June 26, 2020: Welcome to another Field Report. Today Bill speaks with Jeffrey Sturman, CIO of Memorial Healthcare System, who provides context on how Florida has been dealing with COVID-19 and where the healthcare world is headed. Jeff discusses Memorial’s successes within their nursing homes and how this comes down to communications policy and their unique ability to perform their own tests. Bill then asks Jeff about Memorial’s response to the pandemic and how they’ve managed to scale up their telehealth structures. Jeff details the challenges that his organization has faced with telehealth and the need for providers to use non-standard platforms like Zoom to see patients. After emphasizing that telehealth needs a ‘one-click’ solution for accessing providers, Jeff talks about the benefits of virtual care, including the potential for family members to become involved in consultations. Jeff and Bill discuss how Memorial is handling its ‘work-at-home’ situation before focusing on hard-hitting questions about what the future looks like for Memorial Health’s IT priorities. Jeff shares his thoughts on how telehealth fits in with his mobile and social strategy of engaging consumers and about the importance of business intelligence and analytics. Finally, Jeff talks about how he’s preparing for a second surge of patients. Jeff’s insights are valuable in understanding the shifts in the health IT landscape, so tune in now!
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[0:00:04.5] BR: Welcome to This Week in Health IT where we amplify great thinking to propel healthcare forward. 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.
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[0:01:35.4] BR: This morning we’re joined by Jeffrey Sturman, CIO for Memorial Healthcare System in Hollywood, Florida. Good morning Jeff and welcome to the show.
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[0:01:42.3] JS: Morning Bill, thanks for having us.
[0:01:44.2] BR: Well, I’m looking forward to the conversation, we’ve interviewed people from all different types of health systems, give us a little background and idea of Memorial Healthcare System in Hollywood?
[0:01:55.6] JS: Yeah, sure. Memorial is the south Broward hospital district. We’re a county- based subdivision of the state and so the healthcare system is six hospitals, we have five acute care hospitals and the Joe DiMaggio Children’s Hospital in Hollywood as well. About 2,000 in total beds, about 2,000 physicians on our medical staff and the lion’s share are still community- based providers. We don’t employ a huge number of providers still today. We have all 300, of which, most are specialists. We do have a nice footprint on the primary care side and that’s building and growing as you can imagine so I see that our employee base will continue to develop on the physician side. About two and a half billion dollars in revenue, a little less than that and for Florida, that’s pretty sizable and big, certainly for the county. I won’t say that we own the complete market share. South Broward is a competitive market and our sister health care system to the north of us, Broward Health, is about the same size. I think their area of demographics actually is a little bigger but in terms of revenue, they might be a little bit smaller. But between north Broward and south Broward, that is really the primary hospital base. Obviously there’s others in our market, Cleveland Clinic here in West End. We have some HDA antennae hospitals in our general area as well. Really happy to be here, it’s a very community- focused healthcare system. We span from Hollywood on the east side of the country all the way to Miramar which is about 20 mile area of our six hospitals and a terrific healthcare system.
[0:03:48.7] BR: Yeah, you know, I just moved from California to Florida — for people who don’t know, I moved into Naples. I moved on, March 1st is when we moved in. Couldn’t have been a more odd time to move in but I’m looking forward to getting to know the people in Florida and it’s interesting because you know, the Florida healthcare systems, for whatever reason, Florida and California are obviously geographically pretty — you know, dispersed, but I didn’t interact with a lot of people from Florida healthcare being in California. I don’t know why that is.
[0:04:26.5] JS: We always say it’s a bubble here. It’s a bubble where I live in my very small community, it’s a bubble in south Florida and I don’t know if that’s how we are geographically
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placed or why that is and you know, the opportunity to do both consulting in our past and bring some of those lessons learned to places like Memorial, which has such a long and rich history of people working there for a very long time has been terrific and fun. But it is a bubble.
[0:04:57.5] BR: Yeah, it’s interesting. Let’s get into it a little bit because you know, it’s interesting as I’m interviewing you guys now, a lot of you are like hey, “what can I talk about that we haven’t talked about before?” I think each market has a little different bent and it’s interesting to me — the feedback I get from different CIOs and different people within healthcare that they appreciate the fact that we’re interviewing from different markets and different sizes because even though, yes, we’re all doing telehealth, yes, we’re all doing work from home. We took a little different approach to it and that’s helping others to really think through where they’re at. Give us an idea of where your health system or how your health system has experienced the pandemic thus far?
