The M*A*S*H model of care and pushing IT to the limit – lessons from a tough 12 months
The past year has been like no other for healthcare provider organization executives. They have been put to the test, and the successful have survived intact, with many lessons learned along the way.
Today, Healthcare IT News presents the latest in its feature story series speaking with healthcare C-suite officers and other health IT leaders about the healthcare information technology and other lessons learned during the past year, and how they are applying those lessons this year and beyond.
This time around, six top health system executives discuss subjects including telehealth, IT infrastructure, patient engagement, core competencies and collaboration. The executives include:
Candice Friestad, RN, assistant vice president of clinical informatics at Avera Health in Sioux Falls, South Dakota.
Mark Guthrie, CFO and executive vice president of information technologies at Banyan Health Systems in Miami.
Nicholas J. Korchinski, CIO at CareMount Health Solutions and CareMount Medical in New York.
Dr. Adam Landman, chief information and digital innovation officer at Brigham Health, Boston.
Santosh Mohan, managing director of Brigham Digital Innovation Hub, Brigham & Women's Hospital, Boston.
Dr. Mark Zhang, medical director, Brigham Digital Innovation Hub, Brigham & Women's Hospital, Boston.
Keep pillars and core competencies strong
The year 2020 has been a wild ride to say the least – difficult, yet full of opportunity, because the last 10 months have reaffirmed the critical importance of agility and innovation, said Mohan of Brigham & Women's Hospital.
"The Digital Innovation Hub (iHub) team at Brigham and Women's Hospital adjusted our work and focus to help digitally enable several key COVID-19 response and recovery initiatives," he said.
"In many ways, what equipped us to spin up these rapid digital efforts was our focus in recent years on developing foundational competencies – the mindset, the toolset and the skillset – to support and drive digital transformation."
Santosh Mohan, Brigham & Women's Hospital
"From implementing symptom screening and vaccine scheduling tools to piloting innovative technologies for touchless interactions while reimagining the patient digital journey for the new normal, we delivered several digital capabilities that played an enabling role in the effort to ensure the safest possible environment for patients, families and staff during the pandemic."
A key takeaway for Mohan and team from their work over the past year was to always ensure their pillars and core competencies stayed strong.
"In many ways, what equipped us to spin up these rapid digital efforts was our focus in recent years on developing foundational competencies – the mindset, the toolset and the skillset – to support and drive digital transformation," he explained.
"This work involved creating repeatable frameworks for evaluating and piloting new technologies, simplifying processes that can allow us to engage in agile partnerships, and deploying reusable platforms that can facilitate fast connections."
Creative problem-solving required repurposing of knowledge, resources and technology that Brigham and Women's Hospital already had at hand, he added.
"We still had to build many processes and develop many frameworks on the fly," he noted. "However, having the foundational infrastructure in place and the skilled resources to support it and develop custom solutions as needed have helped us with the agility we required to quickly rise to the challenge."
Mohan and team already are hard at work applying this lesson they learned in the past year.
"Despite the unprecedented challenges that 2020 has presented, the rapid adoption and advances in digital innovation have created sustained shifts for the better," Mohan stated. "Digital health in 2020 became an essential part of patient care and operations. From scheduling and electronic consent to food ordering and valet operations, there is a new realization of how digital technologies can help."
Many of these went from nice-to-haves to must-haves, he added.
"Technology that was in place in a more limited fashion is now being utilized across the enterprise," he said. "The past year has really helped bring the necessity of digital health into focus, identifying where to invest for the future to maintain momentum around digital technology advances that have occurred and are continuing."
From what Brigham has seen with the adoption of virtual care as well as usage of the organization's custom-developed tools and mobile apps, technology innovation can be contagious, added Landman of Brigham Health.
"Our internally developed COVID Pass app has seen more than eight million daily staff symptom-screening attestations since implementation and has helped facilitate scheduling of vaccinations for more than 60,000 of our healthcare workers."
Dr. Adam Landman, Brigham Health
"For example, our internally developed COVID Pass app has seen more than eight million daily staff symptom-screening attestations since implementation and has helped facilitate scheduling of vaccinations for more than 60,000 of our healthcare workers," Landman said.
"We have seen great engagement with many of our digital programs, including a crowdsourcing initiative for collecting creative staff ideas for safer workplace environments during the pandemic and a loaner device program to facilitate patient-to-family connection in a time of isolation."
The sweeping influence of these initiatives as core enablers of Brigham's "safe care commitment" has alerted many to what digital solutions can do for them, and Brigham anticipates more demand from colleagues in 2021 and beyond, he added.
