On Best Practices

Staying fit and informed

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If you are working from home during this pandemic, getting enough exercise each day can be a challenge. I spoke to a CIO colleague recently who said he used to get 10,000 steps a day just at work given the size of his office complex.

I recently decided that I needed to up my exercise routine to ensure I get 10,000 steps a day. A long dog walk at the end of the workday plus the steps inside my house from my home office to the kitchen and back are just not enough. While I have never been an early morning exerciser, I am now two plus weeks into a new routine. Instead of rolling out of bed and starting on email and work right away, I now go for a brisk walk. I try to do a minimum of 30 minutes but depending on the time of my first scheduled call of the day, I do anywhere from 20-45 minutes. The end of day dog walk rounds it out to ensure I hit my 10,000 steps.

Besides the physical and mental health benefits of more exercise, I also have more time to stay informed via podcasts. A few weeks ago, I wrote about my latest podcast recommendations. With my new exercise routine, I am ready to recommend two more:

The Osterholm Update: COVID-19 – If you had not heard of Dr. Michael Osterholm pre-COVID, you probably recognize his name by now. Continue reading →

Time to reimagine industry conferences

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Large gatherings such as sporting events and concerts seem impossible to return prior to a vaccine and treatment for the coronavirus. Yet alternatives are being considered and reimagined. In the business world, industry conferences and conventions are in that same large gatherings bucket. So, they too should be reimagined.

Scientists and public health officials would say do not plan on these types of events until sometime in 2021. I do not want to minimize the challenges and complexities involved in these decisions and plans. But I do believe that leaders everywhere must trust science to keep people safe.

The American Telehealth Association (ATA) held a virtual conference last week. Of course, if any organization should be able to successfully pull off a virtual conference, it is the people who do telehealth.

But I am fresh off an entirely different virtual conference experience and I could not be more impressed with what they did and what is possible. It was not an organization in the tech industry but rather a faith community. I am a Unitarian Universalist (UU) and our annual church conference (General Assembly or GA) is held each June. The Unitarian Universalist Association (UUA) board made the decision in March to not cancel but rather to go all virtual.

This meant they had to pull off a five-day conference that included large general sessions, discussion/debate on resolutions, delegate voting, workshops, poster sessions, worship services and special collections – all virtual. The result was higher attendance (close to 5000 registered) than many in-person conferences in past years, education and discussion on everything from spiritual practices, to congregational growth, to anti-racism organizing, and to getting out the vote in November. While people missed the hugs and hallway conversations, it was an overall positive experience for thousands of UUs.

That same UUA leadership had the foresight back in April to advise all congregations to plan on virtual Sunday services through May 2021. UU congregations all over the country are adapting to virtual services as the new normal and they are doing so in varying and creative ways. Many congregations report higher “attendance” than in the past.

The lessons are clear – it is time to reimagine and embrace the virtual world we now live in where we can. If planned and executed right, little is lost and much is gained.

So back to our health IT industry. What does the typical lineup of Fall conferences look like? Continue reading →

Physical distancing: finding our way

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We saw our grandkids again on Sunday. A small family get together for Father’s Day and our youngest grandchild’s 4th birthday. As we all find our way and do our best to minimize our risks of COVID-19, being able to hug my grandkids brings me great joy and is one of the things I have missed the most these past few months.

There is a reason many people want to refer to this new practice as physical distancing, not social distancing. We need each other. Social isolation is not healthy. Technology has helped but it is not the same. Just ask someone who said their final goodbye to a loved one on FaceTime or Zoom.

Living in Rhode Island, my husband and I have taken the shutdown very seriously. Governor Gina Raimondo got ahead of it early with the shutdown order and then a slow, phased reopening. From mid-March until a few weeks ago, we have mostly stayed home except for the weekly groceries, a few trips to the garden nursery and Home Depot, the occasional takeout order, and the daily dog walks.

We limited family visits to outside spaces at our homes at a distance and no hugs. We are gradually loosening up on the hugs. As we all learn more about how the virus is transmitted, spending time with close family who have also been strict during this period seems reasonable.

My 4-year-old grandson first told me back in April on a family Zoom session that he was going to have a birthday parade, no gifts, and a small cake only for his mom, dad, and sister. It was sad to hear him explain this at such a young age but I thought it was probably a reasonable plan. The idea of a parade was exciting to him. But two months later we decided it was ok to do the backyard immediate family only gathering, which was 12 adults and the 4 young cousins, aged 4 through 7. The grandkids gave us hugs and briefly sat on our laps. It was good to not feel like we were all radioactive.

The slow opening of our own circles is a challenge we all must deal with. I do not take this virus lightly. I read a lot and listen to many interviews and podcasts with experts. I try to be as informed as possible about the science. And I take cues from my sister who has a public health background and my daughter who is an NP and has cared for COVID-19 patients in Boston. Continue reading →

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 →