On Best Practices

Systems at scale and optimized workflow

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IT teams work at scale all the time supporting thousands of users. Workflow optimization is often a goal for new systems. The mass vaccination sites and events are at scale and depend on an optimized, efficient workflow. With over 2 million doses a day being administered now in the U.S., these sites and events are becoming more prevalent and will continue over the next several months. While there was much publicity of the problems in the vaccine rollout early on, there have been many improvements in the tools to find vaccine locations and schedule appointments, and the administering of shots. In part that has been due to improved technology and better workflow design.

Two health systems doing mass vaccination sites/events have shared their playbooks in recent weeks for others to learn from. UCHealth in Denver is offering a playbook, “COVID-19 Mass Vaccination Drive-Through Playbook”. It is a 59 page comprehensive and very detailed playbook covering organizational structure and partner involvement, pre-event planning, contingency planning, patient communication, staff, provider and agency recruitment, vaccine storage and handling, and media communications. The Atrium Health playbook is a higher-level guide for leaders – “A Leader’s Guide to Safer, Faster and More Equitable Community Vaccination Events”. Both are valuable tools whether you are in the planning stage or tweaking your current operation.

To build on these tools, I recommend checking out two recent interviews that Bill Russell did at This Week in Health IT.

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We got our shot!

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My husband and I got our first dose vaccine shot on Saturday. And yes, there is a sense of relief to be at this point a year after it all started.

March 5, 2020 feels like the last normal day for me. I had lunch in a restaurant with my daughter who is an NP at a Boston hospital. I was anxiously waiting to hear that HIMSS20 would be cancelled and wondered what they were waiting for. I discussed the risks of going with my daughter. I decided during that conversation not to go even if they held it (I got the cancellation notice as we were leaving the restaurant). I asked her about the Coronavirus from a clinical perspective. She said we’re “f’d” and projected 100,000 cases in the U.S. by April 1st. We now know it was to be far worse.

As a frontline healthcare worker, she was fully vaccinated by early January. Two weeks ago, she helped about fifteen of her husband’s 65 years and older family members and their friends navigate the somewhat confusing multiple websites in Massachusetts to schedule first dose appointments.

Here is my Rhode Island story. The vaccination site was a junior high in our town. Overall, it was a smooth process. When we pulled into the parking lot there was a sign that said wait in your car until 5 minutes before your appointment to avoid people crowding at the door. Our town Mayor was there working – that was a pleasant surprise. He took temperatures and asked initial screening questions at the door. I greeted him and commented on the fact that he was working – his somewhat joking reply was, “I have to earn my keep”.

Next, we went to the “check in” table. We gave them our IDs and they looked us up on the list of people scheduled for an appointment that day. The list was in no sort order, so it took a while. We then moved into the gymnasium where there were about eight vaccine stations. Firefighters and EMTs gave the actual shots. My husband was considered to have moderate risk of a reaction, so his PCP advised him to stay for 30-minute observation. When he shared that information, a physician was called over to ask him a few questions before he got the shot.

With information on how to sign up for the CDC’s v-safe app (after vaccination health checker), and our vaccination cards in hand we went to the observation area with many seats set up socially distanced. There were several people wandering around the area offering to help you make your second appointment or you could just use the QR code they provided on posters visible on the backs of the chair in front of you to sign up for 4 weeks out.

If you know me well, you know that I always have an eye out for process improvements. Continue reading →

What is a “Digital Dog”?

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My colleague, David Muntz, coined the term “digital dog” this week when he described to our StarBridge Advisors team how my two little dogs are so well informed as they walk with me every day while I listen to podcasts. I loved the term and the image!

There is so much great content to listen to. I sometimes feel like my little dogs with their short legs trying to keep up with me as I try to keep up with my two favorite podcasts – This Week in Health IT and In the Bubble. Yes, I subscribe to many more, but these are the top two that I keep up with best I can.