[0:05:41.0] JS: Well, maybe I should start just with some high-level statistics for you and give you a sense of Florida and Broward County and Memorial because I think it will give you a little bit of context for what we’ve done and what maybe we haven’t done compared to some others. I’ll just ramble on statistics as I look at them. So for this state of Florida, I think we have been hit by COVID just like everybody. There’s volumes are high and maybe not as high as some other areas in the country. In context, we have just about 53,000 cases in the state of Florida. In Broward County, we have just under 7,000. So, between Broward and Dade County, unfortunately, it’s where the majority of the population of Florida really is, and we are seeing obviously the number of cases to be highest in those two counties. Just about 7,000 cases in Broward, about 307 deaths we’ve had in Broward, but which 1,500 people have been hospitalized.
I can put that in context for Memorial now — and Memorial has had about half of the total cases in Broward County hospitalized at one of our five acute care hospitals. We had 84 total deaths and we run a census right now of about 110 COVID patients, ranging between a hundred and 120 on any given day. That’s down from about four or five weeks ago at the height and peak of this where we’re close to 200 inpatients across our five hospitals on the acute care side, we’ve had very limited — thankfully on the Joe DiMaggio Children’s Hospital. It’s a big number and we’ve been doing a lot of the same things that so many others have done and early on with
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regard to the testing and working with the state of Florida and the governor’s office. I think we were the first ones to open up a testing center and automate that testing center with our technology so really, creating the throughput and the volume of patients that we could manage in upwards of 800 patients a day.
[0:07:55.7] BR: Wow, did you guys take some of the cruise ship passengers?
[0:08:02.4] JS: We did in a very limited fashion. The port of Everglades is in Fort Lauderdale, closer to Broward health. I know they did take some, we took very limited but we did certainly play a role in both cruise ships and some of the long-term care facilities, some of the nurses. We’ve been continuing to play a leadership role. Really, not just for Memorial’s own, what we call, Manor, our long-term care facility — but long-term care facilities across the county.
[0:08:31.9] BR: Yeah, so what’s distinct? There’s been a lot of talk about nursing homes and I’m going to go off script here a little bit just so from a nursing home standpoint, Florida is sort of being lauded as in terms of some of the approaches they’ve taken versus other states, what are some of the things we did with regards to nursing homes?
[0:08:52.5] JS: You know, I think our instruction of education, communication, and testing. Memorial’s one of the only organizations that I’m aware of that actually has their own ability to do the test. So, do testing earlier on and have all the reagents and have the testing equipment — is something that we helped significantly with our nursing homes. And to continue to provide that education with regard to PPE with regard to as I said, just equipment in general. So I think that education, that communication has really helped and certainly hasn’t mitigated totally all the issues of our nursing homes but we’ve seen a significant decrease actually just in the last couple of days. So we’re happy with that obviously.
[0:09:38.8] BR: All right, the show is This Week in Health IT, let’s start talking about technology. We’ve done a lot of different things, what are some of the things you guys did with regard to technology? Feel free to be competitive. I’ll break it down and go because I’m sure you did some things in telehealth, I’m sure you did some things ‘work-from-home’. I’d love to hear about those and maybe some other things that you did.
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[0:10:02.7] JS: Yeah, I think we’ve done so many things like you’ve said that are similar to others. Obviously telehealth has been front and center for all of us. You know Bill, before COVID, on an annual basis, the penetration for telehealth here and virtual is really small. I’m going to go off a number that maybe is not completely right but 2,000 to 3,000 telehealth visits a year before COVID. And in the last two and a half, three months, we’ve had 42,000 telehealth visits. Most of which have been through Epic. Epic is our EHR and my chart and scheduled visits in the waiting which we are conducting telehealth. We do that through MyChart. Over 35,000 of those visits have been through our actual integration with Epic and MyChart.
[0:10:58.8] BR: You had that in place beforehand and you just scaled it up?
[0:11:03.6] JS: We did. We had it in a limited fashion. Our primary care group has really been out in front of this a lot and some of our, what we call Memorial physician groups. Some of our employee-based physicians, in a limited fashion, and so in the last two and a half months, almost all our specialists, and certainly all of our primary care providers, have been trained. Have been marketing and communicating with their patients that this is an opportunity and an option that we want to encourage. And so, we did have the technology already in place and so that was an easy lift.
