March 30, 2020: Pediatric hospitals are playing a major role in the crisis and for today’s field report, we had Dr. Dan Nigrin, CIO of Boston Children’s Hospital join us to share his experiences. Dr. Nigrin starts by giving some insight into the spirit of collaboration between providers in Boston as efforts to scale increase. He advises as to the role of children’s hospitals in the crisis, and what Boston Children’s’ efforts to scale have looked like from an IT perspective too. We hear about the increase in COVID-19 cases in people below 30, and how pediatric hospitals should prepare to take more child patients from hospitals overloaded with adult COVID-19 cases. Dr. Nigrin also speaks about the amazing increase in virtual interactions his healthcare system has orchestrated, whether it be telehealth, in-person visits, or remote working, and the logistics required to enable this. Make sure you listen in for a brief but informative glimpse into the situation on the ground in Boston.
Key Points From This Episode:
Field Report: Boston Children's with Dan Nigrin, MD.
Episode 214: Transcript - March 30, 2020
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[0:00:04.5] BR: Welcome to This Week in Health IT news where we look at the news which will impact health IT. This is another field report where we talk to leaders in health systems oH the front lines. My name is Bill Russell, healthcare CIO coach and creator of This Week in Health IT a set of podcasts, 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 Sirius Healthcare has stepped up to sponsor and support This Week in Health IT and I want to thank them for giving us the opportunity 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 [email protected] Now, on to today’s show.
[0:00:55.2] BR: Today’s conversation is with Dr. Daniel Nigrin, the CIO for Boston Children’s. Good morning Daniel or Dan, welcome to the show.
[0:01:05.0] DN: Good morning, Bill. How are you?
[0:01:07.5] BR: Good, sorry if I messed up your name at all, we’re all moving so fast. You're a practicing physician in the Boston area and I appreciate you doing this. What we’re doing is just the series on field reports from the front line and I appreciate you and a bunch of your peers have now volunteered to do these quick 10 minute interviews.
We’ll just get right to it. You know, give us some context of what’s going on at your system or in the Boston community at this point.
[0:01:40.1] DN: We’re obviously ramped up in a big way just like everyone around the country, I would imagine. We’re not quite at that New York City levels yet but things are definitely escalating quickly. In the pediatric space, we definitely have had fewer cases than our adult colleagues around town, but for sure, things are ramping up as well for us.
Additional really interesting thing that I’ve heard from a number of other children’s hospitals is that there’s some strategizing going on around the country around having children’s hospital serve as sort of the home base with which adult facilities who also care for children could offload some of their patients if they really needed to, to create some more room in their facilities for ill adults.
We’ve been bracing for either more COVID patients of our own, you know, in the pediatric world or just a big bolus of pediatric patients with all sorts of disorders that might be transferred to us from other adult facilities.
[0:02:46.9] BR: Well, you may or may not be able to speak to this but it already spawned a question in my mind which is, could we expect a significant amount of children cases within children or do we –
[0:02:57.5] DN: Well, it’s definitely not nearly the rates that we’re seeing in the older population but I will say that it’s interesting as we’ve seen around the country, there’s definitely a sizable number of 20, 30 year old folks that frankly, I wasn’t expecting at least from the reports that I had originally heard. You know, there’s many pediatric facilities that do extend up into that early 20 year old range. Especially if they have other sort of chronic disorders that might predispose them to getting COVID more so than a healthy individual.
We do anticipate seeing a fair number of affected patients in that age range and those would come to us.
[0:03:47.1] BR: Boston has a really good community in terms of the health systems working together. Can you describe how you’ve worked with the other systems, within the Boston marketplace to really get prepared for this?
[0:04:00.6] DN: Yeah, well, I can tell you at least at the IT level that we’re all sort of constantly talking with one another, extending support, giving each other ideas of what we’ve done or not done and that’s been super helpful. I also know that our CEOs and COOs are also talking on a regular basis amongst themselves and doing the same, you know?
Trying to assist one another, getting ideas from each other, it’s really been very collaborative and you know, any sense of competition and so on is out the window these days as you would expect.
[0:04:35.8] BR: Yeah, let’s get pretty pragmatic here. What are some of the things you guys have done and what are – what’s like one thing that we would be amazed that your IT team has been able to accomplish over the last couple of weeks?
[0:04:48.8] DN: Well, I think you know, probably similar to many organizations around the country that the two things that I’ve just been bowled over by are two things that we’ve been pushing for a long time and really trying to get adoption for and this was the trigger that really pushed it. Those are first of all, tele medicine, being able to do virtual visits with our patients.
