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March 24, 2020: Today Bill Russell brings you the highlights of the latest news in health IT. The global pandemic has put immense pressure on healthcare systems worldwide, and thus news stories are largely centered around the issues of caring for unprecedented numbers of patients. The medical industry is relying heavily on telehealth to mitigate the pressure, but now these systems are breaking down and failing at times due to the number of people phoning in. Bill talks about the three components of telehealth, the relevance of each, and advises health IT workers on keeping these systems running as smoothly as possible. However, now is not the time to implement changes but rather to focus on getting the already-established processes functioning optimally. He also covers the issues with PPE and testing, talks about what EHR vendors are doing to help equip providers, and the steps that big tech companies like Apple and Google have taken to contribute to the solution. 

Key Points From This Episode:

  • A few helpful resources for those involved in health IT during the COVID-19 crisis. 
  • CNBC’s report about telemedicine companies struggling to serve the volume of patients. 
  • Accepting that your telehealth system is likely to break down at some point. 
  • Advice for CIOs about dealing with the immense burden on their telehealth systems. 
  • The three components of a telehealth system and how important each is likely to be.
  • Why you should avoid implementing anything new to your televisit component at the moment. 
  • Helpful tips on managing and using the queuing system more effectively. 
  • A few examples of health organizations with well-structured websites and online resources. 
  • The importance of having a centralized source where accurate information can be obtained. 
  • Two of the biggest problems currently: The lack of PPE and COVID-19 testing taking too long. 
  • Questions about how EHR vendors are arming providers to handle COVID-19. 
  • How Epic is helping organizations to share information through their network.
  • What Apple, Google, and other big tech companies are doing to elevate the pressure on healthcare systems. 
Transcript

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, which is gonna 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. Before we get going, I wanna give you three resources that, uh, health IT can use during this crisis.

The first is for CIOs. I'm currently helping my coaching client CIOs as a sounding board and advisor through this time. Uh, if you would like to connect with me over the next two months and experience coaching at no cost, uh, shoot me a note at bill@healthericks.com. For anyone in health it who finds themselves in uncharted territory or want to crowdsource solutions, uh, with a team of seasoned professionals, we have set up two ways that you can do that.

Uh, the first, uh, we now have a Slack channel that is monitored and supported by our sponsors, and I am so excited that our sponsors have stepped up to do this. Uh, they're each providing people to monitor the Slack channel. . And, and to, uh, to offer their expertise as well as it's a platform for health systems to interact with each other, to hopefully crowdsource, uh, best practices and those kind of things.

So, special thanks to our sponsors, VMware, Galen Healthcare, Sirius Healthcare, Starbridge Advisors, pro Talent Advisors and Health Lyrics, which is me. Uh, the Slack channel allows you to get your questions answered, whatever they are, help telehealth, VDI, uh, EHR. Um. You know, scaling up your EHR platform or whatever needs to happen.

Uh, if you want to access it, send a note to Slack, S-L-A-C-K at this weekend, health it.com, and we'll get you set up immediately. Uh, now we understand also that some of you are not excited about Slack and you, but you still wanna be a part of, uh, getting some of this crowdsource support. And, uh, we offer another channel, it's an email channel.

You can send an email to support at this weekend, health it.com. If you just want to shoot the email over, we will route it to the appropriate parties and they will get in touch with you and, uh, start to collaborate with you on potential solutions. And once again, I just wanna thank our sponsors for stepping up, stepping into that gap.

And, uh, helping us to provide that service, uh, to our listeners and to the industry. Alright, let's get to the news. As always. I'm gonna focus on health. It, there's a ton of things that I could talk about, but, uh, we are going to stay true to the show and focus on health. It First story is from Chrissy Farr.

It's a, um. Story about telemedicine. So telemedicine companies struggling to meet Coronavirus demand. Um, if you haven't seen it, Chrissy Farr, who does a lot of reporting in the health IT space, uh, she also shared a story of her wedding. She had been planning a wedding up for a year. Uh, it happened during this timeframe.

And, uh, she canceled the wedding and they're going to, uh, do the wedding at a, at another time. Uh, great story. I'm glad she shared it. And, uh, if you get a chance to look it up, it's, it's worth reading. Um, getting back to telemedicine companies struggling to meet the coronavirus demand, there's really three main points that comes out of this.

First, telemedicine companies are seeing unprecedented volumes of patients trying to use their services. Absolutely, uh, what we expect to happen. Hospitals and health insurers are encouraging patients with suspected coronavirus symptoms to try virtual services first, rather than coming into the doctor where they might infect others.

