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March 18, 2020: Our guest for this episode of our series on COVID-19 preparedness is Stephanie Lahr from Monument Health, who has generously agreed to spare some time to share what she and her organization have been doing in the last weeks to combat the outbreak. Stephanie explains how her area of South Dakota has not actually been touched properly by the virus as of yet, which has allowed some time for extra preparation, a luxury that others have not had. We chat about the stringent measures they are taking in regards to the community and providing information and support for staff and the public. The conversation also covers personnel at Monument and how they may bring in some outsourced help in certain fields, especially those in which there might be overflow at the moment. We chat about communication with vendors, the uncertainty of the future and how to go about keeping energy and spirits up with such long and straining hours. 

Key Points From This Episode:

  • The ways that Stephanie and her organization are helping the community around them. 
  • Regions that Monument Health is servicing and the nurse triage line they have set up. 
  • Keeping track of personnel and looking after the healthcare professionals. 
  • The possibility of bringing in outside assistance in areas such as IT.
  • How Stephanie is approaching conversations with vendors currently and her expectations.
  • Dealing with the uncertainty of the current moment; Stephanie's measures for her staff. 
  • Daily meetings and making sure everyone is on the same page and has the agenda. 
  • Keeping morale and connectedness up in these socially distanced times. 
  • Recording important and helpful information for better access and dissemination. 

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 look at the news that will impact health it. 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. This week I'm doing, as you know, a series of interviews with health system executives.

Who will share what their plans are for Covid 19 preparedness. Um, if your system has a best practice to share, please shoot me a note at Bill this week. We will do a 10 to 15 minute, uh, zoom video recording that will hopefully benefit the industry. I wanna thank Sirius Healthcare who reached out to me last week and asked me if they could sponsor a series of these conversations, uh, to help the industry prepare, and I appreciate their foresight in this matter and their commitment to the industry that they serve.

Today's conversation is with Dr. Stephanie Lar, md, CIO, uh, CMIO of Monument Health. Good afternoon, Stephanie, and welcome to the show. Hi, bill. Glad to be here. I, I appreciate, uh, appreciate you taking the time. You are, you are one of those distinct people that has the C-I-O-C-M-I-O title, so it'll be interesting to see what your perspective is on this.

But let's, let's, I know you're busy. We'll get right to the questions, first question's, pretty general, and that's, you know, what are some of the things your health system is doing, uh, to handle the COVID 19 pandemic for your community? Sure. So, I mean, I think we're doing a lot of the same things other folks are doing, uh, particularly if you're in the same situation as us.

So we do have, um, cases in the state of South Dakota, but no cases in our local area as yet. So we are, um, in the. Fortunate position to still be able to be thinking, um, about forecasting and planning and making sure we have everything in order. Um, and being able to be proactive instead of reactive. Some people didn't get that opportunity, so that's been, we feel fortunate to be in that situation.

So really, um, our focus is on one, being prepared if something really significant comes our way and we start to see a lot of patients and how to manage that high volume. We are also working, you know, as a, um, as a primary health system, as the only real health system in our uh, community. People are looking to us for guidance on everything from.

Should we close the schools to, should we close restaurants, to, um, what should we be doing in the rest of the community for, um, you know, social distancing and how do we support that in addition to, uh, what are we doing for healthcare? So, couple of things. You know, we're trying to be extremely collaborative, um, across our region and find ways to be able to leverage the skills and, um, and the, um.

Resources beyond just what we have as a health system. So as we prepare for, um, having a large influx of patients in the acute care setting, in my mind what has become extremely apparent, particularly if this is gonna go on for some time, is that we will be very reliant on the other providers in our area.

Who do acute care or who do non-acute care, um, more ambulatory kind of clinic visits, the primary care providers, especially in our community, to really be the mainstay of keeping our community as well as possible, preferably from the safety of their own home. So, um, one of the things I am doing from a, an IT and informatics perspective is really working, um, internally to figure out

What are the tools that we can be providing for covid specific kinds of responses? So I can talk about a few of the things we've done there. Then we also have another focus on what are the elements that we can deliver, um, to the community so that they can maintain their health while we are going through this problem.

And then a third element is . What kind of collaboration and guidance can I give to smaller healthcare, um, entities and practices across our community who may not have the technology resources or knowledge or the time to be keeping up to date with all the changes that are happening, um, so that I can help them figure out what tools might work for them.

This is this. So this is an interesting conversation because, um, because you're not in the throes of it. I just, I just had a conversation with somebody who's in a market that's, that's a really, uh, high volume already, and they're using things like face. They're just throwing things out. Now it's like, we're gonna do FaceTime, we're gonna do this, whatever it takes.