This Week in Health IT is three different weekly shows (each approximately 45 minutes long) – Newsday (Monday), Solution Showcase (Wednesday), and Influencers (Friday). And starting this year Bill Russell decided his audience could benefit from another option so he launched a daily news show on a separate channel – Today in Health IT (shorter at 8-10 minutes each).

I agreed to be one of the rotating co-hosts on Newsday this year. My second episode with Bill was this week – Newsday – Drive-Thru Vaccine Distribution, Reaching the Marginalized, and CIO Priorities. The first topic we covered was the UC Health Mass Vaccination Playbook – a comprehensive resource that is worth downloading. Even if you are already doing similar mass vaccine sites, I am sure there is something to learn from their playbook to refine and improve your own operation. Best practice sharing is what we do in healthcare! Check out the podcast to hear all the stories we discussed.

So that’s my plug for the best podcast series to keep up with what’s happening in health IT.

Turning to my other top podcast, In the Bubble. This is how I stay educated on COVID-19 and all things related. Continue reading →

Ensuring go live success for large scale IT projects

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Since the pandemic, major system implementations at health systems have continued with successful go lives supported by virtual or hybrid remote/onsite teams. Many organizations have “go live” success stories in this new world of remote work. While virtual support may change some things and certainly presents new challenges, the core work of a successful go live is still the same.

In late 2019, I published several blog posts on successful go lives based on firsthand experience with a major Epic implementation. Here they are again with basic lessons and tips:

10 Go Live Command Center lessons from the field

Epic Go Live – report from the field

9 Tips for Go Live support success

I welcome your comments on any virtual or hybrid go live experiences you have been involved in during the past year. If I get enough new lessons and tips, I will write a new blog so all can benefit. After all, continual learning and sharing best practices is at the core of what we do in healthcare.

Why this topic this week? I am currently working with a client who is less than six weeks out from an ERP go live so it is on my mind a lot. We are doing what we refer to as an Independent Verification and Validation (IV&V), a framework that facilitates audits of major IT projects regardless of area and complexity.  We explore 11 categories in-depth.  The topics range from governance and budget to training and QA.  The detailed analyses for each area involve document review and interviews to ascertain the status of the project.  A risk score is assigned in each of the 11 areas and mitigations are suggested based on the findings.  Ideally, over the life of the project there are three IV&V sessions conducted prior to go live and one session after go live to ensure that projects stay on course, make corrections as necessary in a timely manner, and achieve the defined objectives.

If you think an IV&V from my advisory firm, StarBridge Advisors, is something that your organization can use, please contact us to discuss.

Vaccine rollout – it takes a village, part 3

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Let’s start with the big picture and some good news. There are downward trends in the key COVID-19 indicators – the number of new COVID cases, hospitalizations, and deaths. But we know there is no good news in 3,000 deaths per day and nearly 500,000 deaths since the pandemic started a year ago.

In terms of the vaccine, there is good news at a macro level. According to the Bloomberg COVID tracker, 48 million doses have been given in the U.S. with an average of 1.62 million doses administered per day, 14.6 doses have been administered for every 100 people, and 70% of the shots delivered to states have been administered. (as of 2/11/21 at 6:25PM)

There are more examples of mass vaccination sites with thousands being vaccinated in a single day at stadiums around the country. UC Health in Denver is offering a playbook for mass vaccination sites to other health systems – best practice sharing is something we do very well in healthcare.

Dr. Anthony Fauci projects that by sometime in April, the vaccine will be available to anyone who wants it. That seems very optimistic considering many states are just now in mid-February beginning to vaccinate anyone over age 75. President Biden says there will be enough vaccine supply to vaccinate 300 million in the U.S. by the end of summer.

Access issues continue with a lot of confusion and frustration for those in qualified groups trying to make appointments either online or by phone.  It has become a family affair for many as younger family members try to help their elders figure out how to get vaccine appointments when there are multiple channels possible in their state or city and multiple different websites to go to. I applaud the various initiatives of software engineers in Massachusetts and New York who based on their own frustrating family experiences created a way for people to check availability of vaccine appointments. But we should not have to rely on such solutions. I would expect our government agencies to have made it simpler to begin with.

