The pandemic has created an atmosphere in healthcare unlike anything seen before in modern times. It has set the stage for CIOs and other health IT executives to rethink their approach to accomplishing new tasks.

This is the sixth instalment in Healthcare IT News' feature story series, "Health IT Lessons Learned During the COVID-19 Era." (Click here to visit the portal with all the feature stories.) 

This time around we feature the expertise of the following five leaders:

• David Chou, senior vice president and CIO at Harris Health System, based in Houston. (@dchou1107)
• Joe Fisne, vice president and associate CIO at Geisinger, a health system based in Danville, Pennsylvania. (@GeisingerHealth)
• W. Glenn Hilburn, RN, vice president for information technology at Grady Health System, based in Atlanta. (@GradyHealth)
• Zachary Hughes, vice president of innovation and technology at Aspire Health Partners, a behavioral healthcare provider based in Orlando, Florida. (@ZacharyHughes)
• Steve Phillips, director of information technology at Greene County General Hospital in Linton, Indiana. (@GC_GH)

Among the many insights they've gained over the past year-plus, they discuss the need to secure a place for telemedicine and expand its capabilities, deploy and scale new technologies faster, and embrace Agile processes and collaborative IT.

The new importance of telemedicine

Even at a healthcare institution as prominent as Geisinger, the explosion of telemedicine since early 2020 has offered many lessons, especially that telemedicine now has a bigger role to play moving forward.

"Prior to the pandemic, telehealth wasn't really taking off all that much; it was kind of a very long, slow growth without a high level of adoption," said Fisne of Geisinger. "But when we were able to move our technology to the point of advancing home health initiatives, we've actually seen it take off. In fact, growth has been exponential, and it has been very positive in terms of making the patient experience even better."

"We're actually communicating better and our staff is actually more productive."

Joe Fisne, Geisinger

Fisne offers a personal example. He had several surgeries for carpal tunnel syndrome. The surgeon asked if he wanted to handle check-up appointments via telemedicine, and Fisne took the plunge.

"We went ahead. We did it, and it has saved me so much time, because I was able to just get online to get with my physician," he said. "He took a look at my hand to see how well the progression was going. He could see my movements and everything, and at that point he was able to say, 'Okay, you're good. We'll see you in a little bit and we'll go from there.'"

Patients have gotten on board

"We have found that a lot of our patients have really enjoyed the opportunity to do telehealth, they've really gotten on board," he continued. "So what we're doing now is looking to broaden telehealth even more, to, for example, get into the behavioral health area and make sure we can adopt that. So we've found that with the combination of our electronic health record and telehealth, we've been able to pull this thing together in a very nice way."

Fisne also said that patient satisfaction is up with the rise of telehealth. He compares the conventional in-person appointment, which requires patients to check in and then wait for some time, to telehealth.

"It's not a hundred percent, but you get in quicker, and there's a greater patient satisfaction. We've changed the culture and patients are more accepting of it, in part because it was necessary to do so," he noted. "But at the same time, the adoption has gotten much better, and I think we're only going to go that much farther because of what it's done in the past year.

"It has opened up a new line of business for us," he continued. "We're here for the patient, and we meet them where they are. And we have a minimal impact on their life, but yet give them that greater confidence in the care."

Growing telehealth capabilities

Like Fisne at Geisinger, Hilburn of Grady Health System has had his hands full with telemedicine during the past year or so. Hilburn said one lesson that Grady has learned is that its telehealth capabilities required significant expansion in order to rise to meet the public health need.

"Our organization has utilized telehealth in fundamental ways for some years now, but we quickly realized that we were not equipped to provide the advanced level of service that was warranted," he said. 

"We quickly learned together that this methodology of tight feedback cycles and continuous improvement was the secret sauce needed for rapid development and deployment."

W. Glenn Hilburn, RN, Grady Health System

"The year presented us with a compelling need to rapidly expand our ability to provide care to our patients in new and unique ways. This involved the use of both synchronous and asynchronous telehealth services in order to assess and treat our patients in a remote setting."

The services deployed included video visits in specialty and primary care, remote monitoring of patients with chronic conditions that required medical oversight, and extending the reach of Grady Health's Mobile Integrated Health program with the addition of mobile telehealth kits.

These kits allowed paramedics to deploy peripherals like stethoscopes, otoscopes, ophthalmoscopes and dermatoscopes in the patient's home so that they could be assessed there, as a Grady Health provider was located back in the office.

