While nursing care requires a human touch, the right technology can enhance it without taking away from the patient experience. Every interaction in the hospital is an opportunity to make a difference in a patient’s experience. As this is the most vulnerable time for many patients, it behooves everyone working in the health care environment to create a culture of caring.

Technology such as barcode medication administration (BCMA) is embedded in the safety culture at UPMC, a $21 billion world-renowned health care provider and insurer headquartered in Pittsburgh, with 40 total hospitals across Pennsylvania, Maryland, and New York. Nurses scan medications before delivering them to patients, which allows the nurse to either continue the administration process or provide a warning in real-time. The BCMA technology is also used in addition to the nurses’ responsibility to adhere to the five traditional rights of medication administration, including the right patient, right drug, right route, right dose, and the right time.

IV interoperability was the new best thing. Sadly, COVID played a considerable part in the challenges to the smooth transition of this technology.

In the past, nurses relied on their training and double-checking tactics by other nurses before delivering certain medications. This process was not always reliable or safe. BCMA allows no shortcuts in verifying patients since the patient’s armband must be scanned before proceeding with the administration. Nurses have reported feeling safer with this technology and do not want to go back to how it used to be. Patients, in turn, have appreciated the additional verification put in place for their safety.

The quest for superior technology is not a one-person job. Often, the informatics nurse is charged with the responsibility of seeking out such technology. However, many facilities have gotten wiser and learned the importance of collaboration across hospital departments. At UPMC, cross-department committees are formed for this very reason. Hospital employees, including representatives from the executive suite, nursing, pharmacy, Biomed, and several support departments, all get involved. They offer input into needed technology to support clinical and non-clinical areas.

Recently, a technology to integrate IV medication to interface with the documentation system kept everyone engaged. The implementation of IV interoperability was an exciting time for our nurses. This technology promised to decrease the amount of documentation needed for IV medications since it allowed bidirectional communication between the electronic medical record and the IV pump. After the nurse verifies medication order details and correctly identifies the patient, it infuses and communicates the volume infused to the patient’s electronic health record. Planning for this technology took months, and nurses were anxious for less documentation. Not surprisingly, nurses were lining up to be superusers; those who were selected for this role were responsible for learning the technology and training their colleagues. The superusers were additional resources to the informatics nurses and vendors.

IV interoperability was the new best thing. Sadly, COVID played a considerable part in the challenges to the smooth transition of this technology. Across the country, many hospitals were ravaged with patients that relied on critical care units to survive the coronavirus, thus placing a strain on resources, including IV pumps. Necessary medications required rapid infusions or multiple medications infusing at once.

According to Rust (2017), common reasons for noncompliance are that the user is in a hurry, does not thoroughly read the instructions on operating the device, doesn’t understand their skill level, and makes inaccurate assumptions. Although the rollout was planned meticulously, the steps required to ensure usage compliance proved to be more of a hindrance than a help to clinical staff. The new technology was frustrating for nurses who already had an intolerance for technology, and many didn’t have time to troubleshoot. Of course, these issues weren’t recognized during the implementation stage of the rollout; with so many people around to assist and answer questions in real-time, nurses felt comfortable at the time. Consequently, superusers and nurse informaticists were deployed to clinical areas to address concerns.

Pharmacy is a great partner in making adjustments based on the clinical employees’ feedback. The clinical data realized from this technology provide improved operational efficiency. Providers appreciate timely and accurate documentation of the infusion to make clinical decisions about the patient resulting in enhanced care and recovery.

The implementation of infusion pump interoperability also has implications on the business aspect of health care. Studies have shown that this technology improves hospital revenue (Suess et al., 2019). The increased revenue is mostly due to the automatic documentation of start and stop time for intravenous medications, resulting in increased claims. Prior to this technology, start and stop times for infusions were not consistently documented. Suess et al. (2019) reported over a $660,000 increase in inpatient hospital areas’ revenue post-implementation of IV pump interoperability.

The challenges to implementing technology in the health care workspace can be overwhelming. However, the benefits far outweigh the drawbacks. The lesson here is that nurses must be engaged in discovering, initiating, and implementing technology while understanding its impact on patient outcomes. Not leveraging technology may create a disadvantage for patients where they miss out on the many rewards, including enhanced quality and safety. Patients benefit from IV interoperability as well. Knowing that this technology offers another safety and quality level through accurate documentation is a win for patients.

Patients don’t choose to be in the hospital, and while they are admitted, they deserve to know that every tool is being used to ensure they receive the highest level of care possible. It suffices to say that all patients deserve the very best and incorporating the right technology with health care providers’ individualized care is paramount to this.

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Central to who we are and how we serve at Ascension is our ability to listen and fully understand what matters most to our patients, care teams, and communities so we may deliver compassionate, personalized care for all.

As technology and consumer expectations evolve, listening for meaningful connections and targeted actions remains paramount. Mobile solutions that collect real-time feedback and platforms to automatically integrate the disparate voice of the customer (VOC) data with improved artificial intelligence and natural language processing all contribute to more effective and efficient listening strategies – helping us better serve our communities.

We must improve how we listen in real-time and learn from feedback for the consumer-facing needs such as choosing a provider, scheduling an appointment, finding a location and/or understanding a bill.