I just learned of another tool that notifies people via text message when there are leftover doses in their zip code so no dose goes to waste – Vaccination Standby  List. According to the website, their mission is  “to reduce COVID vaccine waste, reduce unnecessary lines and crowds at stores, reduce misinformation of leftovers, and allow as many people as possible to take advantage of any leftover doses”.

Disparities in vaccine distribution are real. We need more examples like the one in South Los Angeles where Dr. Jerry P. Abraham and the Kedren Community Health Center set up a walk-in site described in the Los Angeles Times article by Erika D. Smith on January 29, “Column: How a South L.A. doctor is beating the system and distributing vaccines equitably”. In Dr. Abraham’s interview on MSNBC’s Rachel Maddow Show on February 5, he said that he and his team are extremely solutions oriented and recognized that people with no car, no Internet access, and no email needed a workaround. Continue reading →

Vaccine rollout – it takes a village, part 2

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Last week’s blog post on vaccine rollout took longer than expected to write as I compiled multiple resources and articles to comment on and share. With the vaccine rollout as massive an undertaking as it is and so many stories (good and bad), I decided to do part 2 this week highlighting best practices, technology challenges, and health disparities.

Best Practices

Last week, I mentioned Atrium Health and their local partnership to do mass vaccination events. It was encouraging to see their update on vaccinating over 20,000 people had a special emphasis on underserved communities.  We need more focus on underserved communities – more on that in a bit.

Another health system doing drive thru vaccination clinics at scale is Memorial Hermann in the Houston area. They are getting calls from health systems across the U.S. asking for guidance on how to design similar large-scale vaccination events and are more than willing to share their blueprint for others to replicate according to Binita Patel, Vice President of Pharmacy Services for Memorial Hermann Health System. The location (NRG Park) and staffing (700 people including many volunteers) were key to their success.

We cannot forget that there are many people leery of the vaccine, sometimes referred to as “vaccine hesitancy”. Education and public health messaging campaigns will be key as the vaccine rollout continues over the next several months. Based on the Kaiser Family Foundation’s latest COVID-19 Vaccine Monitor report, there are key messages that resonate with people. They are listed in this short article from Becker’s Health IT : “8 most convincing messages to promote COVID-19 vaccines”.

Many health IT vendors pivoted their products and services to support COVID-19 over the past year. Vaccine scheduling is the latest focus area for vendors like Kyruus which shared best practices and insights from their customers in their recent blog: “Eight Best Practices for COVID-19 Vaccine Scheduling Online: Insights From Our Health System Customers”. A great transition to the next topic.

Technology Challenges

I mentioned the Vaccine Access Management System (VAMS) in my post last week as a system provided by CDC to states and other organizations for pre-screening, registration, scheduling and tracking. Not surprisingly, a software solution developed quickly and made available for many different but similar situations and workflows has experienced problems as captured in this article from MIT Technology Review. I would hope the problems can be resolved so organizations using it do not have to switch systems midstream with vaccine rollout already in process and moving rapidly. Continue reading →

Vaccine rollout – it takes a village

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The vaccine is top of mind for many of us and a lead news story most days. Whether we are in a prioritized group wondering when/how/where we will be able to get the vaccine or are helping a family member in one of those groups sort it out. We are disappointed to hear the supply from Pfizer and Moderna is so limited at this stage. We are frustrated and anxious not knowing when we will be able to get the vaccine.

I share all those feelings. I am anxiously waiting to learn when my state of Rhode Island will start vaccinating 65+ so I can get my husband and I an appointment. With the percent of doses administered overall in Rhode Island only 56% of what has been distributed and our state currently receiving just 14,000 new doses each week, I am not optimistic that it will be soon.

In spite of any frustration you may feel about your own state’s progress, the good news at the macro level is that in the last week, an average of 1.25 million doses per day were administered in the U.S. That is even better than the goal of 1 million per day for the first 100 days of the Biden Administration. And there is more good news regarding the supply – 200 million more doses were ordered by the Biden Administration this week with the expectation that there will be enough doses for everyone who wants the vaccine by sometime this summer.

