On Best Practices

More podcast recommendations – going beyond HIT

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If you are like me, there is no gym time and no commute time these days. But there are still ways to get exercise every day. My long daily dog walks are one of those times when I try to get smarter. And podcasts are the means.

I have made podcast recommendations in the past and still have my favorite “go to” for health IT but I have added a few more in recent months.

ThisWeekinHealthIT – this has been my “go to” podcast since Bill Russell started it in 2018 as a weekly show. In 2019 he went to a twice weekly format. And during the pandemic, he went to daily podcasts with an excellent and very timely Field Report series – interviews with health IT leaders on how they are managing during this crisis and preparing for recovery and the new, better normal. Many great lessons and insights have been shared the past few months. Kudos to all his guests for their incredible work and making time to share with others. And kudos to Bill for his ongoing commitment to developing next generation leaders. My firm, StarBridge Advisors, is a proud sponsor of the show and share in that commitment.

Digital Health Leaders – this is a relatively new podcast series started by the College of Healthcare Information Management Executives (CHIME) a few months ago. Russ Branzell, CHIME President and CEO, interviews IT leaders on a range of topics.

Relentless Health Value – this is a podcast I first became acquainted with when I was asked to be a guest back in 2018 – my episode was “The Evolving Role of the Chief Information Officer”. But IT is not the focus. Stacey Richter, a healthcare entrepreneur and innovator, has hosted the show since 2014. The website describes the podcast this way: “The show that connects you with other health care leaders trying to achieve the quadruple aim of improving population health and patient and provider experience, while managing costs effectively. Our mission is to help transform health care by breaking down silos and connecting disconnected parts of our industry. The first step toward collaboration is simply knowing what others are working on and wrestling to overcome.” So, if you want the big picture on healthcare and not just IT, add this one to your list. And like Bill, Stacy has a special COVID-19 series as well.

And continuing down the beyond IT path, I have recently started listening to a few other ones: Continue reading →

Hospitals too are part of a safe reopening

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This past weekend was the unofficial beginning of summer. After 2+ months of stay at home orders and a few weeks of phased reopening depending on the state you live in, the images of large crowds packed in close and without masks at a pool in Missouri, on the boardwalk in New Jersey and at a race track in North Carolina were concerning. As I hope many others chose to do, we stayed home and had a family visit on our patio at a social distance.

We are hearing stories of super spreaders from Mother’s Day two weeks ago resulting in upticks of COVID-19 cases in many states. We see stories of a hair salon in Missouri where two stylists who were ill exposed over 140 customers. We see stories of no available ICU beds in Montgomery, Alabama where cases have reportedly doubled since that state reopened two weeks ago.

On Friday, the President ordered churches to reopen and threatened to override governors who refused to do so. Fortunately, many faith leaders acted responsibly and outlined plans for continued online or outdoor services until they are certain that they can safely reopen their doors to congregants.

News reports say the virus is still spreading at epidemic levels in 24 states and is not contained. This pandemic is not over. And it may be a long time before it is. So how do we begin to recover and safely reopen? Continue reading →

Knocking on the digital front door

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Health systems are learning many lessons during this pandemic that they will need to carry forward into the recovery and “new normal” phases. One of them may be the need for an integrated digital health strategy, and more specifically a patient focused “digital front door”. The almost overnight shift from in-person ambulatory visits to virtual visits during this pandemic highlighted the need for a more integrated approach for many health systems.

An integrated strategy for a patient centered digital front door has many components including the core website, the patient portal linked to the electronic health record, improved access and scheduling capabilities, call centers, and care delivery through virtual visits. The goal is to meet patients where they are and guide them along the right care pathway with efficient, consistent, and easy processes in the background.

