Amid the chaos of the past pandemic year, there have been many valuable lessons for CIOs and health IT leaders willing to learn them. Many were discovered while managing unusual sets of circumstances, or from the plain and simple need to shift strategies on a dime.

This is the latest in Healthcare IT News' series of feature stories on lessons learned during the COVID-19 era. (You can read the others here and here.)

Here, four C-suite executives and an innovation vice president share lessons they've learned on such strategic imperatives as organizational evolution, good governance, virtual care, system localization, cloud infrastructure and underserved communities – and describe how they plan to put them into practice in the year ahead.

These executives include:

• Dr. Sameer Badlani, chief digital officer and executive vice president for technology services at M Health Fairview in Minneapolis, Minnesota.
• Randy Gaboriault, senior vice president and chief digital and information officer at ChristianaCare in Wilmington, Delaware.
• Zachary Hughes, vice president of innovation and technology at Aspire Health Partners in Orlando, Florida.
• Dr. Dhrumil Shah, chief medical information officer and a family physician at Compass Medical in East Bridgewater, Massachusetts.
• Dr. Irshad Siddiqui, executive vice president and chief of IT and innovation at Blessing Health System in Quincy, Illinois.

'Super-scaling' telemedicine

ChristianaCare's Gaboriault has been looking at healthcare lately in three distinct periods: before COVID-19, during COVID-19 and after COVID-19.

"We had this world we lived in before COVID, and it was filled with our existing strategy," he said. "Governance, the operating model, all the things we did normally. And what happened? March 11, 2020, became this sort of destabilization point for healthcare, when the WHO declared the pandemic. And that happened to be the same day we had our first patient diagnosed. This was an obvious pivot point."

ChristianaCare had to "super-scale" telemedicine, he said – it had to position the non-clinical and even some of the clinical workforce at home. The organization's forecasts from the "before COVID" era never included such hyper-scaling.

"What we had was this sort of singularity of prioritization," he said. "It was an adaptation to this crazy scenario that we've never faced. It really infused a tremendous amount of adrenaline into the operating fabric of the organization. The entire organization, every function, was focused on one problem. So we went from 'before COVID' into this 'during COVID' world. We're making these pivots in the hyper-scaling, and we began to get this opportunity to reflect."

The organization begins to contend with what will define the regular constraints of operation and the transformation that still has to take place in healthcare – there is a deep recognition that "after COVID" is not going to be the same as "before COVID," Gaboriault observed.

"So as we entered that 'after COVID' reflection period, we effectively took our strategy as an organization and held it over a shredder – we basically had to start over and prepare for an organization that was not about going back to 'before COVID' but one that could live in what this new world looks like," he said.

"It was an adaptation to this crazy scenario that we've never faced. It really infused a tremendous amount of adrenaline into the operating fabric of the organization."

Randy Gaboriault, ChristianaCare

ChristianaCare now has crafted a five-year strategy that's based on what it sees as the fundamentals of a "during COVID" world that staff experienced. Gaboriault sat in on meetings where leadership and staff reflected on the "during COVID" era and lessons learned and positive takeaways, and a member of his team said, "We were able to accomplish so much, so fast, as an organization, and we've got to continue that."

"And I had this realization that an organization can't operate with that level of adrenaline," he said. "It's actually much more complex and nuanced in terms of the problem set that we have to think through, the change of the business, the transformation of where and how care is delivered. So there's this profound lesson of constructing something new based on the learnings of 'during COVID' and the realization that you still have to solve many of the same problems."

So ChristianaCare built the five-year strategy based on the foundation of virtual access, engagement, experience, population-based care and growth.

"But they are rooted in what we've defined as our thesis for everything around this, which is that all care that can be digital will be digital, and all care that can be in the home will be in the home, and that flat out drives exactly where we are, what we learn and where we're going," he said.