The hard lift has been, how do we make the easier transition for all the patients that don’t have MyChart and don't want to use Epic and so we’re still investigating and we’ve used a lot of different technologies to facilitate telehealth that we didn’t have in place. Things like FaceTime and Doximity and Doxy.me and what that’s in Zoom even, we didn’t want to get in the way of our providers providing clarifications as effectively as they choose right now. We know that’s not consistent, that’s not standard, that’s not even where we want to be long-term. We are looking at very simple solutions, in fact, we’re piloting two right now, one is a partner of Cisco and one is Tiger which is an application we have here for texting capabilities, for secure messaging and both of them have very simplified telehealth capabilities. One-click telehealth visits and we think that will take off even further.
[0:12:39.5] BR: So that is for people without MyChart, I mean you are talking obviously, this is something people don’t really recognize. Not everybody has even if they are in your community, not everybody has a medical record at your system but they still in a time of pandemic might
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need to get a task, might need to be those kinds of things and their first hit, their first interaction with the health system could be through telehealth. Well, they don’t have a record. You have to have a way to sort of instantiate them into the system. Is that what you are talking about?
[0:13:11.4] JS: It is. So we are thinking about it in two ways. We are thinking about it for those patients that don’t have a MyChart account and a provider wants to initiate a telehealth visit on an ad-hoc basis with a patient even if they are not scheduled per se. The other thing that we pick through as an opportunity here is we’re telling patients and their family members not to come into the hospital unless they actually have to and obviously we are safe and we can do this for patients. But family members are used to being waiting in the waiting room for their family member or when a patient is having a procedure in the operating room, an outpatient procedure, we are used to waiting there. So now we are having providers actually initiate these very simplified telehealth visits and they are not patients of ours. These are family members where they can actually communicate with a family member the status of their patient or their family member who just had a procedure. They are able to communicate with them real-time and face-to-face, which we think is more valuable.
[0:14:15.4] BR: That is interesting. Any remote patient monitoring or I mean let’s just go there. Any kind of expansion of the remote patient monitoring capabilities that you had?
[0:14:27.1] JS: Yeah, so this is something we were looking at actually before the pandemic and we’ve been looking at tools that we can utilize. We have done this for the last number of years on the value-based care end population health side. So we are going to continue to leverage the tools that we have at our fingertips for further chronic disease and even follow up on some of the home health, long-term care — some of the patients that we want to make sure we are having the right follow up.
And so I think this will take off more. We are talking about it more and more and we are doing some pilots with a vendor and even our ECMO patients right now. So some level of virtual remote patient monitoring of ECMO and then finally, we’ve put in over 300 iPads in our facilities. One so that we can continue to communicate for patients with their family members and two, so we can communicate from a nursing station for example and not burn PPE unnecessarily. So the patient can actually communicate with the provider who is not in the room, who is COVID
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positive and has the ability to ask for something as simple as ice chips if they need it and not necessarily have a provider come in to the patient room without unnecessary risks.
[0:15:54.0] BR: You know I love interviewing CIOs and especially when they have their mail open in the background because it gives people a picture of how busy they are and how these things keep popping up on your computer. Let’s talk work-from-home and actually let’s just project into the future on work from home. How are you going to make the determination of what the new work environment looks like? You know how quickly people come back. Do people all come back? Is it a hybrid environment? How are you going to make those decisions? How are you going to determine what the future of work looks like at Memorial?
[0:16:31.7] JS: Yes, so we are about 15,000 employees and about 2,000 people at any given time right now are working from home. We have been talking about this a lot lately. In fact I am going to my app, you can see I am home right now but I am going to my office this afternoon for a tour with my chief nursing executive and so with my facilities, people actually look at the layout of the building to determine where we have risk areas and how we need to shore things up from a safety standpoint.
And so we are looking at June 15 from a corporate services standpoint to open things up in a very staggered means. So we are going to say, not everyone come back to work right away and certainly we have some other projects going on in IT that allow us to be very productive right now and capable of working from home. So my intention is certainly for the month of June and July to keep people working more remotely than that. and where I think we are going to take this in two week increments and just see where things are both from a corporate services standpoint. June 15th is the date we are targeting to have a phased-in approach. We are leaving it to the discretion of leaders of various corporate departments to tell us whether or not their people can be productive or whether they need to be back in the office. But there is going to be an element of this ‘new normal’ of working from home for, I think, the foreseeable future.