Improvement in efficiency and effectiveness

"Grady plans to expand upon this technology by offering other telehealth services that we not only provide across our organization, but also leverage them strategically for offering specialty services to patients outside of the immediate community," Hilburn noted. "These tools have supported improvement in efficiency and effectiveness in the provision of patient care."

While the utility of this technology was strong, it also met with challenges that Grady Health continues to address. Some of these challenges presented in the form of patients and providers that required an investment of time for both education and workflow optimization. 

Support teams developed collateral and programs to target the identified knowledge gaps and ensure that clinical staff and patients were equipped for a meaningful patient care experience.

"Additionally, as a safety net facility, we are continually focused on assessing social determinants of health as it relates to our patients and ensuring that we identify and address gaps that require attention," Hilburn said. 

"One such gap noted over the past year with some of our patient population was the lack of resources to secure broadband services. While this gap is not easily overcome, Grady Health pursued and was selected as a participant in the FCC Connected Care Pilot Program for addressing such challenges."

Rapidly standing up a call center

Aspire Health Partners had partnered with United Way in Orlando, Florida, to be its behavioral healthcare provider organization. United Way was getting many calls, and it needed a partner in the community to shift mental health-related calls to. These included calls oriented around COVID-19 and resulting mental health issues.

"And so very rapidly, we had to stand up a call center to be able to handle calls coming in from the community," said Hughes of Aspire Health Partners. "We had recognized as part of our strategic planning that we needed to meet these needs for the community, and that just got fast-tracked because of COVID-19 and the volume of calls.

"Over the course of five hours on a Friday afternoon, staff sat in a conference room and reworked our entire phone tree, and then stood up call center software and had it launched and ready to go by Sunday," he added. 

"The overall lesson of this past year, I told the team, when you have no choice but to be successful, you are successful. And so we are able to move much more quickly when we have the unpredictability of what happened last year."

There's the pressure to get things done as fast as possible. Staff did not have any excuses, he said, so they did not let themselves delay further than they had to.

"Some of the things that were on our strategic plan expansion, like telehealth and the call center chief among them, happened as a result of COVID-19 quicker. We crossed them off the strategic plan, because they got accomplished in like two months instead of going into 2022 or 2023," he said.

"But what we realized right now is that people were really energized by getting things done quickly. In the moment, you know, we were very hyper-focused on getting these projects off the ground. And when we go back and talk to those groups of people who were part of those projects, they were really energized. They were excited, because they knew that they were getting things done quickly."

Collaborative IT

Back at Geisinger, Fisne said another lesson they learned was how key collaborative IT tools can be, and how they easily could be used post-pandemic.

"It's the movement to things like Microsoft Teams and teleconferencing in a collaborative approach, whereas before we would have to travel back and forth between each of our sites and have meetings, and get folks in the room and everything," he said. 

"Now [in] the transitions taking place, where we're able to get on and be very productive to the standpoint of having quick meetings, coordination is a very easy job."

He said staff is able to communicate in a better fashion using these tools, and that there are good group dynamics.

"We're actually communicating better, and our staff is actually more productive," Fisne observed. "One of the lessons we have to be very careful of is that staff work very hard through the day. And there comes a point where [we say] 'Okay, Wendy, you need to take a break.' When do you make sure that you continue your work-life balance? But this has been a good thing for folks."

He added that there could be the financial benefit from determining whether they need some of the buildings in the future, or can they continue working from home. He said that it's up to the employer to make sure that employees are comfortable and getting their needs met, because people don't have face-to-face contact.

Fisne said that while some employees will have to return to the campus, others will continue to work from home, because the experience has been so positive.

"The productivity gains have been great," he said. "You don't have to walk to get to another facility. You can be right there. It's basically like changing the channel, and you go to another meeting. Sometimes you can get oversaturated with meetings, but by the same token, if you manage it accordingly, and give yourself that amount of time you need, and you keep an eye on things, it really is beneficial."

The importance of an Agile, iterative approach

Another lesson Grady Health staff learned over the past year was how to deal with and ultimately succeed in uncertain and turbulent times.

"While Grady IT has utilized an Agile methodology in some capacity for a number of years, this past year allowed us to truly understand just how impactful an iterative approach can be in delivering real value to our organization," Hilburn said. 

"The opportunities presented to our teams in supporting patient care required that we organize our work in a series of sprints that were supported through real-time communication of team capacity and full transparency of work," he said.

As technology support teams pivoted to a remote working environment, the need for daily stand-up huddles moved from a good practice to an imperative, he added.