To, uh, to offload some of that stuff to keep our caregivers safe and whatnot. But you have some time to plan and to be logical about it, to build the, uh, coalition within your community. So it's not, you're not competitors anymore, you are. Absolutely delivering care for your region and for your state and, uh, build out those lines of communication with the, uh, state and state governments.

Um, are, are, are you just in North Dakota or are you other states as well? So we are all of Western South Dakota. Um, we have a little bit in reaching in a few patients in reaching into Wyoming and then some into Nebraska. Okay. Um, we, so one of the things that we did do was we have a, a one 800 number, a nurse triage line.

Um, that was stood up interestingly, basically by it. Um, the organization had a need, and I think this is another thing that, you know, as healthcare systems are trying to figure out what do they do? You take the resources you have and the knowledge that you have, and you use 'em wherever you possibly can.

So we had a need for a nurse triage line, and I have nurses that work for me. Yeah, I am a physician. So we said, okay, we got this. And not that we did it just by ourselves, it took help from across the organization, but within a matter of five days, we stood up, uh, a one 800 number nurse triage line that's manned 18 hours a day, mostly by nurses that are in IT and other corporate services.

Um, so we weren't taking them away from patient care, so now we can talk to patients from really all across, um, for sure, Western South Dakota. We are talking with patients even in North Dakota and other areas because as patients become worried and they find a number and they think they have a resource.

They call it, and that's totally fine. So we're partnering also, um, with our, uh, health systems on the other side of the state to make sure we have their information because if we see a patient or talk to a patient who's in their territory, then we give them those resources. As you mentioned right now is not about competition or market share, it's about community health and, and protecting the wellbeing of our public.

And, and that takes collaboration and we're seeing a lot of that. So one of the things we're seeing, and I'm curious how you're gonna handle this, is the, this aspect of, um, the clinicians within health, it are being reallocated. That's one aspect. The second is there is a, you you're trying to create, um, safe, a safe environment for your clinicians.

'cause if the clinicians. End up getting, um, you know, contracting the, the virus. Uh, not only can they not see additional patients, I mean, it, it just creates a significant problem. And we've already seen that. We've seen a, an ER doc and now two nurses, I'm, I'm sure there's others, but those are the ones I read about this morning.

Um. How are you going to stay ahead of who is where, because that's one of the things that happens in a crisis. You, you just don't know where everybody's at and how many resources you have to put towards a problem. How have you thought through that problem? Yeah, we're working on that to an extent. Um, trying to look at, you know, some of our, even our time and attendance system can help.

A little bit with that. Um, we've been looking at some other vendors that are in that space of trying to help us sort of keep track of where people are. But it is, it is challenging. Um, one of the things also that we're sort of thinking about is I. Do you sort of need a reserve workforce, right? Or kind of how, how do you tier things in?

Even from an IT perspective? So for example, it takes desktop analysts for me to deploy hardware, particularly into clinical areas that we might, we stand up a new ICU, if we stand up a new hospital unit, we stand up a new ed. I'm putting those technical team members into clinical space. If they end up sick or quarantined or whatever, how do I make sure the next Ed, I have to si, uh, stand up or ICUI have to stand up.

I have the people to do that. So we're talking through things like do we have a group of people that, um, I. You are sort of tier one and you're doing this work for this week, and the other team members are not a part of that and wouldn't have those exposures so that if we saw something happen, we sort of have that second group of people who would be able to take your place while you may be out or being observed.

Those are things that you have to think through, not even just in the clinical spaces, but in the support spaces as well. Yep. And actually I want to talk to you about vendors, but the, the other thing I I'm curious about is, is there a thought in the back of, I mean, clinicians are hard to come by. It's hard to train a new C clinician and those kind of things, but it people, there could be businesses that are slowing down right now that have IT staff that you could tap into and say, look, we need, we need desktop techs, we need those kind of things.

Is there a thought of doing that in the community? I would say we're looking at that actually very broadly, even including clinical, um, because there will, for example, potentially be, uh, practices who maybe they won't be able to stay open or maybe the physician will do, as we talked about earlier, FaceTime visits or Skype visits with the patient, but might not need their full staff.

And so we actually are partnering with other organizations, um, and practices in the community to talk about what it could look like if our hospital needed to temporarily. Bring their staff on, whether that be clinical staff or things like you mentioned, technical staff, um, from other small businesses and things like that, that may close temporarily.

So we're working then closely with our HR teams to make sure what are those onboarding processes? How do we get that as streamlined as possible? Because while you can make a lot of the rules, um, you know, a little more flexible during a time like this, you still have to have a process. Yeah, I want, so I want to talk about vendors because I've got a couple, couple calls from vendors saying, what are we supposed to do in this?