We know that vaccine plans vary by state. How to Get a COVID-19 Vaccine: A State-by-State Guide from the Wall Street Journal provides state website links and brief description of each state’s status. States vary on how groups are prioritized, the scheduling process and systems used, and the total number of doses available. In the 65+ group, I have friends and family who have driven more than 500 miles around their state for separate husband and wife appointments that they could only make at two different locations due to the demand, a couple who was only able to register for a lottery with 8000 doses to serve 250,000 people, a couple who relatively easily made appointments at their grocery chain to receive the vaccine from the pharmacist, and a couple who relatively easily made an appointment at a local community vaccine site.

The New York Times has a vaccine calculator – Find Your Place in the Vaccine Line – that puts it into perspective. You enter a few key data points and can see where you are in line within the U.S., your state, and your county – in other words how many thousands or millions of people are ahead of you. The graphic it produces helps you understand the order of groups and their relative size.

There are two trackers you might find interesting. The Johns Hopkins Coronavirus Resource Center tracks cases, testing and vaccines by state. You can see how your state is doing and where it ranks on vaccinations. The Bloomberg tracker shows how your state is doing by percent of doses used and number of doses administered.

There is a software system available from the CDC for states, counties and other organization to use – Vaccine Access Management System (VAMS). It handles pre-screening, registration, scheduling, and tracking. My state of Rhode Island will use PrepMod – a software solution in use by several states. Health systems appear to be using their own systems and assuming that patients can schedule through their patient portal or by phone. Some allow you to create an account if not already a patient.

I think we can all agree that front line health care workers needed to be first in line for the vaccine. But there have been stories of health systems vaccinating employees who only work from home, volunteers who aren’t coming into the hospital during the pandemic, board members and others who don’t appear to be in priority groups per the CDC guidelines. These systems have defended their actions by saying the more people vaccinated and the sooner is good for the community and that all staff are critical to the hospital’s operations. I can understand the frustration of people who are patients of those systems and in a prioritized group (such as elders or with underlying conditions) yet still waiting to learn when they will get the vaccine.

Let’s pivot to some positive stories of vaccine partnerships involving health systems to deliver shots in arms at scale. Continue reading →

Developing next generation leaders 2021 style  

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In 2021, I have said yes to one more way I can help develop next generation leaders. I am excited to be one of the rotating co-hosts on This Week In Health IT Monday Newsday series. Bill Russell has done an amazing job the past three years growing and evolving This Week In Health IT into several different podcast series and channels. Bill shares my commitment to developing next generation leaders through his many different offerings, so I quickly said yes when asked to be one of the co-hosts in the new format of the Newsday series.  Our first episode together will be available January 11, so I hope you will check it out.

Bill’s commitment and goal is clear: develop the next generation of health leaders by amplifying the best thinking. This Week In Health IT has proven to be a valuable contribution to our industry. My health IT advisory firm, StarBridge Advisors, is proud to continue as a channel sponsor in 2021.

After a very successful 2020 with 230,000 downloads and 177 new episodes including the daily COVID Field Report series from March to July, Bill has changed things up yet again for 2021. There are several options to pick and choose from for yourself and to share with your teams. These offerings provide a no-cost, easy, accessible way for staying current and continuing to learn from others.

Monday Newsday – replacing the Tuesday Newsday show, every Monday Bill will have a co-host to discuss key stories in the news.

Wednesday Solutions Showcase – 2020 episodes highlighted AI, Robotic Process Automation, Machine Learning, End Point Security, Social Determinants of Health partnerships, Mental Health integration with primary care and more.

Friday Influencers – Interviews with industry leaders. Guests include IT leaders, health executives and experts who can shed light on the challenges that healthcare faces and the potential solutions. Continue reading →

Looking ahead to 2021 – predictions, emerging trends, and some advice

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The calendar is a familiar demarcation for the close of one year and the start of a new year. We celebrate together and make resolutions alone. Never in my lifetime has there been a year that I have wanted to see in the rear-view mirror more than 2020. I know that I’m not alone in that sentiment. But the true demarcation will only come later in 2021 when enough people have been vaccinated and we can say this pandemic is largely behind us.