Adapting and evolving

Shah of Compass Medical observed that the provider organization underestimated its ability to endure change, adapt innovation and provide care beyond its baseline care delivery infrastructure.

"The past year was all about keeping up with changing science, societal dynamics, economic turmoil and evolving reimbursement models in healthcare, all while facing the threat of an ongoing pandemic," he said. 

"I am frankly surprised with our ability in healthcare to adapt and evolve rapidly upon such demands. Previously it took us two years to evaluate, select and implement enterprise-wide solutions like an EHR; and now, within the past year, we evaluated, selected and implemented five different health IT solutions across our organization, including telehealth, care management and remote patient monitoring solutions."

"Previously it took us two years to evaluate, select and implement enterprise-wide solutions like an EHR; and now, within the past year, we evaluated, selected and implemented five different health IT solutions."

Dr. Dhrumil Shah, Compass Medical

An EHR was considered one of the biggest investments a healthcare organization could make five to 10 years ago, but when it comes to return on investment, Shah is not sure an EHR is the best example.

"Perhaps it is one of the solutions and a necessary one, but we need much more mindful change and innovation at our fingertips for us to create value and truly improve healthcare," he said.

Based on these lessons learned this past year, Compass Medical has implemented a new pillar of governance it refers to as the New Initiatives Workgroup – a multidisciplinary committee under the leadership of the CEO where staff processes new ideas and opportunities targeted to address some of the challenges brought forward by a variety of stakeholders.

"This is where we challenge our own biases and assumptions to make better collective choices, to facilitate better teamwork and process many organizational change recommendations," he added.

Analyzing and prioritizing

Another key lesson learned during this past year at Compass Medical has to do with how one needs to focus and analyze a problem before designing any solution or chasing any prioritization list, Shah revealed.

"This pandemic has grounded us all personally and professionally, and coming out of a year full of chaos and uncertainty, we have learned in healthcare IT that, yes, less is truly more," he said. 

"Our workforce, budget and resources at hand all shrunk while projects and priorities multiplied. This not only brought us together as a team and made us more efficient but also more appreciative of each other including our business and clinical users. The biggest lesson we learned is that we got better at giving each other the benefit of the doubt."

When it comes to applying this lesson, Shah said it is difficult to put it into a plan, but he hopes to continue to build on this reorganized, re-energized and re-engineered workforce to meet organizational goals and create more collective success through all staff being grounded on key guiding principles.

"We know the future demands a more complex IT environment to support enhanced usability for end users and more data-driven choices at all levels of stakeholder engagement," he said. "We look forward to continue investing in the workforce of tomorrow and applying solutions to key challenges we can facilitate today."

Making decisions about governance

Siddiqui of Blessing Health System noted that the organization learned lessons during the past year in the areas of governance and decision-making.

"Looking back to our pre-COVID days, even though we functioned as a hierarchy, our decision-making process was becoming flat over time," he said. "Decisions were driven by too many stakeholders, which would lead us to a good shared outcome; however, it would take us a lot of time to get there. The unusual setting of COVID spurred a participatory hierarchy and governance that was quick and decisive."

That helped Blessing Health move projects very quickly.

"The unusual setting of COVID spurred a participatory hierarchy and governance that was quick and decisive."

Dr. Irshad Siddiqui, Blessing Health System

"More important, we had physicians involved from the beginning on every significant decision," Siddiqui noted. "Our command center team included lead physicians from every area of the business. COVID-related projects had a level of urgency to them. As we transition to a new normal, we should replicate this decision-making pattern for at least our high-priority projects."

The IT services delivery team and hospital project management office are collaborating to feed an enterprise project management office.

"This transformation, spurred by COVID, organizes our project intake workflow, eliminating redundant project intake channels," he explained. "It also aligns IT services delivery very closely with facilities, revenue cycle, hospital operations, medical group operations and strategic planning. In the future, the enterprise PMO will be designed to provide a clearer picture of resource allocation from all areas, including IT."