Uh, absolutely true. And, uh, in just in my conversations today with. Uh, health system CIOs, uh, they're, they're seeing a significant increase in telehealth visits and, uh, it's, it's pretty staggering the numbers I'm hearing, uh, some of these companies, she goes on to say, some of these companies say that their, it is breaking down.

Others are frantically hiring hundreds of doctors to meet the demand. Um, alright, so here's what we usually do on the show. I usually give you my take on this. Uh, this is absolutely to be anticipated. The, uh, the networks were not designed really for this. You're gonna have failures. You have a lot of moving parts.

We are moving things very rapidly right now. Uh, even if you have a core telehealth solution, you should have a backup to that solution. And I think one of the things that happens in, in health, IT and healthcare in general is, uh, we strive for perfection and for good reason. You know, we provide care, uh, for people in their moments of need.

So we have to provide solutions that are tried, true and tested, but this is a special case. We are in a crisis mode. And, uh, normally we would have to, uh, you know, put together solutions that are highly integrated and work across the board. Uh, that's not, that's not the case we're currently in. People are looking for solutions.

You have, uh, physician practices, you have primary care physicians who are now doing televisits. They haven't done 'em before. . And, uh, they can't wait for perfect. They need something in place now. So what I'm gonna run through is sort of a, a, a path that you could, could utilize. So, um, the first thing, so telehealth has three main components, teleconsult, telemonitoring, and Televisit.

I. Okay, consult is physician to physician. Your system may need that at this point. Um, it really depends on what's going on in your community. Uh, but consult physician to physician, uh, telemonitoring monitoring people remotely. This is a, an important solution. It may. Become a, an important solution during this crisis.

Um, but again, you're gonna have to determine that based on what's going on in your market. And the last is, uh, televisit. This is the, uh, what we're finding to be the primary need right now. So, uh, I still think you should determine what is the most critical for your system. Uh, I'm gonna assume it's televisit at this point, 'cause that's what I'm hearing.

Um, one of the things I I, I'm telling people in this crisis moment is . Don't, don't implement new unless you have to. Okay. So there's a lot of moving parts, a lot of things happening. Uh, you know, it's a heavy lift to do telehealth and to do it well. Um, you're gonna wanna spend more time training people and building templates and adjusting workflow, because all those things are really required to do televisits and to do 'em well.

Um, I've spoken to health systems just this week that are using FaceTime, and I really applaud that, you know, the HIPAA restrictions have been relaxed. We don't, we shouldn't be thinking, oh, is this our long-term solution? We should, should be thinking, what do we need to do, uh, right now at this moment in time?

And with the HIPAA restrictions, re uh, uh, relaxed, we have an opportunity to utilize, uh, some systems that we normally wouldn't . Uh, but they're appropriate right now. Uh, don't get caught in the integration trap is, is the last thing I'm gonna really focus in on here before I go through the system. Um, you know, televisit is really a queuing system that is a waiting room, an education platform.

How are you going to educate people while they wait for that call, uh, video conference solution? And I'm going to really focus in on anything. We'll really do that works, uh, in a documentation platform if you're gonna try to integrate the EHR during the pandemic. . Uh, likely the pandemic will be over before you're even close to being done with that type of solution.

Alright, so what do you stand up? I've seen a lot of people really focusing in on the technology, and I think, uh, again, you're not trying for perfect here. Stand up something quickly that your physicians can utilize. So the first thing you need to do is you need a, a screen that can really handle two, uh,

You know, two applications going at the same time. You're gonna want one for the, uh, video conferencing solution, and you're gonna want one, want one for the EHR. Okay. And if you do that, you've just solved the documentation and billing problem because while they're seeing the patient over here, they can be documenting as they normally would for a visit.

Um, I would, again, I'd spend more time on the templates and the training and um, . You know, just consider the fact that you're likely ramping up the numbers I'm hearing likely ramping up for almost a tenfold increase in your televisits. Uh, the next thing, queuing system, I would say do return phone calls, do return, uh, video calls.

Uh, in try, instead of trying to stand up some complicated, uh, uh, queuing mechanism, electronic queuing mechanism, have them call in, get their place in line, and then you can call and, and instantiate the, uh, the, uh, tele the video conference, uh, in that direction. Uh, you can use the admin staff for this.