Across our national health system, we operate more than 2,600 sites of care – including 145 hospitals and more than 40 senior living facilities – in 19 states and the District of Columbia. Therefore, improved technology enabled listening strategies, for both large scale insights and targeted, person-specific expectations, allow us to better: 

• deliver an experience that is more seamless, reducing friction and pain points throughout various parts of the consumer journey
• know the person we are serving, as a unique individual, for holistic and personalized care
• serve our communities more inclusively by proactively addressing social determinants of health, language barriers, and other access concerns
• integrate qualitative and quantitative feedback for actionable insights
• identify and scale wins and best practices for faster cycles of improvement
• address gaps and opportunities in both leading and lagging measures
• pivot and remain flexible in addressing what is working and what is not through the eyes of those we serve and
• tailor experiences based on what matters most to those we serve

As we expand technology-enabled listening strategies, including mobile and virtual solutions to intake point of care/point of service feedback, we transition from primarily reactive, lagging measures via post-clinical encounter surveys (like CAHPS) to more proactive and leading indicators.

This broad approach to real-time feedback combined with more traditional outcome measures allows for faster insights and targeted actions. We also know that by only listening for feedback on clinical care, we miss a tremendous amount of key insights to understand how our consumers review and choose our system and providers. We must improve how we listen in real-time and learn from feedback for the consumer-facing needs such as choosing a provider, scheduling an appointment, finding a location and/or understanding a bill. We also must consider matching our listening strategies with evolving ways of delivering care, including virtual, home, senior living, etc. By more comprehensively listening to feedback from across the entire journey, we can better understand, anticipate and exceed expectations. 

While the point of care/point of service feedback is essential, we also stay acutely mindful of the care team and provider workflow in collecting patient and consumer feedback. Addressing the user experience needs for those associates and providers at the point of care/point of service also ensures we contribute to workforce engagement, reduction of non-value-added processes, and streamlined workflow.  

Likewise, our listening strategies and front-end intake platforms are only as good as the insights we derive on the backend to drive targeted action at both a macro and micro level. Gone are the days when the disparate voice of the customer (VOC) feedback, living in various places and spaces is effective, efficient, or meaningful. Manual aggregation and analysis from various survey vendors, platforms, and VOC modalities has historically been an industry-wide barrier to more effectively and efficiently understanding and subsequently using key VOC insights, especially at a large scale. Moving to integrated platforms that aggregate feedback – qualitative and quantitative –  allows us to better understand our consumers and better serve our communities.  

The use of technology with improved Voice of the Customer data analytics allows us to dig more deeply into the patient, family, and consumer sentiment to better tailor experiences that are more seamless, inclusive, and flexible to their needs. We continue on our journey to drive technology-enabled listening strategies that provide meaningful and real-time insights in a way that makes it easier to complete intake, analysis, and understanding of what our patients and consumers are telling us. Through improved artificial intelligence and natural language processing for our qualitative feedback, we can more effectively understand consumer sentiment and overlay that with quantitative data –  highlighting wins to spread while pin-pointing experience gaps and opportunities.

Taking a both/and approach to understanding consumer sentiment broadly and truly understanding our patients’ needs as unique persons requires more sophisticated technology for both intake and analysis of feedback. As we continue to gather feedback from our consumers, using technology with aligned platforms for both the intake and analysis processes of our Voice of the Consumer listening strategies remains critical to more effectively and comprehensively understanding how to best deliver on our promise of compassionate, personalized care for all.

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Over the last several years, it has been increasingly necessary for health care to be more agile in approach to healthcare IT delivery and even responsiveness to operational adjustments. The pandemic further highlighted this, and for health care providers who were not practicing agility, it may have even turned them upside-down. Regulatory bodies, and now even our patients, are expecting responsiveness to the needs of the changing environment at an even faster pace than in the past. If you are not keeping up with the changes, you will likely see the impact on your patient engagement and loyalty scores. 

In the health care industry, we have quickly gone from scheduling an appointment online to having point-of-care telemedicine visits.

One would ask what the role of emerging technologies is in high patient loyalty scores. Long gone are the days where a patient goes to the provider office, waits as long as it takes to see him, receives handwritten prescriptions which then need to be taken to the pharmacy to be filled, gets a test ordered that requires someone to call you to schedule, wait weeks for another appointment to review the test results and finally, receive a paper bill in the mail that you then write a check to mail in to pay.  There are few people out there who prefer the above method. Still, many are demanding quick access to care and additional conveniences that are often seen with technology implementation. In the health care industry, we have quickly gone from scheduling an appointment online to having point-of-care telemedicine visits. Patients see such transitions from having multiple portals to log into for tracking your care to using APIs (Application Programming Interface) for sending your data to whatever portal or smart app you want. The world is inundated with technology-driven access at your fingertips. Healthcare has been a little slow to adopt this, but patients are now demanding it.  

Patients want the same experience that they have in the banking or airline world. They want to access when it is convenient for them. They also want that access not just limited to their care providers, but they also want access to their clinical data as soon as it is available. They are demanding streamlined workflows such as ordering meals when they are ready to eat and paying bills online to include having estimates before procedures to plan costs. They want to know what the prescription will cost them before they arrive at the pickup counter.

