On Best Practices

How do patients rate telehealth a year later?

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Since March 2020, telehealth volume has increased at rates we would never have anticipated. As Dr. Rasu Shrestha, EVP & Chief Strategy & Transformation Officer at Atrium Health, said during a panel at the recent CHIME21 Spring Forum, “It was an overnight success 30 years in the making”. Indeed, when there were no other choices, clinicians and patients were quick to adapt.

But what do patients really think of telehealth a year later? The COVID-19 Healthcare Coalition recently published the Telehealth Impact: Patient Survey Analysis. The aims of their research were to determine:

  • How well did telehealth serve the clinical needs of patients during the COVID-19 pandemic?
  • For what reasons did patients seek care through telehealth?
  • What were the strengths and weaknesses of telehealth related to quality of care?
  • What are patients’ expectations for the use of telehealth after the pandemic?

The 20-question survey was open to persons 18 years or older who had at least one telehealth encounter between March 1, 2020, and January 30, 2021.Survey responders included 2,007 persons from across the U.S. who received telehealth during the pandemic.

The findings were highlighted in an mHealth Intelligence article “COVID-19 Telehealth Delivery Reaps High Patient Satisfaction”, by Hannah Nelson on April 15, 2021. The results are very encouraging for the future of telehealth. Continue reading →

Treasure the good

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The past 14+ months have been a period of loss and sadness. Even if you and your loved ones have remained healthy and employed, the pandemic has impacted all our lives. Now that over 200M people in this country have received at least one dose of the vaccine, 87M people are fully vaccinated, and the vaccine is available to anyone over 16 who wants it, we are on our way to a new chapter. But we still need to get to at least 70% for herd immunity and continue with precautions.

I don’t want to appear Pollyannish as we look to the future, but let’s ask ourselves what good has come out of this past year.

Have you had more quality time and connections with your family being home so much?

Have you found new ways to connect and celebrate milestones with family and friends at a distance?

Have you simplified your life and decreased your consumption?

Have you found new hobbies or restarted old ones?

Have you spent more time reading and learning?

Have you spent more time outside enjoying nature?

Have you explored cooking new foods and eaten healthier at home?

Have you become a kinder person, more caring about your community and people you don’t know?

Have you come to know and appreciate your co-workers in new ways after working together through tough times, and perhaps meeting their kids on video calls and hearing their dogs bark in the background?

Have you converted your work commute into something positive for yourself?

Have you spent time reflecting on your career and what truly is important to you? Continue reading →

Crowdsourcing – looking for your stories on digital transformation 

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I am trying something new with this week’s blog post. I will be doing a talk titled “Digital Transformation: Emerging from COVID19” at an upcoming virtual conference. I will be working on it in my spare time (aka the next two weekends) so it can be recorded in advance.

For many organizations, Digital Health means the “digital front door” and an increased focus on patient or consumer facing applications. But it is far more than that. My StarBridge Advisors colleague, David Muntz, wrote an excellent blog series on Digital Health over the past year. His first post attempted to frame what we mean by Digital Health – “Digital Health – Is Healthcare Ready? Are You and Your Organization Ready?”.

He starts by trying to define it and acknowledge that the Wikipedia definition is good but not great: “Digital health is the convergence of digital technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and make medicine more personalized and precise.” As David expands on his definition, he says ”Digital health requires harnessing the energy from the data tsunami that includes all sources, not just provider-controlled databases. We need to synthesize data from existing sources and use patient generated data, social determinants of health, census information, AI engines, and so many other sources.”

As I work on my upcoming talk, here is my “crowdsource” ask if you are willing to share your stories and anecdotes on any or all of these questions: Continue reading →

Renewal, big rocks, and the elusive work life balance

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Spring is a time of renewal and rebirth. I see daffodils, crocus, and blooming trees everywhere on my daily walks.  After the last 12+ months we have experienced and the vaccine rollout giving us all new hope, it is a time of renewal and rebirth unlike in previous Springs. In past years, I have written about my “big rocks” at this time of year. In April more than any other month I am reminded of my big rocks – it is when my siblings and I lost our father to cancer at a very young age. I turned four years old the day of his funeral.

Over 570,000 families in this country alone have lost one of their “big rocks” to COVID-19. For some families, it has been multiple losses. The stories of a husband and wife dying just hours apart are truly heartbreaking. I am fortunate that all my big rocks here in New England and back in Minnesota where I grew up are healthy and well. And all of us “elders” are vaccinated.

So, in this time of renewal and being two weeks post my second vaccine dose, I look forward to breaking bread this weekend with family members. It will be the first time since an outside, socially distanced, early Thanksgiving we had on November 8th. I told my husband back then that it could be a long, isolating winter as we would not be able to spend time outside with family nor have meals together. After a relatively mild winter, I am happy to say my daughter who lives only 20 minutes away came over on some weekends with her two young daughters to walk the dogs with me and to visit. Some of the visits were outside socially distanced and some were inside with masks.

Thinking about my big rocks is a reminder to take care of myself and maintain a reasonable work life balance, or life work balance as my StarBridge Advisors colleague, David Muntz, likes to call it. Taking on the interim CIO role at Boston Children’s Hospital means I am back to long days and catching up on the weekends. My personal gauge for work life balance each day during this period will be whether I’ve gotten out for walks to hit my 10,000 steps daily goal and if I’ve played the piano. Continue reading →

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.

Continue reading →

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 →