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March 18, 2020: Today, Bill sits down with another health system executive to understand their organization’s COVID-19 preparedness measures. In this episode, Anshul Pande, CTO of Stanford Children’s Health, talks about what they have done in the face of the pandemic. We learn about the multi-faceted approach they have taken, from partnering with the Stanford Medical Center, their adult counterpart to ensuring they have the right testing facilities as well as new internal communication measures. Anshul sheds light on their command center as well as supporting infrastructure. He also talks about other areas where they have needed to scale like telehealth and the challenges that have come with that. There are not only infrastructural requirements but also training and education demands to get these systems working. We also learn their approach to remote work, collaborating with vendors, and the framework the hospital has put in place to ensure safe and efficient testing. Tune in today! 

Key Points From This Episode:

  • Learn about what Standard Children’s is doing to handle the pandemic in their community.
  • Some of the challenges that come with scaling up telehealth: Infrastructure and education.
  • How Standford Children’s have managed to get their networks to stand up.
  • Find out how Standford Children’s has managed remote working solutions and infrastructure.
  • VPN, VDI, and bandwidth: Some of the challenges that Stanford Children’s faces.
  • Learn how Stanford Children’s is working with vendors who face slower internet.

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, creator of this week in Health. it I've set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This week I'm doing a series of interviews with health system executives.

Who will share their plans around, uh, the coronavirus preparedness that they're doing. Uh, if your system has a best practice to share, please shoot me a note at built this week in health and we will do a 10 to 15 minute zoom recording. Hopefully that will benefit the industry. I wanna thank Sirius Healthcare who reached out to me last week and asked if they could sponsor a series of conversations to help the industry prepare.

I appreciate their foresight, I appreciate their commitment, uh, to the industry that they serve. Today's conversation with is with, uh, an pane, the CTO for Stanford Children's Health. Uh, good morning. An and, and, uh, well thank you very much for inviting me. It's great on. Well just, did I get your name correct?

Just so you know, you can correct me. Yeah, you did. Okay, great. You did, you did a great job. Um, hey, thanks for taking some time to meet with us. Uh, I know that you're busy and so we'll, we'll just, we'll, we'll get right to it. You know, the first question is just a general question, um, and then we'll dive into the health IT technology portion.

You know, what are some of the things that your health system is doing to handle, uh, the pandemic in your community? Obviously Children's Hospital, you guys have some specific, uh, cases and, uh, and, and different cases that you would be dealing with. It's a big portion of our response to this particular pandemic is, uh, is multifaceted.

One is working with the adult hospital and the school of medicine in terms of ensuring that. We have the right kind of testing available. So Stanford came up with its own COVID 19 testing, uh, frameworks, and, uh, that's available through our system. Um, another big portion is in terms of preparing our staff what is needed in the hospital, what is needed outside to support that staff, and making sure we have clear communication guidelines.

Uh, for the last week or so, we have a command center running in the hospital. Which is handling all the communication, all the potential changes we've had to make in the EHR as well as surrounding systems just around covid. Um, and at the same time we have an IS command center running, just like it was a go live to support the command center as requests come in for changes into the system.

Um, in parallel we are looking at more.

Uh, support staff, um, including docs. Um, and then we are seeing a massive surge in, um, telehealth visits. Uh, in fact, our approach to a lot of this is that you are not coming to a clinic or a hospital. Um, the first triage point is a telehealth visit. Um, and then based on that, we decide whether you're coming to a drive through clinic for a covid test, or we are sending you to an er.

Um, to be taken care of. So depending on the severity of the situation. Uh, so that's the framework and we've been working in terms of getting that clinic set up, um, getting the drive through 10 set up. Um, you know, our apart as the adult side are setting up wireless in a parking lot, as an example. And then we are supporting the technologies to make sure that the pediatric side is handling our EHR.

With our support tools. So, uh, so as ACTO, you're, you're handling, uh, you're focused in on the technology aspect. So let's, let's talk about that. 'cause I've gotten some questions from people on scaling up and, and those kinds of things. So you're doing, you are, um. Your telehealth is increasing in capacity now.

Did you, did you factor that in when you sort of provisioned your telehealth to be able to scale to this, this kind of magnitude or, or are you doing a lot more telehealth right now than you were say, two months ago? I. Yeah, so we were scaling up telehealth for the last two years. There was a, it was a gradual ramp up every year's.