A exciting as it is, all of this new technology comes with many challenges for healthcare systems and providers. Many healthcare systems took the approach many years ago to implement the best of breed technology. This approach allowed each individual care area to have niche systems that did everything they needed for that care area. Although the technology was sound for the use case it was developed for, it is challenging to integrate seamlessly with other systems, often requiring complex workflows that compromise patient care. Many hospital systems have transitioned away from this approach but have not yet fully replaced the archaic systems with investing in a more integrated system. This transition can often require millions of capital funds and often gets put to the back burner due to other competing priorities for those capital dollars like a new MRI machine. 

With the paradigm-shifting to technology-enabled patient engagement, another common challenge I am finding is not being sucked into the new shiny object twilight zone. Tech companies have jumped on the bandwagon, and every day, there is a new tool, app, system, or hardware that claims to be your life saver to your patient satisfaction issues. It is even more important than ever for healthcare systems to take a minute to access the complete continuum for making any of these new gadgets work.  Technology is just one piece of the triad. They also need to include people and processes to ensure the hospital’s investment will be maximized and not collect dust like a new treadmill three months after it was purchased.

The COVID pandemic has further brought to the foreground how important technology-enabled care is.  At my health system, technology helped us to continue the business. We increased our telemedicine footprint to all our practicing providers. We enabled screening for COVID patients through remote patient monitoring, and now we are using the same platforms to manage our COVID vaccination process. This last year has tested our ability to be agile in the healthcare setting. It forced out to roll out technology that we either were fearful of using or regulation prevented us from doing so. Now that it is out there, there is no going back. Our patients have a taste, and they will only continue to demand more.    

The bottom line is that Patient Engagement is often one of the strategic goals that organizations are focusing on. If it is not, you have probably already missed the boat. It will challenge healthcare systems at all levels and particularly on how (or should I say how much) they invest in Information Technology.  The investment needs include the right talent, the right systems, the right level of cybersecurity, and even more importantly, the right balance. With technology at their fingertips, patients now can shop for their care much as they would shopping for a new car. They are no longer bound by geographical boundaries and providers. Hospitals now need to work harder than ever to earn their loyalty.  

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I have written before about the role of clinician in healthcare IT – the crucial part that the clinician informaticist plays in translating the end-user (e.g., provider, nursing, patients) needs to IT build, and vice versa. I have even stood on soapboxes to broadcast this message. However, the COVID-19 pandemic laid bare the importance of the clinician in another area: prioritizing IT projects, particularly when it comes to introducing new technologies.

There are two key approaches when it comes to the push-pull of technology – business and operational needs driving IT or IT pulling the organization to find new needs. Where your organization lies on this continuum depends on many factors, but in healthcare, clinical and administrative operations almost always drive the IT agenda rather than the other way around. Although this sometimes means that new technology is introduced more slowly than in other types of organizations, it serves to ensure that the focus remains on the clinical and administrative priorities. In the past six months, the need for a fast-paced pandemic response turned that on its head. There was no time for IT to wait for broad-based consensus and identification of needed services – we had to use the clinical knowledge available to us directly to anticipate those needs – even as they were evolving. This phenomenon wasn’t isolated to catapulting into virtual care delivery as so many organizations experienced but crossed the entirety of the hospital’s operations.

I was part of the core team of our hospital incident command through the Massachusetts COVID-19 surge in Spring 2020. As the largest safety-net institution in New England, Boston Medical Center experienced the surge earlier and more intensively than other area hospitals. The coordination of the IT response to COVID-19 has been as complex, broad-reaching, and lasting as the clinical response.

The hospital incident command structure allows for a small group to orchestrate the larger organizational response to a rapidly evolving situation. The vantage point from within incident command allowed me to influence and communicate these rapidly evolving priorities of the institution such that the IT response could be both proactive and reactive. Although we had only a cursory understanding of pandemics, we did understand that our hospital would need to care for its patients while taking public health measures to flatten the curve for the population overall. Having a clinician leading the IT response meant that we could integrate intimate knowledge of care delivery for individuals and populations into this process. We were able to provide for a workforce numbering in the thousands to quickly move to “work from home” (WFH) and engaging patients virtually. We redesigned our clinical spaces to support a surge of inpatients, provided clinical tools to care for a new disease, and produced data analysis to support our clinical and operational work. The combination of knowledge of care delivery and how IT systems are built to support that delivery meant that we could anticipate and respond to emerging needs. Having a team that focuses on the next clinical (and administrative) needs is crucial for the organization to pivot the IT response to meet those needs – and an important function of the clinical informaticist.

The clinician informaticist’s place is not unique to our current pandemic:

1. Anticipate care delivery systems and applied informatics (health IT) needs to support evolving clinical, operational, and business needs (in a pandemic: a surge of infected patients, distancing mandates that sent almost all non-urgent care virtual, new treatment protocols, disease surveillance, and contact tracing)
   
   
2. Ensure the end-user remains a key part of the design and implementation process. No matter how rapidly the process moves from conception to implementation – workflow must always come before IT design.
   
   
3. Broker agreement between competing priorities and institutional functions to arise at solutions that address the challenges at hand.
   