"We are going to continue advancing our digital innovation infrastructure, take the best lessons from our efforts, preserve our agility and rapid experimentation abilities, and strive to deliver even better experiences with emerging technologies that can improve care and convenience and stand up to future challenges," Mohan said.
Relying on telemedicine
Over the course of the past year, telehealth has at long last burst its way into the mainstream thanks to the demands of COVID-19. Friestad of Avera Health has had some important takeaways from the trend toward virtual care.
"A few years ago, before this crazy year, when the outlook in healthcare was based on trends and reliable, comfortable statistics, esteemed experts and pundits predicted that healthcare would turn their attention to the outpatient arena for care, especially from a positive revenue slant," Friestad said.
"The expectation would be that technology and care refinement would allow patients to be professionally cared for – surgery, procedure, consultation – quickly in an outpatient location and then sent home to recover with periodic check-ins, typically by phone."
"As we look at the surge decreasing, thank goodness, in the next few months – many patients and providers have now realized the value of virtual care and visits, and won't be going back to the very full daily clinic."
Candice Friestad, RN, Avera Health
Now, because of COVID-19, the themes in 2020 of "Never waste a crisis" and "We have to think outside the box now" are part of the discussion in every remote meeting. The question comes up: How do healthcare professionals care for patients and leverage technology so that patients do not have to leave their homes?
"We don't have the 'Star Trek,' or better yet, 'The Expanse' technology of the 23rd century, but we are able to use the technology at our disposal," she said. "At Avera Health, we had a very robust telehealth and home care virtual platform in place prior to the COVID-19 crisis that suddenly we found patients and providers were very interested in leveraging."
At one point, to save valuable critical care beds and space, Avera had more than 200 patients at home on home oxygen, monitored remotely by Avera@Home clinicians. In addition, this staff was monitoring an additional 800 patients who had tested positive for COVID-19 and were exhibiting a variety of symptoms. Given the rural nature of Avera Health's footprint, some of this remote monitoring was out of geographic necessity.
"As we look at the surge decreasing, thank goodness, in the next few months – many patients and providers have now realized the value of virtual care and visits, and won't be going back to the very full daily clinic," she noted. "As we move forward to 2021-2022, maybe the pundits were correct, just with a different reason on why it's moving in a remote direction."
From a clinician and telehealth perspective, she added, Avera staff have tried not to look over their shoulders and think, "Well, that pandemic was fun and character building. What's next, and is it going to be worse?"
"Remote care will stay in place, and so far CMS and the Trump and now Biden administrations, as well as third-party payers, have continued to reimburse for this service," she said. "Telehealth is truly now embedded in our future. In addition, the more preventive care and practices that can be incorporated into public health will allow more on-premise-directed resources to those in most need of our care."
Pivot to patient communication and engagement
Korchinski of CareMount Health Solutions and CareMount Medical said that something he found to be key over the past year is the ability for large healthcare delivery organizations to have the capability to quickly pivot patient communication and engagement in response to an unpredictable environment.
"We are based in New York, which was ground zero for COVID-19 in the U.S., requiring us to take immediate action to adjust our operations to navigate this unprecedented event," he said. "Even before the initial COVID-19 outbreak, CareMount Medical revolutionized the way we communicate with patients.
"Today we deliver test results to patients' smartphones, provide appointment pre-check-in from home, send care reminders with an easy online scheduling service, support virtual care, and share quality and safety initiatives to provide a safe in-person patient experience."
"Fortunately, we made a few key infrastructure investments prior to the pandemic – a new virtual visit platform, a customer relationship management tool and an online scheduling platform, for example – that enabled us to create a new, robust patient experience."
Nicholas J. Korchinski, CareMount Health Solutions and CareMount Medical
The pandemic thrust the provider organization's team into more proactive responsibilities to direct, guide and serve – as opposed to following the more traditional healthcare model of patient-initiated activity, he added.
"For us, a key challenge was to create a balance between valuable patient communication, frictionless action and personalized messaging," he explained. "Fortunately, we made a few key infrastructure investments prior to the pandemic – a new virtual visit platform, a customer relationship management tool and an online scheduling platform, for example – that enabled us to create a new, robust patient experience."
This is just the beginning, he noted.
"We understand that, now more than ever, patients want to communicate in an easy manner on their own terms and be given the opportunity to meet their needs without a live discussion," he said. "This benefits our clinicians in that they can spend more time with patients who need direct contact because they gain time by remotely caring for the patients who prefer virtual care."
Today, CareMount Medical is embarking on a new phase of personalized communication that summarizes the outcome-improvement opportunities that its providers identify.