Uh, target was two to three times what we did the year before. Um, and it has increased about seven to tenfold in the last two years from a telehealth perspective. So it was a gradual ramp up, um, on the other side in the last week. Um, it has gone up, um, 10 x. Just in terms of the number of, it's different kind of kind.

How are you going to get the docs or working from home to get trained on a new way of doing business rapidly? How are you gonna support the patients who have never done telehealth and they make a call to say, Hey, I don't do X, or I can't download something, or My video camera is not working. So that framework to support has been, has been an interesting piece besides the technology portions around it.

Um, and then working very closely with the technology partners to say, okay, what is the next scale limit? So today we're expecting about 300 plus visits, and every day the first call is, okay, what's the next hardware limit or software limit that we're gonna hit? And then how do we pre prepare for it so that we don't hit it, uh, in the middle of the day?

Did you guys build out your own telehealth or do you have a cloud partner that you're scaling up with? Well, it's actually not a cloud solution, but an on-prem solution. It's a combination of Cisco and a couple of other things, uh, integrated with the EHR, which is epic. Yeah. So you're, you're, uh, keeping a close eye on that as well.

Uh, talk about, uh, what, what kind of networks have you had to stand up as a result of, of this? And so you talk about the drive-through clinics and whatnot. How did you go about, uh, getting wireless to a parking lot or wherever you did stand those up? Sure a good part of that. That was done by our partners on the adult hospital side.

And a lot of it is around, um, extending the existing wireless network from the buildings, which are actually pretty close to our hospitals. Um, and then putting, uh, external access points, uh, which is a new and unique challenge. And they did it pretty rapidly. In a matter of two to three days, so kudos to them.

In terms of setting the infrastructure, we had worked for a long time in terms of having a common wireless backbone so that our SSIDs actually work on their backbone and vice versa, so that as devices and providers, uh, move back and forth, including patients, their experience is seamless. And so the moment they put the backbone up, our SSIDs were up and running and I had to just worry about ensuring that our devices function out there.

That's fantastic. A any, um, any kind of technology you had to stay? I, I assume you had a lot of this, I mean, obviously you had a website and you had a, probably a plan in place to communicate with the community at large through the website. Mm-Hmm. and other things were, were you called in by say, uh, marketing and communications or others to stand certain things up?

As a result of this, or were you guys pretty well established before this? Yeah, we were in a good shape, but there was still a lot of work to do at the last minute in terms of scaling it up. So, uh, two Fridays ago, one of the big things we decided is, hey, we are gonna move a lot of the staff to work from home.

And so one of the first things we started looking at is, Hey, do we have enough internet pipe to be able to handle this volume? Do we have enough Citrix capacity to handle this volume and do we have enough VPN capacity to handle this volume? And so the first task we did was scale up our Citrix environment internally, uh, scale up our V VPN capacity, and we basically went 10 x on the VPN capacity.

We went about two to three X on the Citrix capacity, and part of it was plan projects as well as test environments. Squish them down and use as much of it. That's possible to reallocate the Citrix, um, VPN. We basically looked at what our licensing looked like and then expanded it up as quickly as possible, and then internet was again a burstable pipe.

We are still not hitting the limits, but we are in a pretty good shape. In terms of scaling to the next and the next level after. So those were the first three, um, to look at. And um, then the next portion was to understand, hey, who needs to work from home? So we actually created a form internally to say, send us your request.

How many devices do you need? What kind of other software do you need? And then we, as a leadership team, we have to set how are we gonna prioritize this across the organization. Uh, we also started calling our vendors to say, Hey, we need you to drop. Equipment as quickly as possible. And you know, it's kind of a first confess of game out there because, uh, they are, uh, very depleted in terms of their pipeline of new laptops and hardware.

Uh, we also started looking at whether we could repurpose a PC that is sitting at your desk to be usable from your home. The security parameters are completely different. So the engineering teams worked last weekend to just figure out how do we convert a on network desktop to a remote worker desktop, and, uh, they came up with a pretty clean solution for doing it.

So we are trialing that. Um, since last night, uh, at about, um, half a dozen. Employees homes. And then the next week we are gonna expand that program as well, uh, so that if needed, people could take their devices home and. Yeah, if you'll permit me a couple, couple more questions. So V-P-N-V-D-I, bandwidth, uh, equipment.