   
4. Guide the analytics and contextualize the data (in a pandemic: to track prevalence, testing, contact tracing, and clinical outcomes; to understand and ensure supply chains of PPE, medications, and testing supplies)
   
   
5.  [in academic centers] Support (and sometimes pursue) research opportunities in clinical trials and health services research through health IT changes and data analytics.

In addition to serving as operational and IT experts, clinical informaticists must take responsibility for going beyond responding to identified needs and anticipate what will be needed next. We must be comfortable both pushing and being pulled into new health IT frontiers.

The landscape continues to evolve as the pandemic progresses and our clinical understanding of COVID-19 sharpens. From video conferencing vendors offering special services to educational institutions, to ride-sharing apps repurposing their software to direct people to care, to clothing companies and plastic manufacturers producing face masks and shields, the outpouring of support and singular focus in combating a common scourge is palpable. This is the time for healthcare leaders to use that momentum for change to lead their organizations in new directions. Clinical informaticists must be seen as integral to healthcare leadership and do the same.

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Two years ago, I decided that my current position was no longer challenging enough. After working most of my 20 years of career in some governmental organization, I thought I would take the opportunity to grow my professional tool kit and accepted an offer to be the CFO of one of the largest Federally Qualified Health Centers (FQHC) in the country. Their mission of providing health care to some of the Nation’s Capital’s most vulnerable populations, regardless of their ability to pay, deeply resonated with me.

While I had served taxpayers in various capacities as a government CFO, this opportunity gave me the ability to help an entire part of the DC community that has similarities to my very own childhood. Like many of our patients, I have experienced homelessness, food scarcity, and had limited access to quality healthcare. Ironically it would be the very lessons that I learned during my childhood that helped me navigate the pandemic in a way that would ultimately help our organization survive. 

1. Managing a Crisis

One thing that you learn to do when you are faced with the idea of not knowing where you are going to get your next meal from or what will happen if you cannot find shelter is how to manage a crisis. Managing a crisis requires you to be able to pivot without a moment’s notice. It teaches you that you must maintain calm and keep a level head in order to devise a plan that will work. According to John Gordon, a calm, positive leader who can express urgency in a way that does not cause the staff to panic is one that will have the best results from their team.

During the initial onset of the pandemic, our organization had barely established telehealth and teleworking was akin to a swear word. Anyone who has been in a natural disaster or experienced a disruption of business of mass quantities will tell you that you must have a contingency plan for every possible scenario. Unfortunately, we did not have a well-practiced disaster plan; much less have one that included a pandemic.  

I immediately thought about what my parents did once we became homeless. They developed a set of rules that determined how they could preserve cash on hand. Right at the onset, our organization had enough to make two to three payrolls and maybe a little left to pay only the most essential vendors. Two weeks post orders to quarantine, our billable visits shrunk overall by 65% and in some of our clinics, it was by 100%. 

Our billable visits equate to about 50% of our total revenues. That is not a hole that can just be plugged by initiating a hiring freeze and stopping all purchases except for items related to taking on COVID. As it was, as a non-profit, we were running a very tight ship with a profit margin that would make for-profits run. However, they do not have the same passion for the mission to care for those that most health care organizations would right off.  

2. You Get More Bees With Honey

According to my initial projections, we would not be able to make payroll by mid-May if our billable visits stayed where they were. I knew that it was going to take more than my title of CFO and having a say as to what and who will get paid. The first part of my plan was to reach out to all our vendors and tell our story and ask for a payment deferral or discount. I shared with them that not only do 100,000 DC residents rely on us for medical care; they also depend on us for many secondary social services that they are linked to just by being our patient. 

I looked back to my second-grade teacher and how she would always say that you can get more bees with honey. She was right. It wasn’t enough to just NOT pay our vendors. I wanted to be able to preserve our relationship with them, but still be able to benefit from holding onto cash longer. I made personal calls to sales reps, CFO’s, and owners. To my surprise, not only did they grant us deferrals, but they also donated meals to our front-line workers. They made monetary donations. They also donated thousand of units of PPE.

3. Find a Side Hustle

It seemed that my father was always trying to find new and additional ways to make money. He taught us that having one job or income stream was never enough to keep you financially secure. The same can be said of any organization; especially during a pandemic. While we were able to fully roll out tele-health within less than two weeks; we still lost about $3 million in revenues that we would never be able to recoup. Besides, one of our contracts that we have with the District Government was losing about $700,000 a month. 

We knew that the lost billable visits would not impact our cash flow for another 60-90 days, but the contract revenue losses were an immediate impact on our cash flow. We had to think about how we were going to keep our billable visit number at pre-COVID levels and more. We also had to think of other ways that we could generate revenue.

Being the largest FQHC in the Nation’s Capital means we have a significant impact on medical care within the District. We wanted to be a partner in every way possible to help combat COVID. We wanted to make sure that we not only stayed in business but were able to meet the needs of the community.  We were able to secure a contract with the local Department of Human Services. We were asked to provide medical care in a series of hotels that the District set up to be used for isolation and quarantine units for individuals experiencing homelessness, those who had COVID related symptoms, or just for those who had nowhere they could quarantine or isolate due to their living arrangements. I am convinced that without it, we would have had to talk about staff reductions. 