"For example, this could be as simple as sharing appropriate preventive measures based on an individual patient's age, disease or family history, or it could be as complicated as following up on actions and recommendations that a provider shared during the last visit," Korchinski said.
"Our goal is to serve up the most important items and make it easy for patients to take action, because taking action is the key to changing a patient's health trajectory."
Good technology support and infrastructure
During the past crazy year, Guthrie of Banyan Health Systems has learned to never underestimate the value of good technology support and infrastructure.
"COVID-19 presented so many challenges as it forced us into the era of telehealth, which in turn places extreme pressures on Banyan's networks and further creates an environment where patient privacy and information must be one of the foremost concerns in our daily operations," he said.
"The ability to provide secure and confidential care must be done daily, consistently and well in order to facilitate quality patient care and enable our staff to provide service."
"We have completely re-engineered our networks, cybersecurity tools, hardware and staff training. These lessons will carry over into 2021 and beyond for years to come."
Mark Guthrie, Banyan Health Systems
To meet these challenges, the Banyan technology team set key service level deliverables ranging from system availability to support staff response times. These are metrics that are measurable, provide the team necessary information and allow for improved service, he noted.
"At Banyan we have significantly invested in improving our entire technology delivery toolbox," Guthrie stated. "We have completely re-engineered our networks, cybersecurity tools, hardware and staff training. These lessons will carry over into 2021 and beyond for years to come. We have reset our technology foundation in order to meet the demands of the current pandemic environment and beyond."
The Banyan technology team has learned to think beyond the next 12 months, he added.
"Our technology plans now encompass a forward-looking three- to five-year timeline with significant upgrades in our technology, people, resources and strategic partners," he said.
IT infrastructure beyond traditional expectations
Korchinski of CareMount Health Solutions and CareMount Medical also learned lessons last year about IT infrastructure, and what is really needed on this front.
"Fight for IT infrastructure investments that have the potential to deliver results beyond traditional expectations," he advised. "Each day, the formerly harmonious balance of running our business was challenged due to the strain on our frontline staff from a significant amount of COVID-positive tests or indirect contact that led to quarantine."
Clinical teams were constantly confronted with not only the everyday challenges of meeting patients' needs, but also with simply fielding a proper team, he added.
"Many businesses across the globe had the option of packing up their work locations and moving home," he noted. "This was not an option for those who work in direct patient care. For those clinical heroes, the constant challenge was to create a safe environment for patient care as well as their colleagues. Those of us in IT, like many support services departments, did what we could to create an environment that helped those heroes do their job a little better."
For CareMount Medical IT staff, the challenge was to maintain a stable, high-performing infrastructure.
"This involved a lot of different initiatives and priorities," he said, "including: converting full departments to remote workforces in a matter of days, outfitting locations with alternative technology, creating new call centers to service virtual visits, embracing instant messaging as a workflow tool, being creative with existing assets to solve new business needs and, finally, balancing creativity versus risk."
When it comes to applying lessons learned, he said the IT team makes investments in tools and infrastructure designed to serve their core purposes while having the ability to scale, but also provide the ability to look at and solve new problems without making new investments.
"For us, the forethought of these investments has returned great dividends in the past year," he said. "We learned that we must continue to fight for these investments, because they may someday yield returns that we never would have expected."
For example, several years ago, the IT team invested in a virtual desktop integration (VDI) platform. At the time, the intention was to create a remote workforce platform for physicians and business leaders that was identical to the in-office platform they used.
"With the onset of COVID-19, new types of users, such as call center workers and care managers, who had never previously needed access to portable tools and platforms, required the ability to work remotely," he recalled. "Our team was able to quickly scale our existing VDI platform to these completely new types of users' needs without requiring any additional financial investment on the part of our health system."
Traditionally in IT, he said, teams think about investing in infrastructure from a perspective that fits with past experiences. While that viewpoint is certainly understandable, teams should strive going forward to break out of the mentality of simply asking "What are we trying to achieve today?" They should think beyond today's need and, instead, about what patients and providers may need tomorrow, he advised.
"In 2021, I will continuously challenge my team to break the traditional mold of thinking to enable us to research and consider new and different types of infrastructure that ultimately create the greatest amount of IT flexibility and scalability in the future, leaving us well-prepared for the next crisis and beyond," he said.
Management commitment to necessary investments
Guthrie of Banyan Health Systems talks on a similar note to necessary infrastructure preparedness, saying that it's key to obtain management's commitment to the investments necessary for providing the best care.
"Hope is not a plan," he said. "It takes hard work, dedication and commitment from management to make the necessary investments needed to extend our technology reach to our staff and patients while meeting the demands of today and tomorrow.