"These short, frequent connections between resource teams yielded the ability for our teams to deliver innovative, timely solutions in time frames that were unheard of prior to that time," he noted. "We quickly learned together that this methodology of tight feedback cycles and continuous improvement was the secret sauce needed for rapid development and deployment."

As a result of this learning experience, Grady Health has adopted daily stand-up huddles across all of its application development teams.

"These meetings last no more than 15 minutes and are facilitated by frontline staff with no leader presence," Hilburn explained. "Their purpose is simply to briefly connect on what the resources accomplished since the prior day's meeting, the day's planned work, and to identify any barriers that require leadership assistance in order to overcome."

The staff is making the investment in resources, learning more about the methodology, and already have recognized their first certified SCRUM master to support the teams through their development and continued adoption of the methodology, he added.

The power of a network

Internal networking and collaboration are crucial, and must be the DNA of an organization. That's a lesson learned by Chou of Harris Health System.

"Leadership emphasized a culture that includes a relentless focus on teamwork and coming together as either a department or a health system fighting the pandemic," he explained. "The inspiration of the teams working diligently with speed was terrific. Examples include setting up a vaccination clinic at a new location in a matter of days to vaccinate our patient population."

"I relied extensively on external networks, such as the executive leaders from health systems around the country, to brainstorm and share ideas."

David Chou, Harris Health System

This was only possible by internal networks banding together, he added. The takeaway is that every organization should implement all projects with the same approach in a non-crisis mode, he said.

"I relied extensively on external networks, such as the executive leaders from health systems around the country, to brainstorm and share ideas," Chou noted. "Before joining Harris Health, I held regular touchpoint calls in March 2020 with CIOs as we shared best practices and challenges that we faced. The external network was instrumental in validating our ideas and plans for execution after I joined Harris in May 2020. And the external collaboration continues to this day."

Creating the in-person experience virtually

Another lesson Chou points to is the difficulty creating the in-person experience in a virtual way, and he is not referring to telemedicine.

"I am referring to the workforce that is working remotely and helping employees fight video conferencing burnout in addition to staff engagement," he said. "Studies have shown that, while employees enjoy the work/life balance of working remotely, there is an impact on engagement where they may miss out on the informal watercooler chats to brainstorm and share ideas."

Chou is focused on communication and promoting informal virtual watercooler chats by holding an online open office hour every Tuesday and a virtual town hall with the department every two weeks. These are in addition to his weekly leadership team meeting.

"I also encourage leaders to embrace collaboration solutions such as Microsoft Teams, WebEx, Facebook at Work or other tools to replicate a social department or organization," he advised. "The key to success is delivering engaging content that can potentially create impromptu conversations."

Hardware availability

Phillips of Greene County General Hospital has always taken the availability of computer hardware for granted – but not after the past 12 months.

"We experienced a shortage of available laptops, IP phones and telecommuting hardware," he recalled. "It was mind-blowing, because resources that were readily available had been utilized quickly. We had to quickly adapt to several employees telecommuting. This led to searching for alternate paths to obtain enough equipment to allow for the mass movement of people working remotely."

"IT is an ever-evolving field. So being open-minded and flexible helps you to be prepared."

Steve Phillips, Greene County General Hospital

As the supply chain dwindled, alternate solutions were used, such as refurbished equipment, other vendors and less than desirable system specs, he added.

"As a result, the IT department plans on keeping all avenues open, being prepared to be flexible, and not being so complacent," he said. "Just because things have not changed in a while does not mean that they will always remain the same."

Also, as a response to the shortage of hardware, Greene County General increased its on-hand supply of laptops, tablets, phones and other items.

"In addition, we experienced a shortage of telehealth hardware," Phillips said. "As a response to COVID-19 precautions, our community turned to telehealth via two-way video-conferencing as a solution. To accommodate, we had to quickly find and order digital exam and diagnostic equipment, additional laptops, and software packages, and increase our HIPAA-compliant encryption system capacity. Our department also had to train additional providers to use the digital exam technology."

Another lesson Phillips learned was that hackers use distractions, such as a global pandemic, in their favor.

"I was surprised to find that even with everything going on in 2020, their efforts did not subside," he observed. "Instead, malicious activity increased. We experienced an increase in phishing emails and outsiders looking to steal our credentials. As a response, we implemented an intrusion-detection system and incorporated multifactor authentication for email accounts."

Phillips said he learned to expect the unexpected and prepare for the unknown. "IT is an ever-evolving field," he concluded. "So being open-minded and flexible helps you to be prepared."

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