Senior VP and CIO for the Hospital for Special Surgery (HSS), Jamie Nelson, joined host Bill Russell in a follow-up conversation from last spring's COVID-19 series field report.
Nelson discussed the hospital's COVID transition, EHR, management styles, communication, and plans for the future.
HSS is located in Manhattan, N.Y., and is a standalone hospital for orthopedic surgery. For 11 years, they have ranked number one in orthopedic surgery by US News & World Reports.
Nelson has stayed in the office throughout the pandemic, as she believes leadership should be on site and visible to their teams. However, besides the desktop, networking, and clinical teams, most of HSS’s staff has worked remotely.
Revising their timeline last spring, Nelson recalled when elective surgeries were not viable or approved during the pandemic, HSS transitioned into a COVID-19 care facility. The hospital's multiple ORs and PACU were converted into ventilator critical care units for critically ill patients. Some of their anesthesiologists and internal medicine physicians became critical care doctors.
With this shift came a new demand on the EHR. According to Nelson, their Epic team worked around the clock in this transition because they did not have the necessary accommodations in their interface for this type of critical care. HSS's Epic team built this and code for their patients’ COVID status into their system. They were able to achieve the latter in one-and-a-half days, Nelson explained.
"What we did in a few days, we normally would've taken a few weeks," she said.
Having a small ICU, they partnered with New York-Presbyterian Hospital to transfer extremely sick patients to their facilities.
To make these patient transfers to New York-Presbyterian, HSS needed a strong interoperability strategy. Additionally, they utilized HealthX, which is New York's statewide information exchange. Nelson believes the hospital can continue improving interoperability, though it is challenging to consider new technology and regulatory changes.
Along with these accomplishments and lessons, the pandemic offered additional silver linings. The most easily identified is the rise of telehealth.
Before 2020, orthopedics had a small level of interest in telehealth, according to Nelson. Most of its use was by nurses for postoperative follow-up appointments. During the pandemic, the use of telemedicine increased to 2000%.
Now, surgeons are interested in orthopedic-specific types of telehealth and how it can improve patient care. This would include accommodating patients who are commuting from outside of Manhattan for care. With the challenge of New York traffic, telehealth could significantly improve the experience of those navigating transportation to the facility.
"Being able to do telehealth visits either for physiatry, pre-orthopedic surgery posts really will help expand our services to patients who really need us," she said.
With this experience, the health system has published a book on navigating physical therapy and rehab safely through telehealth. As for their future innovation, Nelson explained that as the hospital moves forward with wearables and sensors, she predicts that the orthopedic side of telehealth will also gain traction.
When reflecting on their progress through the pandemic, Nelson expects a lasting impact of the pandemic in IT to be the stronger bonds between the team and the hospital.
"When you've all been through something together, some real crisis, and that's what it was. Those bonds really become much tighter, and I think that is so for IT, for our hospital. I'm sure all of my colleagues across the country have extremely similar stories," she said.
As CIO, Nelson was met with challenges as she led her IT organization through a pandemic. A notable challenge was assuring they could deliver safe and effective patient care and meeting end-user challenges while one-third of the workforce was remote.
Though a challenge to overcome as a leader, she found their work gratifying work for both herself and much of her staff.
There was an increase in using collaborative platforms like Microsoft Teams and Zoom to keep the team connected. Nelson had leadership and stand-up meetings daily, which she found important for connecting disparate groups.
"The magic key here was really increasing the frequency and the transparency of communications. And even saying when we don't know something or when we're feeling stressed or worried about something, being empathetic and about our feelings of what we're going through, I think really helped the teams develop," she said.
According to Nelson, HSS is carefully considering the future of office work post-pandemic. They are currently addressing what is best for their patients, culture, and hospital colleagues. She believes there will be a hybrid model in the future.
"My belief is that we're going to kind of ride this everybody staying home wave. And then we're going to understand that there are certain things that we're missing by not having people in the same place, and we'll come back to a more middle state," she said.
For 2021 and 2022, HSS has three priorities: infrastructure, ERP, and digital.
As infrastructure spendings reduced during COVID, Nelson's top priority is avoiding technical debt. There is a need to upgrade their wireless environment, add a new network core, and do a PC refresh cycle.
As ERP was less prioritized in 2020, they have recently sent out an RFP to decide how to progress.
HSS is working towards a single platform for their digital front door that patients and consumers can access their digital assets through.
According to Nelson, as of February, HSS implemented an FDA-approved digital pathology. Similar to a scanner, histology slides are scanned and digitized. The system is tied together in their EMR through Epic. HSS is the first in the country to attempt this. It will allow their radiologists, pathologists, surgeons, and rheumatologists to collaborate with one digital image without being in the same room.
In RPA, HSS is moving forward with several projects; however, the structure project is first needed to make way for IT automation provisioning.
Starting with AWS for their cloud a few years ago, most of their vendors are cloud, according to Nelson. Their ERP is through Epic remote hosting, and their renewed software is nearly 100% cloud.
"We love that because it's less of a load on our technical staff. It's more flexible. All the reasons you want to go cloud, but we needed cloud for our own purposes," she said.
They are now working to layer MyChart as digital and cloud-based.
"I know we all talk about multi-cloud, but with the size that we are, I think it's better to pick one. We're trying to keep everybody in the AWS world," she explained.
According to Nelson, the role of reimbursement in new technologies is influenced by the pandemic.
"When I think about telehealth, we are still riding on the COVID reimbursement wave," she said.
She believes that regulatory practices and reimbursement should adjust to these new technologies and models of patient care. For this to happen, health systems must make the case for telehealth. According to Nelson, there is a need for more longitudinal data on the clinical efficacy of telehealth.
The government is currently considering this, according to Nelson, to determine if telehealth services are being overused. However, she believes in expanding the services to patients who need them.