Conclusion

While times may be uncertain and we are still feeling the financial impacts of COVID, we were able to come together not only to keep our organization operating but to make sure DC residents do not go without quality healthcare that is affordable and accessible. People often ask me why I am a CFO and why I work for Unity Health Care when it can be very demanding of my time. My response is twofold.  One reason is that today’s CFO is more of a strategic partner than ever before; which is what I love.  However, the biggest reason is that I get to provide and maintain resources that allow 100,000 individuals to receive care that could very well save their lives.

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The decisions surrounding the selection and use of technology in healthcare have many influencers, some positive, and some due to barriers. Such obstacles to adaptation of new technology include preexisting limitations of current infrastructure such as application deficits, physical work environment, human resources for training, and support of involved staff. Behavioral barriers include behavioral issues or attitudes towards technology and organizational hierarchy of the influenced care models within the system.

Due to these factors, at the first start, it can be wise to phase in the introduction of new technology to understand the full impact before making a full financial commitment.

One advantageof a phased approach in the environment is to ‘test the waters’ with relation to breaking through barriers. Another is to identify areas where resources will have the most impact utilizing some of the technology and evolving its’ use as adaptation occurs. All this can occur while environments are modified. But most important is to be certain of the problem you are trying to solve by introducing new equipment. If this is unclear, so too will be the adoption, use, and understanding of its’ need. In addition, if the problem solved is one that is understood by the end-users, the continuous change of technology inherent in today’s world, particularly as it applies to health care, can help to yield a symbiotic relationship between the two while allowing for the chaos of this change.

In building infrastructure, we consider the capital spend and longevity of the hardware, the flexibility of the software, and the willingness of partners in either domain to work with us. The end-user must be involved in decisions around selection and design, not just of the technology but also how it is utilized. The greatest amount of time invested should be in the workflows. Simply purchasing technology because it is the shiny new toy will not result in a problem solved and quite likely a costly problem created. 

Before purchasing, consider what the problem is you are trying to solve. Is it time, distance, image storage, communication, provider shortages, and replacement of existing technology? Is it consumer-facing, employee-facing, provider facing, or a combination of all? What are the KPIs for the project? Will you be able to influence outcomes based on the technology and vendor you select?  What does the workflow look like today before the technology is inserted, and what advantage does the technology bring to the provider and the patient entities? If you are unable to answer these questions, you may be solving the wrong problem.  There may be growing pains around new workflows related to the new technology. Spend a great deal of time understanding current state workflow and design of the updated workflow with the new technology in place. Use mock scenarios before a live launch, especially if patient or consumer-facing. Finally, plan for adequate support, both educational and technical for the first few weeks and be clear on what the vendor is responsible for vs what you are. Make that support plan clear to everyone. There will always be hiccups, but the more you can anticipate, the less complex those will be.

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Meet Alice

Alice is a 66-year-old Medicare Advantage member who has Type 2 Diabetes, Multiple Sclerosis, and Major Depression. Being homebound with very limited mobility, she is fully dependent on a caregiver to help her with daily activities of living. In addition to her health challenges, Alice has few financial resources, consistently worries about her health costs, and feels hopeless.

As we know, Alice’s situation is not unique – according to the Centers for Disease Control and Prevention, 4 out of 10 adults in the U.S. have two or more chronic conditions.¹

For patients like Alice, health care is difficult to navigate; their health needs are complex, getting to the doctor is extraordinarily taxing (physically and logistically), and they don’t know what services are covered by insurance vs. out-of-pocket. As a result, patients like Alice often avoid or defer engaging the health care system, physical and behavioral health conditions often go untreated until they become acute, and quality of life worsens and costs skyrocket in the long run.

The rise of virtual health

“Telehealth” and “virtual health” have gained buzzword status in some regards, and often only focus on web-based or telephonic virtual visits. However, I see virtual health as a broader strategic category that also includes specialty care, digital engagement, remote monitoring, and AI-based health tech solutions that provide nontraditional access points to content, solutions, and coaching.

Patients like Alice can use virtual health to get the care they need without transportation and mobility obstacles. Additionally, virtual health and remote monitoring help Alice’s care team and caregivers by providing real time health data and enhance clinical workflows and processes by providing streamlined patient touchpoints. In turn, costs for patients fall while their health outcomes improve.  

One positive development for virtual health in 2020 has been the Centers for Medicare and Medicaid Services’ (CMS) lifting of some of its strict limitations on delivering virtual health services. These changes have made it easier for members and providers to offer and use virtual services.

Humana’s approach to virtual health

This year, we have accelerated our commitment to remove barriers to care and meet members where they are; with the onset of COVID-19, we instituted $0 copays for COVID-related appointments for our Medicare Advantage population, and have since expanded this benefit to all telehealth visits through the end of the year.

Our overall goal is to build a customer-centric model of care that works with members across a comprehensive array of health services spanning all levels of intensity – from traditional services such as primary and urgent care to more nontraditional like Cognitive Behavioral Therapy, group therapy, and physical therapy.

To build this model, we have started from the customer-back and built pilot programs that incorporate new ways of working and engagement in areas across the care continuum. We’ve asked ourselves: What do members need that they can only currently get through brick and mortar? How can we remove barriers to our members getting that care? How can we make sure the same level of care is provided virtually?