Obviously, on the ambulatory side for less acute patients, we’ve – I think the current number is about 30x what we were doing before COVID and just to give you a sense of volume, we normally see around 650 to 700,000 ambulatory patient visits a year. Our current telehealth visit rates are approximating about 40% of that total volume. If we were to keep this clip up for an entire year we’d see almost 40% of our usual in patient, I mean, in person ambulatory visits which is just a phenomenal number.
Now, I don’t know if that’s a sustainable number or if these are just quick visits, you know, in order to tithe us over until this period’s over. But regardless, the adoption has just been incredible and honestly, the experience is good both on patient side as well as provider’s side. We’re actually asking both patients and providers to rate their experience after each visit.
Uniformly, it’s up in the eight or nine range out of 10 for both of those parties, both patients and providers. Really strong there. But the other place that we’re using virtual visits which is really neat is in the inpatient space as well, so that providers are not exposing themselves potentially to patients with COVID and vice versa frankly, the further patients to not be exposed too much.
We’re using video to interact with patients inside the room. For that consultation, that needs to be done or that quick question that needs to be asked of the patient without dawning all of the PPE and utilizing PPE, we’re preserving that and reducing exposure. You know, we’ve gotten creative and what technologies we’re using for that. I’ve heard about a variety of different efforts around the country but that’s really neat as well and that got put together very quickly.
Virtual visits is one big place. And then the other big place is just in remote work, you know? Here I am at home, we’ve got over 50% of our staff that work normally at Boston Children’s working remotely now and scaling that up quickly and effectively has just been incredible thing to watch.
[0:07:44.2] BR: Yeah, talk to me a little bit about the telehealth. I know we’re coming up on our timeframe here but were you able to just scale up what you already had or did you get really creative and come up with just new ways?
[0:07:57.3] DN: A little bit of both, Bill. We did have to scale up both from a licensing perspective as well as hardware perspective, to make sure that the infrastructure was ready but we also had to branch out a little bit so as an example, our existing platform didn’t provide the ability to provide multiple clinicians participate in one visit.
For our patient population, we have many instances in where multiple providers need to participate in a visit, we’ve got many patients we need interpreters and so bringing them in to a visit. That was a little bit tricky for us using our existing platform and so, this is where the HHS sort of HIPAA relaxation really came in handy for us because we’re using things like Zoom and other technologies to enable those kinds of visits as well.
[0:08:49.5] BR: Are you surprised – I’m doing all these recordings are on Zoom and I’ve been surprised, I haven’t had a hiccup, I haven’t had a performance degradation or anything. Have you experienced the same thing or has it been –
[0:09:02.7] DN: Not really, just a few edge cases where sometimes the call quality, especially people dial in with a cellphone, rather than using Internet audio. But really, other than that, for big meetings too, we have these big town hall meetings for our entire organization to be able to listen in on and with thousands and thousands of people participating, it still works incredibly well.
[0:09:30.1] BR: Last question, what’s the one thing in the prep process that you wish you had done earlier in the process?
[0:09:37.1] DN: I totally underestimated the need that we would have to get people computing devices for their home environments to do remote work. I thought, “Well gosh, everyone’s got a laptop, at least one that they could utilize at home, sure it might be a personal one but we could, you know, engage our staff to use that device.”
There’s plenty of people who don’t have one who just simply are using their phones on a regular basis. I was completely caught off guard by that and so, our ability to provision, you know, laptops very quickly, obviously, supply chain constraints have made that even more difficult but that was one that I wish I had sort of rethought early on and had started the process of getting machines and getting them distributed and built out to folks earlier in this.
[0:10:32.6] BR: You’re letting people use their personal machines, not work machines at this point?
[0:10:36.2] DN: Yeah, we are, there’s no other way to –
[0:10:40.9] BR: Did you just send them to Best Buy and say, “Look, expense it, go get something.”
[0:10:45.0] DN: Yeah, we didn’t go quite that far although some people took it upon themselves to do that. Much to my dismay but now, we’re trying to still constrain it to devices that we control and can provision appropriately but it has been a little bit rough and tumble, I’d say, as we’ve gotten through it, but it’s working, is the bottom line.
[0:11:09.5] BR: Any last words for maybe children’s hospitals across the country as they prepare for this?
[0:11:15.3] DN: Well, I think, just as I mentioned before, there have been discussions, I know around the country about the need for us to serve as that aggregating place for children’s care, COVID or not, and that makes a lot of sense to me as again, we look to New York and seeing how overwhelmed they are and knowing that that’s likely to be the case everywhere.
It does make sense that those pediatric patients would find a home at the children’s hospitals where there’s the most expertise in being able to care for them.
[0:11:48.7] BR: Absolutely. Dan, thanks for your service and thanks for taking all this time, I appreciate it.
[0:11:53.9] DN: Appreciate it, likewise, thanks Bill for the opportunity.
[END OF INTERVIEW]
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