"Without support and planning from the most senior leaders of the organization," he added, "the delivery of quality patient care using the best available technological resources available to the organization can become very expensive, unproductive and actually drag the organization in the wrong direction."
At Banyan, the executive team is engaged in the development of the organization's technology plan.
"The Banyan technology team and five-year plan are aligned to the vision and direction of the organization," Guthrie explained. "Our plans are developed with executive sponsorship and all annual budgets are consistently realigned to this vision.
"Our year-to-year operating plan encompasses our resolve to excel in service delivery through consistent systems availability and having the best talent in our technology staff and business partners."
Guthrie and the IT team believe achieving these technology benchmarks will further reinforce the organization's commitment to providing quality patient care and enable staff to achieve their standards of excellence, as well. This plan is presented to the board of directors and managed daily to the standards the team has set.
Open and cross-disciplinary collaboration
To quickly grasp the problems that the pandemic presented and identify possible solutions, it was crucial to encourage and support open and cross-disciplinary collaboration, observed Landman of Brigham Health.
"We needed to share best practices and pitfalls, and collaborate to innovate at a rapid pace in a time of crisis," he explained. "Having strong vendor partnerships and peer institution relationships were also critical. Reaching out to other health systems to see what they were doing – and learning from their mistakes and successes – sped up our efforts."
"To address financial challenges unleashed by the pandemic, health systems will need to innovate closer to the core of operations, with a focus on rapid value creation, cost efficiency and continued recovery."
Dr. Mark Zhang, Brigham & Women's Hospital
For example, Brigham learned from Providence St. Joseph Health in Renton, Washington, how it was using chatbots to help triage patients with COVID-19 symptoms to appropriate care settings, and then implemented similar solutions.
"We also paid it forward by sharing our learnings with other organizations that approached us," Landman said. "We made the COVID Pass source code freely available on GitHub, and we are proud to see versions of the app now being used at other institutions across the nation. We launched a digital crowdsourcing campaign to make it easier for staff to voice needs and suggest new solutions using existing resources."
Brigham also took part in virtual hackathons to pitch its most pressing problems and seek solutions from the external community.
"COVID-19 has certainly accelerated imperatives in a few key areas that will continue into this new calendar year and beyond," said Zhang of Brigham & Women's Hospital. "To address financial challenges unleashed by the pandemic, health systems will need to innovate closer to the core of operations, with a focus on rapid value creation, cost efficiency and continued recovery."
With patient preferences for convenience, choice and simplicity growing stronger than ever, Brigham will need to accelerate efforts for building a "digital front door" and delivering digitally differentiated experiences, Zhang added.
"To address these large, complex imperatives, we will need continued robust technology partnerships, and open and cross-disciplinary collaboration, while also learning from industry trends outside healthcare, and watching closely to see how we can translate newer technologies and engagement models into healthcare to drive digital transformation," he said.
The M*A*S*H model of care
Friestad of Avera Health described one more lesson learned over the past year: the need for what she calls the M*A*S*H hospital, referring to the military hospital portrayed in the popular film and TV show.
"As we moved from a trickle to a full-blown five-inch-firehose surge with COVID, we quickly realized that at 36 adult ICU beds for our 544-bed hospital, we were needing to somehow increase this bed capacity, including monitors, ventilators and negative airflow rooms, to accommodate the very ill patients with a positive COVID-19 diagnosis," she explained.
"And as we moved further into the summer months and a second surge in the fall, their length of stay exceeded two to three weeks."
It became clear that Avera's best course of action at that time was to forego elective surgery for a period of time and turn those areas (ORs/PACUs) into critical care units. There were several facilities on the East coast that already had moved in that direction, and from a technology perspective, it made the most sense, Friestad said.
"Between IT, bio-medicine and clinical informatics, the transition of those rooms to critical care rooms was truly outside-the-box thinking, and an all-hands-on-deck approach," she said. "Nursing and providers were key in helping move to a different approach of care location and the various departments working together toward a common goal was wonderful to be part of."
Relationships with both employees and vendors were crucial during this period, and those relationships have continued to be strong as Avera unbundled and unpacked these changes as 2020 became 2021, she added.
"We're all in this together," she said. "As we look toward leveling the healthcare playing field, we should not waste this particular crisis in realizing we are all better together. A diverse teamwork approach will be necessary in the future if we're to survive in one piece, because this is not a singular crisis."
This pandemic has reverberated throughout healthcare and has highlighted the substantial cracks in the foundation, she contended.
"If we are to learn from our mistakes and meet the needs of our patients in the future," she concluded, "we'll need to be flexible and innovative in constructing our future healthcare delivery model."