One such pilot program we have built is in the area of behavioral health. This program brings together a myriad of technologies and best practices to provide a comprehensive, anticipatory, and proactive approach to behavioral health – all virtually. Specifically, the program leverages passive monitoring and AI to anticipate when a member may have a health event and wraps around different services such as medication management, talk therapy, text on demand to stabilize the member and provides a feedback loop.

On a larger scale, what we have learned has been fascinating:

Total visits – COVID-19 has helped to accelerate virtual visits and shift the site of care from in-office to the home. In April alone, we saw telehealth visits with traditional telehealth partners more than doubled and the growth is even more compelling when you factor in brick-and-mortar providers that have pivoted to telehealth.

Adoption and Repeat Usage– We’ve seen a higher number of repeat utilizers amongst our Medicare Advantage (MA) and Commercial populations with our national vendors.

Satisfaction – Both MA and Commercial members have reported a positive experience rate, with a 93% satisfaction rate on the MA side, and a 4.9 / 5 star rating on the commercial side.

Customer Experience – Members also reported short wait times (under 10 minutes) for virtual medical visits.

We’re excited about the progress we have seen, but we have miles to go. We’re continually assessing and learning from our customers on what they value most and where we can make the greatest impact.

Alice – A Success Story

Let’s revisit Alice’s situation:

On January 10, 2020, a Humana nurse contacted Alice for a health consultation. While speaking with Alice, the nurse learns she lives with an emotionally abusive partner, which exacerbates her depression. Worried for her safety, the nurse schedules Alice virtual appointments with Jan, a Humana Behavioral Health specialist, and a therapist, Deb.

Over the course of several months, Jan and Deb worked together as her care team, all virtually, to:  

• Build trust with her as she moved to Indiana and out of her unhealthy living environment
• Re-establish her relationship with her former neurologist in Indiana who treated her MS
• Connect her to a physical therapist to improve mobility
• Help complete financial aid to assist with paying medical bills
• Find a new power chair affording her better mobility
• Stabilize her depressive symptoms

Because of how Humana leveraged virtual health channels, Alice is thriving – “the thought of changing insurances makes me emotional … I never want to lose support like you.”

Historically, it would have been challenging to support members in Alice’s situation – a long distant patient with complex medical and behavioral needs – but with virtual health, we were able to connect Alice with specialized clinicians, a behavioral health specialist and a therapist – all virtually – allowing us to make a difference in Alice’s life.

Looking towards the future

With any winds of change, one must adjust the sails. As the health care ecosystem—and our world—adapts to the “new normal” after COVID-19, we expect more members will gravitate towards virtual health.

From listening to our customers to learning from our pilot programs, we are continually rethinking routine and exploring how best we can advance our technology to pioneer simplicity, experience, and outcomes for our members. Because the less time people are in the hospital, the more time people can spend at home living their best lives.

References

Centers for Disease Control and Prevention. (2019, 10 23). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/

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Virtual care, or being able to affect healthcare from a distance and access patients and doctors from all different corners of the world, has existed in some form for decades. However, it has grown incredibly in the last few years and we are in an exciting time for imagining how to harness this care modality to its fullest extent. While I’ve worked in telehealth since 2013 – less than a decade – the beginning of the new decade is a good time to evaluate what we have learned and what we hope for the future.

Why Telehealth?

Our clinical needs are changing drastically. We have a larger amount of healthcare needs due to an aging population, an increase in chronic disease with the added burden of closing hospitals and increased ER populations. How to better take care of our patients, all while working with less resources, seems an insurmountable problem. Healthcare has traditionally been structured around the providers and buildings; patients have to come to us for their care. However, most of our health happens mostly outside these small slivers of time leading to only understanding a small part of an individual and population’s health.

We required finding a vendor relationship that believes in the same iterative process and could make changes along with us.

At the same time, technology has changed our lives tremendously in the last decade and we have become more reliant upon it. It’s used in almost every aspect of our lives and we have to try to leverage the already available solutions for better patient care. Telehealth, as a prime example, can increase access, decrease costs, improve effectiveness and experience. These goals, the tenets of the NQF Framework for telehealth, determine how best to create programs and implement telehealth for its various use cases.

For example, in provider to provider telehealth which is practiced between providers allowing rural or resource poor areas to see a specialist, the consultant can do a video consult, evaluate the workup and aid in creating a plan of action. This can mean transfer to a higher level of care or keeping the patient in their local hospital for treatment there. This increases access to specialists where most needed, improves effectiveness of care since patients can be kept in their home hospital or evaluated for transfer. It decreases costs if can keep patients at home and reduce unnecessary treatments. It can improve satisfaction for all of the above reasons. All programs can be evaluated in this manner to be most effective.

Jefferson Health and Telehealth

At Thomas Jefferson University, we wanted to create an all-encompassing digital home for patients which meant creating a broad-based program that included remote consults to rural areas, provider to provider specialist consults, programs within the hospital, and acute care direct to consumer telehealth. It takes time, resources, staffing and a thoughtful rollout to be successful. Our process included thinking through every part of a patient’s healthcare journey and creating programs to intervene at every part. Outlining each of these programs is outside the scope of this article, however, I want to stress the startup mentality at a large academic center that gives us our success – we work quickly and iterate often. We required finding a vendor relationship that believes in the same process and can update and change with us. We try new things often, fail or succeed fast, and try again. This is a unique asset within the world of academic medicine in this rapidly changing tech world.