There's a lot of displaced admin staff right now because, uh, quite frankly, because our waiting rooms are empty, we're not doing, um. You know, we're not doing voluntary, uh, surgeries and other things. So there is some staff that can be put to use for this and they can help queue people up. It's low tech for sure, but it works.

Uh, the last thing, educate. Not the last thing, but the next thing is education. Your education platform today should be pretty much your website. Okay, this is how I'm thinking about it. You, you wanna be communicating with the community, not only for, uh, not only for your telehealth platform, but for, you know, just general communication with them.

Uh, I would look at a handful of organizations that have done this well. Baptist Health has done this well, Intermountain has done this well. Uh, Mayo has a great, uh, FAQ, uh, MultiCare is a good example of, uh, the, uh, homepage. Uh, there's chatbots and other things. Uh, in fact, that's probably the next thing I'm gonna say.

If you can take people away from even the televisits and get them into the chat bot, uh, workflow, that would be great. CDC has a self checker bot that you could utilize. There's a . Um, there's a free C Ovid 19 chatbot available from Orbita and, uh, Charles Boise with a clear sense also shared with me, uh, a company called Hiro, HYRO has AC Ovid 19 assistant and self-assessment tool.

There's a lot of things here, uh, that are available to you for free that you could utilize on your website for education and for routing of people. . And finally, people are spending too much time worrying about the video conference solution. Look, zoom, WebEx, Skype, FaceTime. These are all appropriate for clinical uses right now.

Okay? In this moment, they're appropriate. Um, we have people going out there and trying to find the, the perfect video solution with integration into your EHR. Uh, don't get caught in pursuing. Perfect. Stand something up. So that's my take on that. Probably a little longer than I wanted to, but, um, but I did want to cover that because, uh, telehealth seems to be something that, uh, keeps coming up.

Uh, the next next thing is, you know, some, some great frontline reports from his talk. And I'm gonna share a couple of these with you. Large, mid Midwest health system. With, uh, medical school, uh, continuity of command structure, statistics show that as much as 30% absent rates could be realized. We have been asked to document our command structure at least three levels deep.

Uh, we've talked about this with, uh, several people on, on the podcast earlier. I. And, uh, it's important, especially if you are a clinician who is in an IT role. We're seeing a lot of those people be, uh, reallocated, redeployed in, in different places within the, uh, health system. And, uh, you know, being able to know who you're gonna hand the baton to, to do certain things and preparing those people for the ability to step up is really important.

Uh, Boston based health system, um. And, and this is an interesting, so a patient does not exist in Epic until they have a visit or a bed. This has been always, this has been one of the problems with EHRs, not just Epic, but EHRs in general. EHRs are great for tracking patients. But that's not all we have in our community.

We have consumers of health, we have, we have, uh, you know, just the whole population to track. And this is why we overlay things with things like Salesforce. And I would like to see this really change sometimes soon. The ability to, to have Epic or the EHRs, uh, especially in these kinds of situations, track more than just patients.

Anyway, with that being said, um, . With new temps being added, lobbies being beded and new ICU beds being planned. Epic builds, uh, builders and managers. Physicians and leadership are working overtime, uh, to get it all built. And, uh, they talk about how the command structure's been set up for nearly two weeks and they're doing, uh, Hercules task and they go on to say, I'm not sure anyone outside of Epic would understand how much work this takes.

It absolutely takes a ton of work. Uh, it's amazing what health it is doing. I was saying to somebody today, . That I think, uh, what health it has been able to do over the last, I don't know, 30 days, uh, is probably comparable to the amount of work that we've done in the past year. Uh, we don't normally move at this pace.

It's amazing what we've been able to do with focus. Focus is an amazingly powerful tool when everybody in the organization knows, Hey, this is the most important thing that's going on right now. And these are the things we need to stand up. Uh, and health, it is rising to the challenge. Um, it's just fantastic small rural health system in the Pacific Northwest.

Okay, so this is the heart of where things are ratcheting up, uh, Pacific Northwest, I. Uh, and, uh, New York City. But, so this is a small, rural health system. One of the things I appreciate about these people is they don't have a huge staff, so they have to stay focused. So here's, here's what this one, uh, talks about.

Agility matters. Stay hyper informed about what is going on locally and nationally. Literally try to guess what is going to happen next and keep planning for worst case scenarios, which so far have been proven to be, uh. Have been proven to be the case every time. Keep it simple a quickly deployed. 60 to 70, 70% solution is better than nothing at all.