However, these multiple components and functions are often led and directed in an uncoordinated manner by different senior leaders within the organization. The core website is typically owned and directed by Marketing and Communications with technical support from IT. The patient portal is often managed by the ambulatory team in IT partnering with the Chief Medical Information Officer, Ambulatory Services, and Marketing. Improved patient access and scheduling initiatives are often directed by Ambulatory Services or in an academic medical center by the Physician Practice Group leadership. The call center may be managed by Marketing or Ambulatory Services leadership. And telehealth may be provided by a specialized team either connected to or part of IT but be directed by physician leadership.

A successful patient centered digital health strategy needs to involve all these components in a coordinated, comprehensive manner. In some respects, who leads this strategic initiative does not matter. What does matter is that there is buy-in and collaboration from all leaders involved with a common overarching goal to meet patients where they are at and provide an easy, consistent experience to access services. Continue reading →

IT requests increase while budgets decrease

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As hospital systems develop their COVID-19 recovery plans, the financial impact of this pandemic is deep and far reaching. IT budgets are no exception. IT leaders are being asked to take salary cuts, furlough staff, and deal with a capital freeze for the rest of the year. This comes at a time when the demand for technology solutions is only increasing. And at a time when IT teams have performed at their peak in providing and supporting new solutions with agility and in record time.

In a recent Becker’s Hospital Review article, Hospital IT Spend Pivots to Mission Critical Projects: 7 Leaders on the Key Focus for the Next 12 Months, IT leaders covered telehealth, digital transformation, analytics, informatics, and of course the reality of cost reduction facing them and their organizations.

IT leaders have long faced the supply vs demand challenge. And they have long faced the need to reduce their budgets while meeting a growing user base and increased demand for technology solutions. The days of significant year to year budget and staff growth in IT are a distant memory.

As we look to the future after the COVID-19 recovery, some people talk about the “new normal” phase and others refer to it as the “re-imagine” phase. The latter certainly encourages us to think differently. Regardless, it will be with far less resources. So how does IT manage and ensure success in this ever more constrained environment? Continue reading →

What next for health IT?

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Two weeks ago, I wrote about looking ahead to the “new normal” post COVID-19. Since then some states have started slowly re-opening while other states are defining what their phased re-opening approach may look like. Hospitals have started to develop plans to expand their services beyond emergencies and COVID-19 patients – performing elective surgeries and opening outpatient clinics. All of this is new territory. Patient scheduling, workflow changes, and appropriate staffing and PPE to provide safe care must be accounted for and planned for very carefully. This will happen over the coming weeks and months.

Given the financial impact COVID-19 is having on healthcare systems, executives also need to be looking at how to position their organization for not just recovery but long-term success. One of the articles that I have seen on this is a white paper published by the Chartis Group – “After the Surge: Five Health System Imperatives in the Age of COVID-19”. In it they discuss how COVID-19 has fundamentally changed the care delivery landscape. They outline what they consider to be the five imperatives for future health system success:

  1. Engage consumers and other referral sources to recapture patients
  2. Fundamentally reduce the cost base
  3. Restructure the physician enterprise
  4. Transform the clinical operating model
  5. Closely evaluate partnerships, both horizontal and vertical, traditional and non-traditional

Other management consulting firms that work with healthcare providers most likely have a similar analysis and framework. Regardless what they may look like, all of these long-term efforts will require IT support. Continue reading →

Leading through a crisis

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As a leader, you are called upon to lead in good times and bad. At normal times and when there is a crisis. It may be an incident in the community with mass casualties, a natural disaster, or a widespread pandemic as we are living through. Barring any of these truly awful crisis, it might be a system failure and as an IT leader you are front and center. Whatever crisis you may face, it requires the best of your leadership skills.

Here is my list of the needed skills from my own experience and watching the best leaders in our current global crisis.