And, and part of my, I put my hat on as ACIO and I'm like, look, if you're not already in a health system, they, they don't have, they don't have the bandwidth right now to set you up as a new. Vendor. Yeah. So all of your existing clients are the ones that could potentially use your services. That's who you should focus in on.

Um, and, you know, and understand that they're swamped. I mean, I've, I've put a call out to many CIOs saying, Hey, can you come on the show? And at least, at least one or two of them have sent me notes back. Do you have any idea how many hours I'm working right now? Yeah. And I'm like, just 10 minutes. And they're like, no.

Not gonna happen. I'm working, I'm working 12 hours a day. My team's working 12 hours a day. We're just, you know. Yeah. Um, so what do you, what do you say to vendors? There's, there are some strategic vendors that you're gonna need to have on speed dial to be able to say, look, we need to take our VDI environment from here to here.

And I need you guys to make sure that this is gonna work and this is not gonna come down. Uh, so what do you say to vendors? Yeah, so we've been having, I I, I would compartmentalize it into two. I I agree with you. There's the vendors we already work with. Um, and then my team, mostly, most of those conversations are happening by my team.

I don't need to have conversations with them. We already have a relationship. They know us, we know them. So I'm dependent on my great leaders that work for me, my directors, and those kinds of things. Working on those elements of making sure if we need to, um, spin something up, ramp up, get more equipment, do whatever, that they're having those conversations.

I will tell you that I have signed, uh, two and maybe on the verge of three agreements with new vendors in the last five days. Interesting. And, um, and I would say this in most of those instances, um, I had something I was looking for. And so I went out to go find it. I used certainly resources, um, from colleagues mostly to say, who do you know that lives in this space and, and what are your thoughts on them?

Um, in one instance, there really was sort of a, I got an email, it was targeted. I think that's super important when we, right now, if I had any, you know, the advice I would give to vendors is if you are going to send me something, please make sure that it is targeted and personal. Sending out broadcast messages about, you know, backing up my archive system and things like that.

Right now, I, I am, I am. Archive is not on my mind right now and it makes me think you don't know what my priority is. If you're gonna send me something about archive, however, if you have a solution that could help me get. Something done I need to get done today in a different way than maybe even I'm thinking about it.

I've had a couple folks reach out to me and say, for all of our customers, we're offering this. Um, let us know if you're interested in it. This is how we think it fits into the current, uh, pandemic situation that we're dealing with. That I then can take those and if it's in, you know, something I understand, I can respond or I can send that on to my directors or whatever and say, take a look at this and let's see where it is.

But it at least tells me, I. You are thinking about what I'm going through right now and you are thinking around how you can target solutions for that. And then the other thing is they just have to be patient. Don't ping me three times in a week. I saw it the first time. It might take me two to three days to get back to you and more than likely it will be midnight or one o'clock in the morning when you get that email back.

Um, but be patient. 'cause there are times that I, um, that I will do that. The other thing I would add, and I am seeing this from our vendors, their availability. I'm signing contracts at nine o'clock at night. I'm sending them back at nine o'clock at night and I'm getting a response from them at nine o'clock at night saying, we got this.

Let's set up a time for tomorrow morning to begin talking about execution. Eight to five doesn't exist for me. Seven to seven doesn't exist for me. I need them at the exact moment I need them. And I, and again, I am seeing that from vendors and that's something that's building that feeling of trust even in people that we haven't maybe historically worked with or haven't worked with in a particular space.

Yeah. So let's, let's talk about this moment in time, this, uh, challenge. So with your staff. Your staff is, um, you know, wondering about the work situation, wondering what's coming down the pike, wondering, there's a lot of unknown and uncertainty and in those times it's important to have, uh, great communication, leadership skills and those kind of things.

Uh, what are the kind of things you're doing with your direct reports? Who have staff that report to them, to, uh, to assure them to, uh, you know, to prepare them for a time when things could get a little more crazy. And what are you doing to communicate to the broader staff? Maybe directly as the CIO? So I'll start with my own staff first.

Um, I. I we're doing a few things here that I think, and I'm really glad we're talking about this 'cause this actually just came up and we made some changes to this today. One of the things that's interesting is, uh, I have a, a staff that has mostly worked from home. Most of my analysts have worked from home for the better part of the last year.

They work from home three out of five days a week. So they're already somewhat used to a work from home strategy. However, now that they are . Further, in many some cases, working five days a week from home and things are changing so rapidly. I mean hour by hour, not even day by day, they are feeling out of touch with what's going on.

And so it's this balance. What are we gonna do to communicate? But I can't spend all the time communicating because we have to get the work done. So a couple of things that we are doing, my, um, leadership team has a huddle every day, um, for 30 minutes. We go through the new projects that we're working on, um, the things that it is involved in.

