals, we chose to set up a, a call center, a hotline for covid, uh, a physician. When they would wanted to order a COVID screening exam, they would actually call the hotline, walk through the patient system symptoms. Then the hotline would enter that screening exam in our as an order in our laboratory product.

At first, that sounded inefficient to me, uh, but over time, over about three days, I started to see the wisdom of it because they were able to. Match a bit the demand with the capacity that was available for these screening exams. So what we were able to steer away from was having everybody order the screening exam and us not having enough supplies.

Uh, and then you have patients out there with open orders. They can't get the screening exam in a timely manner. Uh, and then there would be missed expectations. So we try to balance that like a lot of health systems. Um, the first priority is the intensive patients inside the acute care setting, you know, most notably the ICU.

And then it gets triaged to, to folks that are highest risk and that the others. And so, uh, having this phone-based line, um, in the efficiency of it. Was admittedly a surprise. And then in our screening process, um, the other, uh, efficient surprise for me was with that phone-based hotline. For our screening process as a patient, uh, or as a person drives up, uh, to one of our drive-through centers, they, um, need to have a physician order.

And this is common with most health systems. Uh, but what we do is, um, we have a person at the front that's on the phone with the call center and once they see the patients, uh, or that person's. Uh, license or information, they merely have a, a phone line back to the call center, to the same agent. Once they read off that patient's, uh, information, the call center actually hits the print routine.

Uh. To the label printer that's sit sitting in the specimen collection area. So it's interesting, we don't really have any computers at our screening centers. We just have wire, we just have, um, connected label printers. And those label printers are for the purpose of, uh, attaching to the lab specimen.

That's pretty, I. It's interesting 'cause I, one of the things I've been hearing and I've been talking about on the show is just, uh, you know, to be creative and use whatever tech is available. And that's a really great, I, 'cause I heard people trying to stand up wireless and doing all sorts of crazy things in, in for, for some of these remote locations.

But that gave you a lot of flexibility in terms of where you could, you could place all these things, doesn't it? Well, it, it, it does. And so, um, it gives us a lot of flexibility because we, we really merely need a, a phone up at the front. Um, you know, consider it two, two stations. One is the verification that a, a person has a, a physician order on file.

Uh, and then the second is the actual screening location, uh, where they're gonna swab your naval cavity. And so, because. Um, we had it designed in this way up at the first station. They really just need a phone and they hold a constant phone connection to the call center agent. The hotline, uh, they read off the patient's information.

The hotline can either confirm there is an outstanding order. Um. Every once in a while there's not Right. People kind of wait in line and they, they, they hope to get an order once they're in line. But if the, uh, hotline validates they have an order, then they push a, uh, print routine. Uh, we happen to use soft lab, but they push a print routine out to a networked connected printer.

It sits at the specimen collection tent, and so the, um, the caregivers in the specimen collection area just pick off the label, um, and await for that patient to drive up. So let me, so let me close out with this. I wanna talk a little bit about your call center 'cause what, so are, are any of your call centers still operational with people like sitting six feet apart from each other?

Or has, have you pretty much dispersed most of those to be, uh, you know, geographically dispersed, people working out of their homes and your call routing to them specifically? Yeah, I, I think largely dispersed. Um, we do still have our buildings open, so I think on some cases where, uh, an individual might not have connectivity at home, uh, we still have our buildings open.

And in those cases we do take daily, uh, temperatures of the folks entering the building and do a screening for everybody who enters the building. Um. It's in our state. That's a, a govern, a governor's request, uh, to do that if you're continuing to operate a building. But I, to my understanding, the capacity or the attendance in that building is, is quite low now.

Most people have gone virtual. So how were you able to do that? I, I assume you had some VoIP solution that you could redirect these calls and, and still utilize your, your call center software to, to track things. That's right. So in our case, it's largely a, uh, Cisco based, uh, unified communication platform.

So we have Cisco call call manager. Um, we have Calabrio call recording. Um, and so, um. We, uh, we largely have, um, we largely have, uh, continued that operation, um, without too, too much disruption because, uh, we, we have a soft phone that works on the computer. So we have a Cisco, uh. Soft phone that rings. And so as long as the agent has a headset with a microphone, uh, they have access to their phone, um, they have access to their same phone number that they normally call into.

And because it's a call center, there's this concept of agent on and agent off. And so they're using the same software as if they were sitting in our office building. They're just using it at home. Yeah. No, that's fantastic. Uh, I know we've gone over and I appreciate your time. Uh, thanks again, Robert. We will have to connect, uh, again, uh, at a, at a later time.

We'll, we'll, uh, touch base. I'd love to hear some of the stuff you guys are doing. Okay, bill, thanks for, uh, connecting. Thank you. That's all for this show. Special thanks to our channel sponsors VMware Starbridge Advisors, Galen Healthcare health lyrics 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 a peer. Send an email dmm, whatever you do. You can also follow us on social media. Uh, you know, subscribe to our YouTube channel. There's a lot of different ways you can support us, but share it with the peer is the best.

Uh, please chip back often as we'll be dropping many more shows, uh, until we flatten the curve across the country. Thanks for listening. That's all for now.


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