  • Communicate often to everyone involved and impacted. Be open and transparent.
  • Focus on the facts. Be explicit when you are stating opinion instead of fact.
  • Own the situation. Don’t make excuses. Take responsibility.
  • Be genuine and empathetic. Stay connected.
  • Stay calm and project calmness.
  • Be available and present. Stay close to your team. Provide the encouragement they need.
  • Listen to the input of others, especially the experts.
  • Be adaptable and ready to make quick decisions.
  • Lead by example in all you do.
  • Let your organization’s core principles guide you.
  • When you can, look ahead and past the crisis. Develop a return to normal plan
  • Capture lessons learned.
  • Express gratitude often. There are many heroes in a crisis. Find them and thank them.
  • And don’t forget to take care of yourself.

I have heard many health IT leaders describe the work they are doing in support of their hospitals during this pandemic – some common themes are being nimble, partnering closely with clinicians, staying focused, ensuring the safety of their onsite staff, being responsive with a can do attitude and providing rapid, innovative solutions. I have great respect for all of them as they navigate and lead during this unprecedented time.

Becker’s Hospital Review published a summary of advice from healthcare leaders last week titled “73 hospital leaders in 10 states hit hardest by COVID-19 offer advice to colleagues: If you do nothing else, at least do this”. Respondents are from New York, New Jersey, Massachusetts, Michigan, California, Pennsylvania, Illinois, Louisiana, Florida and Texas. The responses are organized by theme – I focused first on the leadership, communication and strategy theme. Continue reading →

Looking ahead – the “new normal” post COVID-19

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It’s hard to think about anything good coming out of this pandemic. Every story of a life lost is heartbreaking. Like you, I have shed many tears in the past month as I read and heard their stories.

And yet, it is encouraging to consider some of the positive changes we may see when we get to the other side of this crisis and are living and working in the “new normal”. We don’t yet know when that new normal time will come. But there are changes in healthcare and how we work that will hopefully be long lasting. I’m not talking about the overall healthcare system or macro societal and economic changes – I’ll leave that to others.

From a health IT lens, here’s my take on some of the positive changes:

Telehealth – There is no question that this crisis has led to a huge increase in telehealth and new use cases. Some organizations are seeing 50+ times the number of telehealth visits compared to before. With regulations relaxed and no alternative, telehealth is being used in many different scenarios. Training, broad deployment and adoption has accelerated as clinic visits are cancelled and telehealth becomes the primary means to connect with your physician. And on the frontlines of COVID-19 hospital care, leveraging it with inpatients to protect staff and reduce the amount of PPE used has also become common. We’ve reached the tipping point for telehealth and I expect we’ll see it continue to grow in the future. A recent article in NEJM Catalyst by Judd E. Hollander, MD, and Frank D. Sites, MHA, BSN, RN, titled “The Transition from Reimagining to Recreating Health Care Is Now”, covers how organizations need to look at expanded telehealth use post COVID-19.

Rapid deployment – From an IT perspective, supporting the effort to stand up a field hospital or alternate care site such as the 1000 bed Boston Hope Medical Center is like a “greenfield” hospital compared to rolling out a new EHR and the associated infrastructure at an existing hospital. What lessons can be learned and applied from these rapid deployments when it comes to getting all hospitals in a healthcare system on a common platform? Does it have to take years?

Interoperability – I use this term loosely here. New York considers all hospitals statewide as one system to share resources and staff. The Hospital for Special Surgery (HSS) in New York City quickly transitioned from an orthopedic only hospital to take other surgical cases and COVID-19 patients, credentialing physicians and providing access to systems. While state and regional Health Information Exchanges (HIEs) have varied in their successes over the years and physician credentialing is one of the slowest and most tedious administrative processes in healthcare, it gives me hope to see how effectively and quickly hospitals are working together in a time of crisis.

Workflow changes – With EHR systems it can often take weeks or months to identify requirements, reach consensus, make the changes, test, train, and implement. Those changes are now measured in hours or days if it’s needed for COVID-19. IT teams and their clinical partners should ask what processes can be streamlined when we are in the new normal. Continue reading →

How daily life has changed

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Whether you live in a state with strict stay at home orders from your governor or are still going about your life with few adjustments other than social distancing and more frequent hand washing, your life has changed.