Health IT leaders and their teams across the country have demonstrated incredible creativity, collaboration, resilience, and commitment to their communities this past year. I am in awe of and encouraged by what they have accomplished.

As we come out of this long, dark period in our history with so much loss and so much learned, like others I have some advice for IT professionals next year.

My StarBridge Advisors colleague, David Muntz, has already shared his thoughts on the challenges and opportunities for the coming year as he does each year in a View from the Bridge blog post – “12 Steps to Prepare for 2021 – Big Challenges – Bigger Opportunities”. As always, David has done an excellent job of capturing the key ones with his comments on collaboration, reinventing your IT organization, partnerships, life-work balance, cybersecurity, SDOH, EHR satisfaction, ERP solutions, and more.

I’ll add a few to the list:

    • Capture and institutionalize what allowed your team to work at “COVID speed” – laser focus, fewer concurrent priorities, rapid decision making, and funding.
    • Double down on efforts to increase interoperability within your system and region. Enhance your analytic capabilities. Scale and extend virtual care options which will continue to represent a good portion of care even post-pandemic.
    • Establish the right balance of onsite and remote work for your team once it is safe to return to the office. Account for both the organization’s needs, and your employees needs. Continue to be flexible knowing your team delivers regardless where they are working. Use your new model as an opportunity to rethink your recruitment and talent strategy.
    • As CIO claim your expanded role whether it is as Chief Digital Officer, Chief Innovation Officer, or leading a non-IT operational area. You have more than proven yourself during this pandemic and the rest of the c-suite knows it.

Continue reading →

8 health experts to follow

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In past years, I’ve used the end of the year mark as a way to highlight my most read blogs of the year and encourage you to check them out if you missed them. But who cares about my most read blogs? Instead, I want to amplify the voices of health experts who have educated us throughout this pandemic and who will continue to for many months to come. If you aren’t already following them on social media or listening to their podcasts, I encourage you to do so. They are often interviewed on the major news programs.

Trusting the science, knowing the facts, and maintaining objectivity are critical for all of us to do our part and get safely to the other side of this pandemic.

Here are the experts I recommend you follow in alphabetical order:

Esther Choo, MD, MPH, Co-Founder, Equity Quotient, is an emergency physician and professor at the Oregon Health & Science University. She has been speaking from the front lines of the pandemic since the beginning. She did a podcast series called Doctors’s Log – A Covid-19 Journal in the early months of the pandemic. Twitter: @choo_ek

Laurie Garrett is a Pulitzer Prize winning science journalist and author of several books including “The Coming Plague: Newly Emerging Diseases in a World Out of Balance” and “Betrayal of Trust: The Collapse of Global Public Health”. In 2007, she did a TED talk “Lessons from the 1918 Flu”.  Twitter: @Laurie_Garrett

Ashish Jha, MD, MPH, is an internationally respected expert on pandemic response and preparedness. He recently left his position as faculty director of the Harvard Global Health Institute and became dean of the Brown University School of Public Health.  His recent interview on In the Bubble with Andy Slavitt, “The Next Three Stages of COVID-19”, is worth checking out. And as I just learned, he also has his own podcast series, “COVID: What Comes Next”. He is a frequent contributor on all the major news outlets. Twitter: @ashishkjha

Vivek Murthy, MD, MBA, has been nominated as the next U.S. Surgeon General, a role he also served in during the Obama Administration.  He is the co-chair of the Biden COVID Task Force. His recent interview on in the Bubble with Andy Slavitt, “Inside the Biden COVID Task Force”, is worth checking out. Twitter: @vivek_murthy

Michael Osterholm, MS, MPH, PhD, is the director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota and is a world-renowned epidemiologist who has spent his career investigating outbreaks. He is a member of the Biden COVID Task Force. Continue reading →