With that same mentality, since our infrastructure was created it has been much easier to leverage telehealth or other digital programs for other use cases. We are setup for scheduled visits at most outpatient practices and run a 24/7 direct to consumer acute care program. When the current coronavirus spread made the news cycle, we were able, within a week, to establish protocols for outpatient practices, urgent care, or at home for screening and testing/transfer. This is the most interesting part of being part of a robust program and faculty – being able to leverage it for other needs quickly. At the time this article was written, there hasn’t been a case in PA and even if it doesn’t spread here, we are prepared for other future eventualities.

Future goals

Telehealth is poised to be just another modality to see providers and eventually getting rid of the tele- prefix and being healthcare. Improved communications, networks and devices will allow closer and better contact and more access to patient data. Other parts of healthcare, such as machine learning, genomics, sensors and the resulting data gathering will give us better treatment plans that can be coordinated from anywhere. Healthcare workers will have more time for other parts of care that we can daydream about but is likely something we won’t really understand until we have it established. More pressing is ensuring that whatever we create remains equitable as any new technologies are always in danger of being inaccessible to some populations. To that end, the future of medicine requires unlikely bedfellows to work together to ensure future health care is equitable, accessible and effective.

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During a time of crisis, such as the COVID-19 pandemic, healthcare organizations must rely on an “All Hands on Deck” approach. However, what has this meant for those that support their healthcare organization via the organization’s information technology? It likely meant the Information Systems (IS) department was even busier developing new processes, implementing new technologies, and supporting more users as the pandemic approached. Team members needed to remain strong to meet the needs of our patients and our communities. However, it also meant that we all had to keep our team members safe and fully informed.

At Baptist Health, we were in the early stages of our telemedicine journey prior to the COVID-19 pandemic. We understood that we would need to incorporate telemedicine models into our strategic plan for growth and sustainability. I sometimes joke that we implemented five years of strategic plans for telemedicine in five weeks. We deployed telemedicine via Zoom for all of our ambulatory clinics, including specialties such as psychiatry and cardiology, in just two weeks. We quickly deployed telemedicine for pediatric and adult rehabilitation services, including physical, occupational, and speech therapy. One of the challenges we faced was determining how we could utilize telemedicine for our inpatients. After many hours of pilots and process evaluation, we were able to deploy telemedicine for the inpatient providers using Zoom and an iPad on a cart for tele-ICU rapid assessment, wound care consults, and dietary requests. We developed a strategy where each COVID-19 patient had an iPad in the room so hospitalists could meet with the patients virtually to minimize exposure and save Personal Protective Equipment (PPE). Finally, we enhanced the patient experience by promoting Zoom virtual visits with loved ones while the inpatient units had visitor restrictions to keep our patients and our staff safe.

As an IS leader, my lesson learned was the primary emphasis is on the importance of our people, rather than technology.

Baptist Health was in early discussions about beginning a work-from-home program prior to the pandemic. Several analysts worked remotely, enabling us to recruit top talent. However, we were also evaluating how work-from-home could be applied to other areas in order to have increased employee satisfaction. An announcement was made that work that was not essential to be on-site should be remote. We had to evaluate what could be done remotely and to further assess how to stand up the necessary infrastructure required for a remote workforce for an entire organization of over 12,000 team members. We supported the transition of our employees to a remote workforce by increasing the number of VPN licenses, purchasing laptops, and enabling Webex and Zoom technologies.

To support the deployment of these technologies, IS team members, from executive assistants to project managers, went to our temporary storage location to open up boxes and set up iPads on carts, Work Station on Wheels (WOWs), and laptops with Nuance microphones. We wanted to ensure the bedside caregivers were not limited by the technology, but rather have an expanded reach because of the technology.

Our Clinical Informaticists (CI) and analysts were essential to the support of the organization. They designed new rules to minimize the clinician risk of exposure, developed lab orders, created order sets specific to caring for COVID-19 patients, and streamlined documentation templates. They also designed, built, and validated COVID-19-specific reporting tools to track and monitor our patients.

Additionally, we evaluated whether the nurse informaticists could serve in a patient-care capacity, and if any additional training would be necessary. It was ultimately decided that the nurse informaticists could serve patients by manning the drive-thru testing site, where they swabbed potential COVID-19 patients in a tent equipped with appropriate PPE.

As an IS leader, my lesson learned was the primary emphasis is on the importance of our people, rather than technology. “All hands on deck” was asking myself what I could give to my team members during this time of crisis. During this time of working extended hours to support the organization, our employees were and will continue to be at risk of feeling fatigued and isolated. I tried to think of new, virtual ways to make my team feel appreciated and engaged. I hosted a virtual “Town Hall” at the end of every week. To do this, the first requirement was to ensure video capabilities were turned on for all team members. The second creative challenge was to come up with a theme everyone could participate in. The themes included superheroes, with appearances by Superwoman, Spiderman, and, of course, many nurses (the real superheroes!). My favorite theme was the “Tiger King.” It was a fun way for me to communicate important updates about COVID-19 with all of my team members while allowing for a little levity and togetherness in a time of social isolation.