Suboptimal is the new normal focus on telehealth. True expect and plan for big support overhead with telehealth and work from home from all levels of it. That's true. Expect all your technology partners to be fairly overwhelmed. Uh, that is true in some areas, to be honest with you. There are some underutilized, uh, organizations, so, um.

You know, reach out, see what you can find. Stay engaged with your clinical and operational leadership. Absolutely, you should be in lockstep at this point and dust off your disaster plans and business continuity plans. I would say on that one, the reality is you should know what they are. Uh, if you didn't plan for certain things, if there's gaps, you'll probably finding them right now.

If they're critical, fill them. If they're not, uh, what you're doing right now looking at those plans is really planning for the next. Um, the next major business continuity challenge, North Carolina health systems spanning urban and rural areas. Big investment in telehealth, uh, capability, network upgrades, uh, training investments are all paying off, and that's really true.

There's some health systems that have made those investments and done the right things, and it's paying off right now. Um, I did get this email from a Northeast Health system. We have literally going nonstop working with Epic, uh, modifying our systems, uh, rapidly adding televisit capacity, both Epic Video and Teladoc.

Again, primary backup, adding drive-through, uh, drive-through sites modifying the lab system, et cetera. Uh, there is a morning meeting just to track the COVID 19 related IT projects and leadership has. A maximum, a minimum of two calls per day. Everything is being, uh, put on the website for communication, which is great.

Uh, we started with 25% remote work two weeks ago, and, uh, with no in-person meetings allowed the technology team scaled up. After adding to the capacity, we are now at a hundred percent remote in all areas that can, we do daily and twice daily scrums with teams. Uh, zoom is being stretched. Uh, we, uh, you know, and they're augmenting their support center as well.

Uh, contingency planning is in process. I. For our upcoming go lives. And, uh, they also talk about how they think this is going to change everything moving forward. That is, uh, that is probably true. Uh, you know, I just wanted to share some stories from the, uh, from the front lines. What's going on? Uh, I, what I've found is we're really falling into two camps.

We're falling into camps that are, uh, busy beyond their belief. There's just so much going on. And then there's camps that are, are waiting for the surge to really, uh, to, to come to fruition. And they are planting, they're planning, uh, for the worst and putting all that, uh, prep work in. But for the most part, they are, uh, not nearly as busy as what's going on in say, uh, Pacific Northwest or, uh, New York are really Northeast corridor right now.

Uh, the two most common problems, PPE, you know, it's hard to care for, care for people when you can't protect yourself. Uh, continues to be a problem and testing the testing's all over the board. It sounds like people are waiting, uh, you know, seven to 10 days potentially for the tests to come back. Uh, that's really not working for the health systems.

We have some health systems with the wherewithal, the academic medical centers are coming up with their own tests. Uh, we heard that in the podcast from, uh, Stanford. I heard that from another academic medical center just, uh, uh, two days ago. Um, so we're seeing that work being done as well. So, let's see. Uh, another story, A great story just came out how EHR vendors are arming providers to handle c Ovid 19.

Uh, again, I put all these, uh, links on the, uh, COVID 19 resources page on this week in health. It, you could check 'em out there. All scripts is virtually, uh, there. A lot of 'em are focusing in on, uh, updating, um, . You know, up updating the, uh, the workflow, updating the, uh, capture, um, you know, updating to CDC, best practices around order sets, social hi history questions, and the like.

Uh, Allscripts Virtual history, uh, follow My health is also doing, uh, patient to provider telehealth. This is important. Athena Athenahealth. Uh, again, order sets and those kind of things. Virtual care, Cerner, uh, also, uh, additional screens and monitoring. They just did an update to Millennium. Uh, around c Ovid 19, uh, telehealth again as well.

Uh, eClinical works focused on, uh, virtual care. Uh, Meditech has offered their expanse, ambulatory and patient portal use complimentary, uh, deployment of their scheduled virtual visits functionality for a six month timeframe. Uh, be looking at that. A lot of, um, a lot of, uh, organizations are offering, uh, discounted, uh, licenses and services, uh, right now.

So have those conversations. And finally epic. And as you would imagine with their market share and their breadth, they're doing a a fair amount. The company is encouraging organizations to share c Ovid 19 information through Epic's interoperability network, uh, uh, through Care everywhere. Uh, also for non-Epic organizations, uh, they're sharing, uh, through their interoperability network as well.