You may be an essential worker reporting to your workplace each day or adapting the best you can to working from home or fearing a layoff or already out of a job at this point.

You may have elder parents living with you or other family members with health issues that make them high risk.

Regardless, your life has changed. The fears, uncertainty, anger, sadness, exhaustion, confusion, and so many other emotions and feelings are real. We all have them.

Self-care is important for all of us. As a CIO/CMIO colleague keeps telling his team, it’s a marathon not a sprint. The image I used this week is one of my favorites shared on Facebook by Brooke Anderson, a photographer in California. It’s a good reminder of how we need to take care of ourselves..

Here’s what my daily life looks like now:

  • Staying at home: My husband and I haven’t been anywhere in 2 weeks except for when I picked up takeout at a local restaurant over a week ago.
  • Working from home: Splitting time between our StarBridge Advisors business and work with a health system client on a variety of projects.
  • Exercise: Walking our two little dogs and trying to get 10K steps each day keeping appropriate social distance with all the other walkers. There is a joy in seeing the spring flowers and buds on trees change each day – gives me hope!
  • Family connection: Talking to my sister in Minnesota where I grew up and where all my three siblings and their families live. Keeping in touch with my daughters and their changed lives. One daughter is a Nurse Practitioner who will soon be caring for COVID-19 patients while her husband adapts to working full-time from home and their 3 and 5-year-old kids play together. The other daughter was already working from home; her husband is adapting to working from home while their first grader is doing the eLearning school program and their 5-year-old plays.
  • Sharing resources: It’s hard to not be in the thick of it knowing what healthcare organizations are going through and how IT teams are working hard to support them. I’m channeling that energy into supporting Bill Russell and “This Week in Health IT” with a growing number of free COVID-19 resources for health IT teams.
  • Social media with a purpose: I try to share what is most informative and useful as well as positive and motivating.
  • Managing how much news I watch: On my busiest workdays I only watch at night. On more flexible days, I get snippets mid-day. In the spirit of being positive, I will say that the leadership demonstrated by New York Governor Andrew Cuomo is the leadership we need at all levels of government – fact based, informed, action oriented, and empathic.

And as the days blend together, the weekly routine now includes a couple new things. We gratefully receive grocery delivery that our nearby daughter has helped coordinate. We do a weekly family video call where the four grandkids stick their face right up to the camera and call out to their cousins then eventually go play so the six adults can talk and check in with each other. And we make a quiet moment to do Sunday online church which are YouTube messages from our ministers that we can watch anytime.

No matter what your days look like now, practice self-care. There are many resources out there to support you. The latest This Week in Health IT podcast – “Mental Wellness During Crisis” with Dana Udall PhD, Chief Clinical Officer at Ginger is definitely worth listening to.

Whatever you might fear or feel inconvenienced by during this pandemic, think about the healthcare workers who like firemen run into the burning building, not away from it. They are going to work so we can stay home. They and all the essential workers who are keeping things running are the true heroes. To them I say thank you, be safe and well. To all of you, take care of yourself and those you love. We will get through this – together.

COVID-19: Health IT collaboration and best practices

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We are an industry that shares best practices and continually learns from one another. As we all deal with uncharted territory, that sharing is needed more than ever before. In conversations with healthcare CIOs it

Message from Brigham and Women’s Hospital OR nurses: #StayHome

is obvious that the amount of work currently being undertaken by health IT teams is extraordinary.

