Structural and nontechnical barriers to innovation are a big reasons why technical innovation is so challenging. The need to integrate telemedicine quickly and an opportunity for a better patient care model caused a digital transformation road map to accelerate. The COVID-19 crisis put laser focus on how clear it is that data and advanced analytics can be powerful weapons in the fight against pandemics.

These are some of the lessons learned by chief information officers during the past year or so as the healthcare industry has been tossed and turned by the COVID-19 pandemic. The CIOs in this tenth installment of our Health IT Lessons Learned in the COVID-19 Era feature series explain these lessons and how they are going to apply them moving forward.

(Click here to access the portal containing all the feature stories in the series.)

The health IT leaders discussing their 2020s and 2021s in this edition include:

• Dr. Bruce Darrow, senior vice president of information technology, deputy CIO and chief medical information officer at Mount Sinai Health System in New York City. (@MountSinaiNYC)
• Ben Patel, executive vice president and CIO at Cone Health, which is based in Greensboro, North Carolina. (@ConeHealth)
• Scott Richert, CIO of Mercy Technology Services at Mercy, a health system based in St. Louis. (@FollowMercy)
• Dan Waltz, vice president and CIO at MidMichigan Health, based in Midland, Michigan. (@MidMichigan)

Structural, nontechnical barriers to innovation

Darrow of the prominent Mount Sinai Health System said that he and his team learned since early 2020 that structural, nontechnical barriers to innovation are a big reason why technical innovation is so challenging.

"Telehealth is a great example," he said. "Prior to 2020, payers didn't want to pay for it, and physicians were largely comfortable with a business model that had patients lined up outside their doors waiting to see them. Both of those barriers fell by the wayside in March 2020, allowing us to focus on more pertinent issues, such as how we could use the technology to make the experience more reliable and easy for our patients and clinicians."

The example of telehealth highlights the importance of advocacy at multiple levels of government to simplify the complex regulations that make it such a challenge to use the technologies that are prevalent in so many other fields of business, he insisted.

Between the mandates of the federal government and the individual states, there is so much ambiguity between the origin of a good idea and the realization of a successful initiative, he added.

"Addressing the technology comfort level of the clinicians about how well they can do their jobs via video is another matter," Darrow observed. "Before 2020, telehealth visits composed a miniscule fraction of our ambulatory care.

"Today we have sustained virtual visits at about 15-20% of total. In many cases, we needed to overcome the barrier of, 'I can only do my job with my patient physically present,' with a tolerant combination of, 'In some cases, virtual care may be an appropriate alternative,' and, 'Perhaps your patients don't want to spend so much time traveling and sitting in your waiting room for the privilege of seeing you.'"

Darrow and his team succeeded, he said, by identifying early adopter physician champions and allowing them to endorse both the technology and the workflows.

Building equity into the system

On another note, Darrow said that Mount Sinai's patients may not all have the same access to the organization's health IT options, and it is the responsibility of the health system to intentionally build equity into the system.

"When we retrospectively assessed how our patients used telehealth in the spring of 2020, we saw variations on the basis of age, race, ethnicity and preferred language," he explained. "While it's an important first step to provide technology options equally to all of our patients, it is not valid to assume that all patients will take advantage of them at the same rate.

"We have worked to build in options for translation services with our telehealth encounters, and as an organization obtained several FCC grants to allow us to provide technology to some of our most vulnerable patients, including patients who are homebound, cancer patients and at-risk pediatric patients," he continued. 

"We've also established a strong partnership with our organization's Institute for Health Equity Research and Office for Diversity and Inclusion to make sure we incorporate their viewpoints into our initiatives, including the impact of social determinants of health on how our patients embrace technology."

The power of focus

For Richert of Mercy, the first lesson he points to is, as he puts it, "the power of focus."

"As the pandemic emerged, there were clear objectives on which to focus, and agreed-upon metrics by which to measure our progress," he recalled. "We've had plenty of successes and accomplishments prior to the pandemic, the focus and agility of the entire leadership structure resulted in faster decisions, and alignment between multiple teams focused on the same outcomes.

"This permeated into our technology response as we developed fast minimally viable products and fast improvement iterations for digital solutions for testing, home care, follow-up and eventually vaccination management," he added.

Today, Mercy has maintained much of the leadership and decision framework that was activated during the pandemic.

"We're still focusing on clinical quality and operational efficiency objectives with similar focus and urgency," he noted. "The challenge is to maintain that operational agility to solve operational problems quickly, but also keep in mind all of the long-term 'change the game' strategies that we know will be necessary for long-term success."

This all can be challenging, he added: balancing the urgency of the short-term operational improvement sprints, while also making sure that the long-term strategies (technical and otherwise) are being served by the operational improvements and that investments in long-term objectives don't take a back seat to the urgent, operational objectives.

"This plays out in governance and resource planning, and has many practical implications in budgeting, architecture and organizational change management," he said.

Moving to connected health and telemedicine

COVID-19 placed tremendous pressures on healthcare provider organizations that did not have enough beds, equipment or personnel to handle infected citizens while still providing emergency and chronic care to other patients. This novel virus also endangered exposed healthcare workers, many of whom became infected.

"We quickly learned that digital care would be the best method to take care of patients and to comply with CDC guidelines," said Patel of Cone Health. "We went into execution mode to install enterprise virtual care platforms along with remote monitoring. The goal is to provide e-visits/video visits and become more situationally aware of patients' symptoms and conditions before they become acute and require hospitalization."