Similarly, epic has advised provider customers that it's MyChart portal that can, can be used to handle questions, complete screening. Uh, and communicate through eVisits video visits and secure messaging, uh, which is, uh, fantastic in this time. Uh, several weeks ago, epic issued an update to its travel screen criteria to identify patients who had traveled to affected regions.

While travel restrictions mitigate these concerns, epic says they will continue to update these criteria. Uh, using analytics with Epic suite of products, clinicians can create and run reports, uh, to hopefully pinpoint, uh, hotspots using, uh, covid nineteens by zip code, uh, patients by zip code to discover potential hotspots.

So that's what the EHR providers are doing. I wanted to share that that is, uh, really good work that they're doing. They're, uh, supporting the industry at this point. If you, uh, want to get to those links, go ahead and hit our resource page. Uh, find the EHR provider that you're looking for. Click on that.

It'll take you to their page. Uh, finally I wanna talk a little bit about what Big Tech is doing right now. So, uh, interestingly enough, you know, apple, updated Siri. I. To help people who ask if they have coronavirus. You can test this out right now on your, uh, on your phone. I don't want to do it 'cause I'm recording this on my phone.

Um, but if, if Siri is asked, you know, do I have coronavirus? It will respond to you. So that is a great update. I'd like to love to see what they're doing. I, I love that work that they're doing. Uh, Google's coronavirus search hub. Uh, makes C Ovid 19 information easier to find. Uh, this has been much talked about, but you know, since literally billions of searches a year start with Dr.

Goo Google, it is important for them to have the right, uh, tools available for the people as they're searching. I played around a little bit with this. It is a really good tool and, uh, very informative. I like it a lot. Um, also, CDC uses Microsoft's healthcare chatbot chatbot symptom checker. Man, say that 10 times fast.

Uh, the chat bott runs on uh, Azure and the CDC owns and maintains the tool and does not share any personal information. Uh, users enter into the bot with Microsoft, uh, versions of the chatbot already online and nine health systems. So it's the Wall Street Journal. Um, let's see. Healthcare provider Providence launched a limited version of the bot on March 5th, opening it to all users on March 8th, according to the Wall Street Journal, and says that the bot has had more than 40,000 sessions, uh, and more than 6,000 hands off, uh, handoffs to video consultations so far.

So, again, fantastic work, uh, happening on top of Microsoft's platform. Uh, you know, heck, even Elon Musk is getting into the, uh, into the works. Musk. . Uh, he talked ventilators with Medtronic, uh, and as they were doubling their production. And then he also went out and sourced a whole bunch of material from China, which, uh, he, uh, he and his team orchestrated, uh, the acquisition of and brought it into, uh, la and they are now distributing that, uh, information.

So that's our, is the, that equipment, which is fantastic. So big tech is stepping, stepping, stepping up. And, uh, doing a lot of stuff at this time and it is greatly appreciated. Uh, you know, that's all for this week. 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.

I. Of health leaders. This shows a production of this week in Health It. For more great content, you can check out our website this week, health.com, or the YouTube channel if you wanna support the show, the best way to do that is to share it with the peer, just however you do that. Shoot 'em an email, shoot 'em a note, uh, do it on social media.

Um, however you do it. Go ahead and do that. We'll be back again tomorrow with another episode and we'll just keep dropping 'em as, uh, we line up interviews and we have a bunch of interviews lined up. Uh, right now we are gonna start, we, we now have a known problem set, and we're gonna start focusing on solutions.

So I'm gonna be talking to people about, uh, scaling up your EHR environment, scaling up your VDI environment. I'm gonna talk to a Citrix expert, uh, around what, uh, they're doing. Uh, and then I have some, uh, interesting, uh. Uh, different kinds of podcasts coming up. I'm talking to a former CFO of a major health system.

We're gonna talk about the financial aspects of this. Not that we don't appreciate the crisis that's going on, uh, but there are a lot of ram, a lot of money being spent right now and not a lot of money coming in. I think that's going to create a problem and I wanna talk to somebody who is, uh, adept at this, who can help us to understand it.

Uh, we're gonna talk, um, mental health with, uh, with a former guest of the show and talk about, uh, what people are doing around that. . And I think that's gonna be a, uh, very good topic. And then we talk, uh, leadership in crisis, uh, also, so these are all episodes that I've either already recorded. I'm just in the production phase, so we're gonna just keep dropping 'em every day.

Uh, as long as you guys find value and you're downloading 'em and listening to 'em, we'll keep, uh, we'll keep putting 'em out there. So, uh, thanks for listening. That's all for now.

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