In that spirit, this week I’m highlighting several resources that might be useful to health IT teams:

Through ThisWeekInHealthIT Bill Russell has produced valuable podcasts for health IT professionals for the past two years, interviewing healthcare executives and IT leaders across the country. Last week he pivoted to focus on COVID-19 with two new services:

COVID-19 Resources is a page dedicated to COVID-19 resources during this time. It’s a resource site for health IT teams when they are asked to stand up a relevant technology or implement a technology enabled process. Visit the page now to see what’s already been shared. And you can help him help others. Just forward any resources for health IT that you are willing to share to Bill at hello@ThisWeekinHealthIT.com

Podcast interviews with health IT leaders on the front lines of the pandemic who are willing to share some of their preparedness challenges, lessons and best practices:

COVID-19 Prep with Baptist Health KY

  • Standing on the lessons of the past
  • Protecting the care providers during COVID-19

COVID-19 Prep with Asante Health OR

  • Establishing communication in crisis
  • Preparedness huddles
  • Prioritization of IT work
  • Leadership skills needed

Continue reading →

Healthcare providers on the front lines of Covid-19

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In my blog last week, I consciously decided to avoid the Covid-19 topic. The situation was evolving day to day and I asked myself what useful insights or comments I could possibly have.

Just 11 days ago, the cancellation of HIMSS20 conference was announced. Many of us were hoping for this as we worried about being in a convention center with 45,000 people from not just around the country but around the world. With the cancellations of major sports, Broadway, closure of Disney, limits on the size of large gatherings, and school closings, the times have changed drastically in a matter of days.

We are being encouraged to practice “social distancing”. People who can are working from home.

But hospitals remain open for business as they must. Our nurses and doctors are on the front lines. IT teams and all the hospital staff who support the clinicians are doing what is necessary to ensure that they can deliver care.

While all healthcare organizations have emergency preparedness plans in place for a variety of incidents, this is uncharted territory that tests the limits of those plans. There will be much to learn and share when we get to the other side of it. But in the spirit of we’re all in this together and the culture of sharing best practices we have in healthcare, here are a few links that might be of value in the days ahead.

UW Medicine CIO’s advice: Prepping IT systems for COVID-19 – by Eric J. Neil published in Health IT News, March 12. UW Medicine was one of the first health systems on the front lines of the pandemic in the U.S. Their insight and advice are invaluable to IT leaders around the country.

While you may question the value of Twitter, it is yet another forum where lessons are being shared from the front lines. Dr. Kira Newman has worked in the ICU in Seattle the past week and posted a 10 part thread:

In one part Dr. Newman provided the link to their Covid-19 Resource Site for other hospitals to use.

17 Coronavirus (Covid-19) Actions for Healthcare CIOs – by John Lynn in Healthcare IT Today, March 11. John is continuing to collect info from IT leaders and will share as he does.

Healthcare IT News is maintaining a list of trusted resources that can be found here: Key resources to keep track of the coronavirus pandemic.

Most of my readers probably work in healthcare organizations and fully understand the magnitude of this pandemic. For those of you who don’t and need some convincing, remember that science and math do matter. Here are two of the best articles I’ve seen:

Why Outbreaks Like Coronavirus Spread Exponentially and How to Flatten the Curve – by Harry Stevens in the Washington Post, March 14.

Coronavirus: Why You Must Act Now – Politicians, Community Leaders and Business Leaders: What Should You Do and When? – Tomas Pueyo, first written March 10 and updated on March 13. The author closed with this message: “This is probably the one time in the last decade that sharing an article might save lives. They need to understand this to avert a catastrophe. The moment to act is now.” So, I share with all of you.

And if working from home is new to you, here’s a good resource to check out:

Work in the time of Corona – a blog by Alice Goldfuss on March 11th.

My paternal grandfather died in the 1918 flu pandemic. He was young but married with three small children. My father and uncle were sent to an orphanage and my grandmother and aunt went to live with friends. Yes, it’s not 1918. Healthcare has advanced significantly. But we are an even more global and mobile society. The most important lesson from 1918 is the impact of social distancing which is shown in this graph:

In closing, I want to express a huge thank you to all who work in healthcare. The strain on our healthcare system is real. The stress on our healthcare workers is real. Let’s all do our part to #SlowTheSpread and #FlattenTheCurve.