Like most other hospitals and health systems nationwide, Charlotte, North Carolina-based Atrium Health has had to make some pretty big changes to the way it does business over the past few months of this ongoing pandemic.

Even as it pursues big pre-COVID-19 strategic goals – not least its major electronic health record transition from Cerner to Epic, which was announced in February – Atrium's attention has of course more recently been focused on an array of initiatives meant to combat the coronavirus crisis.

But having been hyper-focused on the public health emergency since March, Atrium has begun to expand its offering. It recently announced a pivot toward a larger strategy of "COVID-Safe" care across its 40 hospitals and 900-plus outpatient clinics.

Starting this week, the health system will expand the scope of the care services it delivers, guided by CDC recommendation for extensive safety precautions.

By requiring that all patients be tested before any scheduled procedures – using its own in-house testing capabilities – Atrium will be able to set up dedicated facilities and clinical teams to offer treatment for non-COVID patients in safe environments, according to health system officials.

It will also make wider use of what it's calling the COVID-19 Virtual Hospital – enabling positive patients to receive care for other conditions from home via telemedicine.

"We’re pleased that the stay-at-home policies have been successful in diminishing the impact of COVID-19 locally," said Dr. Scott Rissmiller, Chief Physician Executive at Atrium Health, in a statement announcing the expansion. And Eugene A. Woods, Atrium's president and CEO, said he hoped the safe expansion of services would help "lead the way towards better days ahead."

Building from experience

Even as it takes these incremental steps toward opening up, Atrium Health is also digesting some lessons learned over the past few months, Chief Strategy Officer Dr. Rasu Shrestha told Healthcare IT News.

The health system was well positioned from the beginning to do battle with coronavirus, he said. But thanks to its hard-earned experience, it should be in an even better place going forward.

"During a crisis like COVID-19, it is less about what you're immediately able to do – although that's important – and more about what have you done, leading up to that to that crisis, that really positioned you to really come together as an organization, or even a community, to rise to the occasion," said Shrestha.

"There are many things we've done over the past year," he said, "to get to the point where we're able to be as nimble and agile as we are right now."

Having a culture that encourages different ways of thinking, even as various stakeholders with different expertise from across the enterprise work as "teams of teams," is key. So is having a "service-first culture" that prizes innovation and nimble approaches to fast-moving challenges.

"We will forever have changed as a result of COVID-19. And I'm not just speaking about Atrium Health, I'm talking about the industry as a whole."

Dr. Rasu Shrestha, Atrium Health

Case in point: Atrium had embraced telehealth and virtual care for many years now. But its established bona fides in that area offered an opportunity to more easily amp up its readiness and capacity – to a scale commensurate with "the surge we knew would be coming" – as the coronavirus crisis first came into view, he said.

"We saw a tremendous bump up – several orders of magnitude – in virtual health."

Beyond virtual visits, there were other tweaks to patient-facing tools, such as the fact Atrium was quickly "able to turn on an AI-powered chatbot to help triage inbound queries coming in to our website."

As the magnitude of the COVID-19 emergency became apparent, Atrium started marshalling its resources: "IT elements, virtual health elements, and then even things were able to quickly put together from a community perspective."

The COVID-19 Virtual Hospital at home, set up in a matter of days, "was remarkable," he said "We didn't need to bring in patients that didn't need to be admitted. We gave them a package, consisting of pulse ox, a BP monitor and a thermometer, and we were able to essentially monitor them at their homes."

A "tipping point" for telemedicine

Already, Shrestha is looking at ways tools and strategies such as these can be built upon in the future, serving as the basis for further care innovations.

"I've spoken to my team about this," he said. "We will forever have changed as a result of COVID-19. And I'm not just speaking about Atrium Health, I'm talking about the industry as a whole. And that's good.

"I think we need to come out of this different," he explained. "A lot of people say they can't wait for things to return to how they were. But I don't think it'll return to how things were, nor should it. But there's a silver lining in this."

Most obviously, that appears as the sudden proliferation of telehealth, which has for years been stymied by regulatory and reimbursement hurdles, and often viewed with skepticism by both patients and clinicians, despite the best efforts of many true believers.

"We've been working on it for such a long time now," he said. "I think finally there's been a realization that it is important to push telemedicine forward. I call it the overnight success story that was 30 years in the making, whether it's funding that's now come to bear, or it's payment parity, where payers and the federal government and others have risen to the occasion."

Consumers are becoming more comfortable with the concept of video visits – a familiarity encouraged, no doubt, by myriad Zoom and House Party chats with friends this spring. And many physicians are now realizing that they're able to be "a lot more efficient," said Shrestha.

The pivotal moment to prove the ease and efficacy of remote monitoring and connected health could finally be here.

"Think about it: When the last pandemic hit the United States and globally, no patient, no consumer, no clinician had smartphones in their pocket," said Shrestha. "It's a different environment right now where we're connected online. Telemedicine actually makes a lot of sense in ways that we've not fathomed before. There's definitely been a tipping point."

Homing in on healthcare inequities

But at a more basic level, COVID-19 has exposed the many failings of the U.S. healthcare system, particularly with regard to how underserved and minority populations have borne the brunt of the pandemic.

The coronavirus crisis has put a harsh light on healthcare inequities – and made it clear how important it is to tackle social determinants of health.

"As we've seen, unfortunately, a lot of the folks who are suffering most acutely from this are people who are underserved or have chronic conditions, or people who just don't have the health resources that others do," said Shrestha.

It is his sincere belief, he said, that the public health emergency will help focus some needed attention on these disparities and reshape how they're addressed.

"Without a doubt in my mind, it absolutely will," he said. "And it already has."

Just this week, for example, it was reported that Atrium plans to boost the availability of mobile COVID-19 testing in Mecklenburg County's black and Latino communities.

"We're really good at doing a lot of things around food security, around social housing, but also specifically in terms of target mobile testing sites we've set up for the underserved populations – targeted initiatives, in terms of how we're trying to address the gaps that exist across the communities we serve," said Shrestha.

The coronavirus crisis has exposed the health impacts of another social determinant factor that's less often discussed: loneliness.

There was already a loneliness epidemic in the United States, and this new era of social distancing and sheltering in place has only made it worse.

"It's important for us to understand that," he said. "Our patients are lonely. They're dying alone in the ICUs. Our clinicians are afraid to go back home because they don't want to expose their loved ones. That element of loneliness has just been exacerbated, and we should be doing something to manage it."

More broadly, especially going forward from this initial stage of the crisis, "We're not just standing back and commenting on or observing. We're actively being part of the solution here at Atrium Health," said Shrestha. "We're a community-based health system that's focused on serving the needs of our communities."

For more detail about how Atrium is integrating SDOH data into its EHR workflows, see this recent Healthcare IT News case study.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com
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