[0:18:02.2] BR: Yeah, do you anticipate any people sending you an email saying “Hey I don’t want to come back?”
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[0:18:06.5] JS: Do I anticipate it? I get it about 10 times a day already. So yeah, I can’t believe my team of about 300 people in IT are planning to get back into our corporate building, nor do I think they need to. I think one of the biggest lessons learned is that we all have — and we were really fearful of — would this work at home experiment that we were forced into work? And can we create the productivity that we all really need for work today? And is this sustainable? And so many people from the leadership standpoint were very fearful of that. And I think we have proven out, certainly for my team, we are productive if not more productive by working at home right now. So I don’t think it is a bad thing.
[0:18:55.9] BR: Yeah, it’s May 28th, 2020. I say the date because I am going to ask you for something and I want people to understand the timeline we are asking this. So what are the priorities for health IT today on May 28th and what do you think they will be post-pandemic?
[0:19:15.4] JS: Yeah, it is a great question. I think so much of what we were doing before pandemic and now during and after have shifted we’re reprioritizing everything. In fact we are on a fiscal year that ends at the end of April. So we just concluded our fiscal year, which is really odd and we had our budgets fairly well secured in February. So now we have been taking a look back and saying, “Where and how do our priorities need to shift?”
I am certain in virtual care — we had a fairly good and strategic meeting with even physicians yesterday about virtual. You talked about remote patient monitoring earlier and obviously telehealth. That is going to be first and foremost and really I think we need to continue in terms of where we need to be looking. I put that in the category of virtual but if I look at our strategic priorities in IT, it fits in the world of mobile and social as well and those are two of our major priorities before the pandemic. And will certainly continue beyond the pandemic. So the whole idea of engaging our consumers in the most effective way has always been something in our mind for this last year and it is even more front and center. So, consumer engagement, what are the tools we need to create and develop and partner with to make that all happen is still under evaluation. Obviously analytics and data is something that also is very important post-pandemic. And certainly has helped us make decisions during the pandemic. So I think business intelligence and analytics will be a strategy that we continue to have to build out. We don’t have the best governance around analytics. So we need to get that resolved but I think that will be a big to-do for this coming year as well.
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[0:21:13.2] BR: All right, so two closing questions. The first one is really around — we’re seeing claims data showing that we are seeing an uptick in volumes across the board and actually we are seeing it in all markets. So I am assuming that is true for you as well. What specific health IT projects are either you putting in place to augment the safety procedures or putting in place to prepare for a potential second surge if that does come about?
[0:21:44.5] JS: I talked a little bit about this already but I will reiterate. You know I think if a second surge were to come, we are doing a lot of things to, again, look at the data and make sure we have the dashboards and tools accessible. And make sure they’re tuned in a manner that is sustainable and right — not just for today but for the future. Texting and the way in which we are communicating to patients and our consumers from not just a one-way text but a two- way text that we have all gotten used to in other industries and for whatever reason, Memorial, and maybe other health systems, are a bit behind here. I think we need to continue to look at how we engage our consumers on the texting front and make sure that we are getting information out to them as real-time as possible. Memorial is looked at because of our size and because of who we are to the community as really an agent for information and education.
And so we continue to look at ways in which we can provide that information for them. Really I talk about it from a mar-tech, a marketing and technology collaboration and so there will be so much more to be done there. And then finally, this easy solution for telehealth making this as seamless and simple for our end-users that sure, Epic is terrific and MyChart has a great capability for scheduled appointments but there is so much more we could be doing to make and ease our population from consuming information to getting the right care at the right time.
[0:23:26.4] BR: Jeff, thanks again for taking the time. I really do appreciate it and after this is — you know, we have progressed through this a little bit. I’d love to come over there and visit with you guys since it is only a couple hours drive.
[0:23:38.5] JS: You know I love Naples. I will come over there to visit you. It is not even a couple of hours. For me I live in the west end. It is like an hour and 10 minutes. And it is terrific just to come right Alligator Alley, so, yeah make your way over here for sure.
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[0:23:53.0] BR: Absolutely thanks. [END OF INTERVIEW]
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