It's interesting. I mean, if you have Lenovo as a, uh, as a standard, and I know a lot of health systems do and it's good equipment, but their supply chain has been mucked up now for the better part of exactly. Two to three months, or at least two months. Um, so, uh, you know, this will probably change how we think about things going forward.

How do we line up al alternative, uh, equipment vendors going forward? But I do wanna talk about, uh, V-P-N-V-D-I. And bandwidth. So, VPN, uh, it sounds like it was more of a licensing challenge than an equipment challenge. You had enough horsepower already in the, uh, in the data center to handle the VPN. Is that, is that pretty accurate?

Correct. Uh, VPN hardware is right now not an issue. We just have to make sure that our licensing was adequately set up and the hardware will actually scale up to our needs. So, you know, you, we are on always on VPN. So moment you take any of our laptops anywhere in the world, the first thing it'll do is home in with the PN connection, uh, so that all the communication is private.

But in order to handle that, we have to make sure. As we scale this up, the problem doesn't begin that people working from home feel like the experience is super slow. Yeah. Um, so, so that was more of a test and a check to say, Hey, yeah, this is done. We'll be fine. This will be interesting. This will take us back to an A sometime in the future.

I'd love to have you back on the podcast to talk about. What, as a result of this changed the way we look at architecture or those kind of things? Uh, VPN though a little, a little more challenging. Uh, a lot, lot more moving parts in VDI, uh, environment. Um, but I would imagine same kind of thing. I mean, you already have the build and the applications packaged up so you can deliver them really anywhere remotely.

It was just a matter of having a, making sure you didn't outstrip the capacity of the system that you had. Absolutely. Uh, you have to stay ahead of that, right? So on a steady state, you have an understanding of what your environment, and if you're growing at 10% or 5%, you know what that's gonna look like over the year.

But this is like a sudden ramp up. And sudden ramp up means you have to have that additional capacity. Plus you'll find new problems, right? Which you hadn't thought of, or. Understood. Uh, scalability you'd assume is a straight line game, but it's not. At some point it just drops pretty dramatically. And so you have to stay ahead of all of those problems.

And, and, and luckily for us, we have, we have stayed ahead of it, um, till now. How do you think, how do you, so this will be my last question, I promise. Um, , I'm just more curious than anything. So, if I were sitting in that chair and I just sent everybody home, one of the, one of the problems is not gonna be, uh, my pipes and bandwidth.

'cause you know, I'm, I'm stand for Children's and we've put in a, a really great infrastructure. But now all of a sudden you have all these endpoints coming in from . The vendors that you don't have a relationship with potentially. Uh, you could have all sorts of bandwidth challenges as people move into their homes, not necessarily because of you on your side, but on on their side.

Are you working with those vendors and, and trying to help the, uh, uh, the staff to sort of navigate that bandwidth challenge? Yeah, totally. I mean, this is the, the running joke in Silicon Valley is that the. Speed it up because there's nobody on the highways. But then the, uh, the internet highways have slowed down 'cause there's so many people working from home.

Um, and so part of it is to have those conversations with the bigger partners like Comcast and Verizon and At&t to say, Hey, how are you to support this? And this is not just a healthcare challenge, but the entire values challenge. Were a big chunk of, uh, the tech workforces working from home to say, Hey, how are you going to manage this?

And then, by the way, how can you prioritize us? On top of everything else so that we can actually provide the critical services, uh, that are needed to support the community overall. Do they have a, it's definitely a discussion. Prioritize. They don't, yeah, yeah, they don't today. Uh, they don't today. And, and we have been talking to them to figure out, Hey, can you prioritize these specific endpoints?

Considering it's AVPN traffic, it looks slightly different from everything else, um, to see if they can do it. So we've, we've been in interesting conversations with them, um, to see how that'll work. Well, uh, again, thank you for taking the time. I really appreciate it. And, uh, we, we definitely will have to have a, another conversation if you're open for it at a later date, just talking about how we're rethinking architecture as a result of this, uh, moving forward.

It'll be, uh, I think it'll be interesting. Thank, thanks again. Absolutely. Nice talking to you, bill. That's all for this episode. Special thanks to our 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 the production of this week in Health it. For more great content, check out the website this week,, or the YouTube channel. Uh, if you wanna support the show, best way to do it. Share it with a peer, share it on social media, however you share things with people, do that. Uh, we'll be back again for more of these interviews as well as our, uh, Tuesday Newsday episode and our Friday, uh, influencer episodes as well.

Thanks for listening. That's all for now.


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