Blessing Health also has embraced a program/portfolio management approach. Organizing projects based on specialties, for example, virtual care now is a separate program/portfolio within the PMO with its own program manager.

"We have decided to begin classifying specific projects as 'imperatives,'" he said. "This designation means that a particular project has a COVID-type urgency. Decisions for these projects will be made faster, following the shortest path of approval. Where possible, we are trying to eliminate flat governance patterns and ensuring there is a participatory hierarchy that includes physician and clinical leadership."

Virtualizing care delivery

While telehealth and digital health capabilities have existed for a long time, the pandemic required M Health Fairview to adopt this change virtually overnight, Badlani said.

"We successfully leveraged not just virtual visits but pre-diagnosis, asynchronous care and post-diagnosis, app-based care," he explained. "Before COVID, there was a level of mistrust and a low rate of acceptability for virtual care in both the provider and payer communities. But the quick uptake by patients and providers has clearly shown the value such assets bring to the healthcare delivery ecosystem."

Today, the organization's healthcare providers are seeing patients through video visits, phone visits and e-visits at an unprecedented scale. In January 2020, it conducted 3,500 virtual care visits. By April, that number had grown to 120,000 visits. In an eight-month span beginning in March, the health system logged more than 1 million virtual care encounters with patients. For several months last year, virtual care accounted for as much as 80% of the organization's total outpatient visits.

"In an August survey of more than 1,300 of our patients, 80% of people who responded said they were likely to use phone visits as part of their healthcare journey going forward, and 68% said the same for video visits."

Dr. Sameer Badlani, M Health Fairview

"In an August survey of more than 1,300 of our patients, 80% of people who responded said they were likely to use phone visits as part of their healthcare journey going forward, and 68% said the same for video visits," Badlani said.

"Reactions were similar for older patients surveyed. Two-thirds of people ages 65-74 considered themselves likely to use a video visit. Overall, only 16% of respondents were concerned about their ability to use virtual care technology."

The sudden and dramatic demand for virtual care sparked by the arrival of COVID-19 is not a one-time effect of the pandemic, Badlani insisted.

"It represents a long-term shift that will make healthcare more accessible," he said. "We set records for telehealth, conducting more visits in one month than in the entire previous year. We cannot lose the momentum that allowed us to make these tremendous advances in such a short time."

While M Health Fairview always is on the journey of digital transformation, it now is moving much faster, Badlani added.

"Redefining the concept of appropriate access, clinical care must be more outcome- and consumer-centric," he said. "We are breaking through barriers to address a longstanding gap in how our services match customer expectations. We recognize that there are inequities in healthcare access and outcomes. There are also opportunities in digital health to address and improve these challenges. This will continue to be a major focus.

"There's an adage that health systems are at their best in moments of crisis," he continued. "We come together, make difficult decisions and unify to deliver care on behalf of our patients and our community. This kind of momentum is what will propel us forward, toward our vision for a healthcare system that is more affordable and accessible, and better serves our community as a whole."

Localizing and standardizing

On another front, the unusual setting of COVID-19 exposed many complexities and non-standard workflows that prevented Blessing Health System from implementing much-needed changes effectively. That leads Siddiqui to another lesson learned: the need for localization and standardization within systems.

"COVID-19 spurred everyone in the healthcare industry to accelerate their digital strategy, including virtual health," he said. "We needed to execute our 1-2 year plan in days to weeks. Non-standard workflows and customizations to our electronic health record and the practice management software prevented us from executing our digital strategy smoothly."

For example, Blessing Health found it does not have standard patient appointment types.

"This made the deployment of online scheduling and a mobile check-in process complicated," he noted. "These processes were essential to get our patients back into our offices. These workflows were put in several years ago and served a purpose at that time. To borrow a quote: 'Today's problems were yesterday's solutions, and today's solutions will be tomorrow's problems.'"

The organization also had to pivot very quickly to a work-from-home model. The human resources systems and policies and procedures had to be flexed tremendously to accommodate for that.

