This post was co-authored by Rebecca A. Stametz, Geisinger's vice president of digital transformation; Karen Murphy, RN, its chief innovation officer; David Vawdrey, chief data informatics officer; John Kravitz, chief information officer; and Paddy Padmanabhan, CEO of Damo Consulting.
In January 2020, Geisinger, the Pennsylvania-based integrated health system known for decades of clinical innovation, launched a multi-year digital strategy to make health easier for patients and members in its health plan.
Built on a foundation of advanced information technology, informatics and data science, Geisinger’s digital strategy was designed to promote continuous improvement opportunities across the spectrum of healthcare delivery. Just as the digital strategy was beginning to take shape, the first COVID-19 patient was admitted to a Geisinger hospital.
As with the rest of the world, the COVID-19 crisis came to Geisinger in a severely disruptive fashion. With the implementation of social distancing measures to slow the spread of the virus, healthcare delivery systems have drastically scaled back services, including postponing clinic visits, procedures and nonurgent surgeries.
Against these headwinds, and entering a new era that could redefine healthcare, rather than slow innovation, COVID-19 has accelerated Geisinger’s digital efforts.
Digital tools to combat COVID-19
COVID-19 required health systems to quickly pivot to predominantly digital methods of patient and staff engagement while adapting the hospital environment to care for patients infected or showing symptoms of the novel coronavirus. At Geisinger, these digital efforts were organized in three areas: 1) prevention of future infections through communication and education; 2) leveraging technology to advance clinical protocols; and 3) pivoting large portions of our workforce to telecommuting.
Preventing future infections through communication, education
As scientists and government officials continued to uncover how COVID-19 spreads and its associated symptoms, it became critical to have timely and reliable communication channels that reached our communities. Such channels aided in raising awareness, education and triage protocols.
Geisinger developed an in-house mobile application aimed to provide guidance to the emergency medical service communities. Our team added a COVID-19 resource hub to the app as a key feature that provided dynamic content to aid our first responders that saw an additional 400 app downloads and 3,200 app launches – while the COVID-19 resource hub was viewed 1,075 times.
During this same time, we also launched a contact-tracing program to help identify those who may have been exposed to COVID-19 to prevent future spread. A cross-functional team across the health system came together to build the program quickly. To date, more than 1,100 individuals have been contacted to alert them of potential exposure. Phone calls are the primary method currently, but plans are underway to augment the calls leveraging a digital platform.
This digital platform will enable contact-tracing employees to reach more individuals in a short amount of time and create various digital channels for the consumer to interact with the contact tracing program. This transition will include a connected CRM platform for our contact tracers and an interactive web chatbot, live-agent web interaction, text-message outreach and email notification for our contacts.
Leveraging technology to advance clinical protocol
As social distancing measures prevailed as a primary way to reduce the spread of COVID-19, visitation policies across the hospital changed rapidly in response to (nearly daily) updates in guidelines. Geisinger needed a way to capture self-reported information from patients, visitors and vendors that provided actions to staff that supported system policies.
To meet this need, a digital screening method, along with an administrative dashboard, was created to replace the ad hoc paper process. Digitally capturing symptoms and visiting location allowed the front lines to more efficiently follow system policy and keep waiting rooms less crowded.
More than 250,000 patients and visitors across hospital entrances and community practice clinics were screened for COVID-19 symptoms. The ability to effectively and immediately report out on numbers screened by entrances, as well as entrance breakdown (patient, visitor, vendor), allowed leadership to understand capacity and ensure staffing levels are appropriate.
The same type of solution was deployed for employee screening utilizing the REDCap survey system. Integrated with Geisinger’s digital Employee Health system, a custom dashboard tracked the quarantine status and return-to-work eligibility of employees who exhibited COVID-19 symptoms.
This allowed managers to effectively monitor their direct reports and ensure appropriate guidelines are followed when employees screen positive for symptoms. Additionally, it provides insight to leadership on how COVID-19 is impacting our employees, allowing for mitigation tactics and real-time planning as the situation evolves.
Telemedicine availability has also rapidly expanded. Utilizing a secure network, Geisinger is able to provide primary care and access to a wide array of specialties while practicing social distancing. In April and May alone, more than 60,000 video visits occurred, averaging more than 1,000 per day. In the month before COVID-19 created operational and innovative changes, Geisinger averaged 27 video visits per day.
Geisinger also deployed a variety of efforts to improve remote patient-monitoring and overall care at home. Programs that are currently in place include remote-monitoring equipment with no or limited connectivity capabilities for periodic spot-checking and an app that helps capture and manage symptoms over a 14-day interactive care plan. And we plan to announce a continuous home-monitoring system for the most at-risk COVID-19 patients who do not require hospitalization.
Pivoting the workforce to telecommuting
Before Pennsylvania announced a statewide shelter-at-home policy, Geisinger acted to move all nonclinical staff to a predominantly remote workforce. In the immediate aftermath of the pandemic, Geisinger had around 13,000 remote employees, a doubling of the previous remote workforce. This meant enabling employees with the technology tools required to continue to be effective in supporting the organization. It also required IT infrastructure that was sufficiently robust to deal with large increases in remote users.
Like many health systems, Geisinger’s primary concern was protecting the well-being of its staff and reducing the incidence of COVID-19 transmission. This work has enabled us to support both clinicians directly for in-patient care and nonclinical employees as they transitioned to working from home.
The silver lining
While business as usual changed dramatically in a short time, Geisinger did not take our eye off the true digital transformation, North Star: a reimagined future. As a result, we’ve modernized our application programming interface and microservices architecture, developed an enterprise strategy for patient/member data and rationalized our application infrastructure.
Our experience with COVID-19 exposed an opportunity to accelerate many of our initial investments. And our team recognized it must continue to push forward on our digital transformation initiatives to position ourselves for the post-pandemic future.
If there is a silver lining, it may be this: We’ve created a culture that embraces digital health technology. And we believe the acceleration of digital transformation will have long-lasting positive impacts for our frontline staff, patients and the communities served, which will always be first priority.