The remote monitoring solutions include widespread use of sensors for data collection like heart rate, oxygenation levels, blood pressure and temperature, he added.

"Our digital transformation road map got accelerated due to this lesson and [created] an opportunity for a better patient care model," Patel said. "A digital blueprint has been developed with key stakeholders. We are now deploying self-service digital tools such as digital front door, medication adherence and a remote patient monitoring platform. This is in addition to our enterprise virtual care platform for virtual visits to patients and consumers."

Recently, Cone Health kicked off an initiative to outline its hospital-at-home care model. This will help the health system take care of patients in their home or preferred care setting.

Telehealth woven into the care model

Over at Mercy, the massive health system has been successfully conducting telemedicine for years.

"During the pandemic, as we looked for options to solve the clinical and operational challenges and extremes of the pandemic, we found our investments and expertise in virtual care to be extremely valuable," said Richert of Mercy. "During the pandemic we learned that virtual care services are most effective when they're completely woven into the fabric of the overall care model – digital, virtual and physical."

Going forward, the IT organization will be enhancing the effectiveness and efficiency of the health system's care model with an extremely high level of virtual care integration.

"We're discovering the ever-growing harmony we can create with an integrated digital/virtual/physical care model," he explained. "Not just sending patients down one channel or the other, but leveraging digital and virtual woven into inpatient, outpatient and care-at-home population models.

"Also, thinking about virtual and digital care beyond the simple concepts of two-way video alternatives to in-person care, which we certainly provide and have increased during the pandemic, but also realizing that building workflow tools that make it easy on the patients and the caregivers to request a virtual service," he continued. 

"Skills-based routing, request queuing, SMS messaging and surveys, and other 'service-management' type capabilities, become very important when you're scaling virtual services and need to make sure they are easy to request and that service fulfillment is managed in a service-management model."

For instance, if an inpatient nursing staff member can easily request episodic virtual assistance for something without breaking out of their workflow, and they can depend on reliable service levels, then that virtual service is going to thrive and add value, he added.

Authenticity, vulnerability and transparency in place

A whole different kind of lesson comes in the form of building trust in a health system and its leaders. This was key to Waltz of MidMichigan Health.

"It would be difficult to build trust after an emergency occurs. In our case, we had the pandemic break out, then the historic Edenville dam flood two months later. So my thinking is that you must have authenticity, vulnerability and transparency in place with your leadership team and staff prior to an emergency," he observed.

"A couple of things we did to help was to encourage virtual daily huddles with Teams, weekly management meetings, and all-staff meetings every other week," he added. "We did this for about a month until the staff and leaders asked us to back off a bit."

In these meetings, Waltz encouraged leaders to use empathy and transparency – looking to help those who were impacted by remote work and those who had damaged homes or relocations because of the flood.

"We encouraged teams to help each other whenever they could," he said. "We allowed staff to work very flexible hours, knowing that schools were going back and forth between on-site, hybrid and remote scheduling. These situations caused lots of stress on the teams. Many times staff [members] would get together in remote locations even without their leader to work on issues or to just be together."

In routine meetings, leaders and staff focused on business priorities and on what had to be done.

"We had open time to allow team members to ask questions and bring up concerns," he explained. "The teams really appreciated how we managed these challenges, and many never worked harder to keep up the great support and project work that had to be done.

"We routinely discussed the mission of healthcare before and after the pandemic and flood," Waltz continued. "We would talk about how working in healthcare is a privilege and having the opportunity to help patients and clinicians during their greatest need helps to keep us all focused. It is truly about the mission."

Waltz created a personal goal to have a virtual lunch with a small group of employees twice a week.

"We have arranged random team members to join me virtually for lunch," he said. "We talk about vacations, kids, books we've read, and then I will end with a few things that are going on at work and ask if they have any questions. This has been great for me as I get to connect with all the team members in my department. I have received positive feedback from the team members and management staff as well."

Data and advanced analytics

The COVID-19 crisis has put a laser focus on how apparent it is that data and advanced analytics can be powerful weapons in the fight against pandemics, said Patel of Cone Health.

"COVID-19 has reinforced the urgency to focus on data strategies and investments to support ongoing containment, mitigation and bio-surveillance activities," he said. "Lesson learned is that data and analytics could have changed the game from detecting the outbreak to responding to critical shortages of tests, resources, beds and supplies, to helping us be more operationally adaptable."

Advanced analytics, artificial intelligence, algorithms, data visualization tools and graph technologies are being applied at Cone Health to understand COVID-19's nature and character.

"Our enterprise data warehouse platform is leveraged to build the pertinent data marts for the advanced predictive models and forecasting solutions," he explained. "AI-based predictive models have been developed to forecast susceptible populations, hospitalizations and PPE needs. Moreover, we incorporated mobility data from Facebook and Google into these predictive models for accuracy."

Patel said they need a regional HIE to effectively manage pandemics like this for data sharing and to improve predictive models.

"Going forward, linking clinical and travel data with personal data collected from social media, such as family history and lifestyle habits, it's possible to create detailed predictive models relative to individual risk profiles and health outcomes," he said. "We need to implement pathogen and disease surveillance – and advanced warning-signal capabilities.

"Our plan is to be agile by making data accessible, liquid and fluid across our health ecosystem," he concluded. "And we must execute an enterprise data architecture that connects interoperability, integration and real-time capabilities."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.