Things like time cards, remote access and VPN access had to be simplified and scaled to accommodate a remote workforce. As the organization took a step back and looked at its IT build in several situations, it wished it had not customized.

"We have to ensure that the lessons learned during the past year lead us to hardwire and embed successes and improve our flaws," Siddiqui stated. "We now clearly understand that too much customization, non-standard workflows create complexity that can hold us back during a crisis. We have started initiatives to address this."

First, Blessing Health is going back to the basics of IT service management best practices that ensure that it has an excellent knowledge base, a mature configuration management system and proper documentation of all changes to systems, Siddiqui said.

"We hope to address business relationship management, partner with the business on best practices, and standardize and simplify our workflows through this IT service management framework," he explained. "We are focusing on application rationalization that can help us reduce our technology stack and remove complexity."

Blessing Health also is starting a localization and optimization project where it approaches every functional area of the health system locally and intentionally to remove unnecessary and redundant customizations to the system, getting to a simpler, standardized and scalable platform.

Capitalizing on cloud infrastructure

At M Health Fairview, one of the focus areas in 2019 was simplification and stability of its infrastructure. It had started multiple projects including some early work on cloud-based transformation.

"When the COVID pandemic struck, and we needed to pivot to remote work instantaneously, many of these projects were instrumental in our success and agility," Badlani said. "This highlighted the value in moving faster on cloud transformation. Since then, we have increased our focus on transitioning various capabilities and are looking forward to becoming cloud proficient as part of our larger digital transformation roadmap."

The biggest learning that came through experiencing the challenges and success in remote work was that the future of work is here and now, he added.

"Reducing our dependence on office space and being able to work from anywhere were plans we had for the next five years, but we already have made a successful transition," Badlani noted. "However, we have much to learn when it comes to defining and influencing culture in this new hybrid model."

Deconstructing nebulous and incorrect presumptions on productivity metrics is one area being looked at with fresh eyes and a digital mindset, he added.

Serving the underserved

Another lesson of the past 12 months for Gaboriault of ChristianaCare involved the underserved communities that the health system covers.

"A really clear lesson is the underserved communities we serve, and this deep realization that as we went to these communities with virtual care, they were not virtually enabled, and for numerous reasons," he observed. "And as you stratify these communities of underserved people, you start to think about, you know, the grandparents that may not have access to technology, they're not technologically informed."

ChristianaCare realized it had an acute set of problems it had to solve in a very different way, he added.

"Part of what we did was win a grant from the Federal Communications Commission for about $715,000," he said. "With that grant, we are creating a technology layer in that community where we're actually bringing the devices, the Internet of Medicine type things like iOS devices, where we can, for example, monitor the disease burdens for people with diabetes."

The organization also is empowering people in these underserved communities with handheld devices like the iPhone with enabled cellular service, underwritten and paid for by ChristianaCare via the FCC grant in order to connect these populations.

Taking care of the team

For Hughes of Aspire Health Partners, the most important lesson learned in 2020 was that one has to take care of their team.

"Self-care and mental health have always been important, especially as a behavioral healthcare company," he said. "We've always encouraged our team to take time off and to know their limits. However, 2020 was unprecedented. Shifting rapidly from the office to a work from home/telemedicine environment represented the greatest technological initiative Aspire has ever undertaken."

"Shifting rapidly from the office to a work from home/telemedicine environment represented the greatest technological initiative Aspire has ever undertaken."

Zachary Hughes, Aspire Health Partners

The team worked long hours implementing, troubleshooting and providing remote support. As the days turned into months, and isolation became more extreme, Hughes started checking in with his team for signs of burnout, encouraging time off and time away, and offered a voluntary, daily, virtual hangout after hours to help with the social distance.

"This mirrored our broader company initiatives, focused on health and self-care, and today continue to be a top priority for our IT team as well as for the entire company," he concluded.

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