We talk a little bit about just what's happening in the organization and our community at large. Again, it's a 30 minute call. We are now taking the notes from that. Sending it out to everyone in the division so they all get that information. 'cause I can't, um, I can't assume that the managers are all gonna have time to go and have all of those conversations.

So we're gonna at least send it out in print. The other thing that we, um, are then doing our, our organization has a daily huddle that is more disease state specific. What's happening in our community. We are sending that out to our folks and we are offering an opportunity for them to reach out to managers and ask questions and get their answers because they're not just our caregivers.

They live in our community and they have some of those kinds of questions as well. My, um, team is also working on what are, um, tools that can be used and I mean like games and. Other kinds of things that are out there for in work, from home environments, there are tools that exist to build, um, build culture and to build relationships and connectedness.

So we're looking at things like, Hey. This is a marathon. This is not a sprint. So we gotta be able to keep some balance here. Let's, what's an online kind of, um, work related, but fun game or interactive, something that we could all do that keeps people connected. Let's have a virtual coffee. Let's get together for virtual lunch so people can just

Talk about things, but they're staying distant. So that's another thing that we're working on. And then the final thing is on, uh, we have a, a Facebook group that is a private Facebook group just for our IT caregivers. Um, about two thirds of our team is already on it. We're working on seeing if we can expand that further.

And every Friday I am gonna do a Facebook live. Video, video, um, they can log on, ask questions. We'll do it during the day when most of them are working, but then obviously it'll stay on the site. I will talk about, it'll kind of be a state of the state for where we are, right? So what have we been working on this week?

Shout outs. Great job. Um, here are successes. Here's what's . Going on. Um, here's what's happening in the organization from a healthcare perspective. Here's what we're thinking is gonna happen next week to try and keep people again connected. Um, and, and then we use that Facebook site for other kind of those similar fun things of just trying to keep the teams positive.

Yeah. And that, that is so crucial in these times. And I, I appreciate you really focusing in on, on some of the stuff that people call the soft stuff. And I always laugh every time I hear somebody say the soft stuff, and I think. It's a lot harder than what people think to keep people, uh, engaged, to keep people, you know, smiling from time to time, hopeful, uh, you know, just EE energized.

I mean, if you're gonna keep putting in 12, 14, even 16 hour days, um, you know, people have to smile every now and then. They have to, they have to let off steam every now and then, and that is, uh, that is not a, that's not a soft skill for leaders. I don't think. I, I completely agree with you. The organization, I will admit, is harder and we are still working on what those things are because again, everybody's so busy, we don't wanna bombard them.

Email's not gonna work. Um, we have a lot of calls for pe, certain groups of people. Um, but one thing that we are looking at doing for, for example, for our providers is starting next week, doing a daily. 30 minute, again, mostly report out, um, probably, uh, a phone call kind of thing where people could call in.

But maybe the first 20 minutes is a report out, and the second last 10 minutes is, is for questions. Um, helping them understand. Stand, where are we with telehealth? When might their clinic be, um, having an opportunity to do things like that? How might they be helping in other areas? What's our current testing procedures?

That's such a moving target right now. People have lots of questions about that. So what are those things that are clinically relevant to them, but then recording it so that those who can't make it to that time. We could put it on our internal SharePoint site, we could send it out to people and they'd be able to come in and, and, um, get some of that more medical staff related, um, education and information, um, every day.

Well, I thanks for your time. I just, one last quick question. I just wanna give people perspective. On a normal day, you get so many emails. What, how much has that increased during this time? Well, my phone did tell me my, um, screen time has gone up by. 40% in the last week. Um, it's, it's a lot . Uh, there are, I mean, it's, you know, I probably on average get a hundred to 150 emails a day, and I'm probably twice that at this point.

Yeah. Um, and, you know, but it's, it just kind of, it is what it is and we're all managing. The one thing I think is, um, really great in a situation like this is typically you see the. Best in people come out, people give each other grace. People give each other, you know, help. Seeing so much opportunity for collaboration out there.

People saying, here's something we did, it went great. Take it and run with it. You know, some of those kinds of things. Providence did something on their website. I worked with my team. We recreated something very similar. Um . Those are things that we can all be doing, and people are really open to that. And so I think that's sort of keeping everything going.

It's very, very busy. Um, but at the same time it's pretty, um, it feels like you're doing important, valuable work and so it's gratifying to be doing it. Absolutely. Thanks again, Stephanie. I really appreciate you taking this time, uh, today and, and, you know, I just really appreciate all the stuff that you guys are doing.

Thanks much. That's all for this week. 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. This show is a production of this week in Health it. For more great content, check out the website this week,, or the YouTube channel.

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