It is important to tell your team members, although they may not be the ones performing the telemedicine visits with patients, they have impacted the care of those individuals by developing and testing the process. The team members who deployed the WOWs, iPads on carts, and laptops are very much a part of the care team. We made an impact every day, keeping the workforce safe by supporting the capability to work from home and facilitating virtual provisioning care. It is also important to remind your team to take time to care for themselves. We sent daily system-wide communication with simple self-care steps, including tips for eating healthy and reminders to spend time outside. In fact, several rest-and-revive tents were set up throughout the organization for team members to recover in a relaxing setting surrounded by soothing music and support of our Baptist Behavioral Health and Spiritual Care team.

Now, we must look to the future. We need to think about how to restart the physical organization, but also how to adjust to the changing paradigm of health care in which telemedicine is a new reality. Baptist Health successfully maximized the care of our COVID-19 patients by developing a home-monitoring program utilizing home health nurses via telemedicine visits with our primary care physicians. We will need to expand these innovations into the future by developing a “Hospital at Home” program utilizing digital monitoring devices. We should all be evaluating how we can develop a telemedicine workforce dedicated to monitoring patients for disease states beyond COVID-19, using digital devices and telemedicine visits.

The impact each of us has had on our organizations will last long after COVID-19. I was just lucky to be a part of it, at Baptist Health, and as a teammate of health professionals throughout America. 

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Responsive information technology quickly became a pivotal weapon in New Jersey’s largest hospital, Bergen New Bridge Medical Center’s, COVID-19 arsenal.

Bergen New Bridge in Paramus, New Jersey has 1,070 beds. It provides acute and ambulatory care, substance use disorder treatment including medical detox, inpatient, andoutpatient mental health services. It has the largest licensed nursing home as part of its campus andwith more than 2,000 staff members, the Medical Center has a large footprint with many diversified user needs.

Supporting the Medical Center by rapidly deploying mobile devices and work stations to the temporary tents housing the COVID-19 testing center and additional beds to care for our patients was critical. This entailed multiple tiers of staff providing end-user training and support while troubleshooting the challenges of non-traditional locations. Additionally, the Medical center’s gym was converted by the US Army Corps of Engineers into additional patient care space. IS had to fully equip this area with the technology needed to power.

As the situation progressed and many of the Medical Center’s outpatient medical clinics and mental health clinic services needed to be offered to patients virtually, developing multiple telehealth platforms to support these programs became vital to sustaining continuity of care for vulnerable populations. We know it is critical for people to be able to manage their medical conditions and receive their medication to stay as healthy as possible. We also recognize that this pandemic will certainly yield a mental health epidemic that will be far-reaching and as a leading provider of these services, we had to make sure we created a way for people to reach out and get the help they need.

Establishing a COVID-19 screening protocol platform was instrumental in getting our community, particularly our heavily impacted first responders and healthcare professionals, tested. Our Governor has made it very clear that testing is an essential part of his plan to logically and safely reopen New Jersey. As new testing options such as saliva and antibody became available, IS had to be ready to add them into the platforms. IS was also instrumental in implementing telehealth for court commitment hearings, working hand in glove with the County of Bergen. 

To accommodate the needs of staff during this unprecedented time, some of the Medical Center’s workforce needed to move to remote locations. To make sure this happened as seamlessly as possible, IS rapidly set up the off-site systems, structure, protocols, and monitored security to ensure sustained communications integrity. The security piece is critical for a healthcare facility. With so many moving pieces, managing those aspects was the most impressive and essential outcomes of our pandemic response thus far.

We suddenly found ourselves in a situation where we could not meet in person. The IS team had to deploy webcams and support teams throughout the Medical Center to facilitate virtual meetings and virtual new hire orientation. Education and support were also necessary for this endeavor. Staffing became critical and our ability to onboard new hires and convert our very hands-on orientation successfully to a virtual platform ensured the sustainability of our workforce. Without a robust and capable IS team, the ‘new norm’ could not have evolved so expediently.

Visitation at our Medical Center was suspended as the virus began to be community spread. This meant that our more than 500 long term care residents could no longer physically visit with their loved ones. It was imperative that we kept our residents connected with their loved ones. IS provided iPads so virtual visits could happen. Ensuring the strength of the Wi-Fi signal and establishing hot spots to adjust to the ever-increasing demands of the facility during this unprecedented time also became a critical component of our pandemic communications response.

All of these things were done as the IS team was adjusting to heightened procedures for safety, such as wearing masks and increased workspace sanitation. It was important that our end users were comfortable with the team in their space and working on their devices, knowing we were adhering to the strictness infection prevention protocols possible to keep everyone healthy and safe. There was very little time to get comfortable and adjust as we had to react and do so precisely, professionally, and quickly. No CIO could have asked for a better response or more from their team. Character is truly shown, not made, during times of crisis.

Never has information technology played more of an essential role at a healthcare facility than during this pandemic. COVID-19 impacted swiftly, but we responded with equal speed. The ability to work remotely, care for patients and meet virtually, and connect those in our care with their loved ones as they battled and at times, lost the fight with the virus, is a defining moment for any CIO. As we continue to battle this virus, it is our unified efforts, embracing the best of medicine, science, technology, community, and kindness that will help us all rise and win this war together.

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