On Leadership

The year we meet again

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This is one of those weeks where I throw out what I was writing to mark an historic moment. It has been one year since the worldwide pandemic was declared. We all remember that week. It was a week when suddenly everything we knew as normal changed.

But a year later, this same March week feels like a hopeful turning point. The CDC has released guidelines on what fully vaccinated people can do. Congress has passed the American Rescue Plan and President Biden has signed it. The President is projecting we will reach 100 million vaccine doses in arms by his 60th day in office (next week) compared to his original goal of 100 million in the first 100 days. And he has directed the states to make the vaccine available to all adults by May 1 while the federal government mobilizes thousands of vaccinators and launches a new website to help people find the vaccine site closest to them.

I wrote last week that my husband and I have received our first dose. Our “magic date” as I call it is April 10 (though I know it is about science, not magic!). That is the day after our 45th wedding anniversary. That is when we will be fully vaccinated – two weeks after our second dose appointment on March 27. Like everyone who has missed spending time with their families we are looking forward to breaking bread together again. My husband and I are talking about which of our favorite restaurants we will go to for an inside meal for the first time in over a year.  And we are making plans to go somewhere for a long weekend.

I have shed tears many times this past year as I saw story after story of healthcare workers struggling to deal with overflowing ICUs and families describing the loved ones who they lost to COVID. This week I had tears reading the story of a young EMT in my town who transported many COVID patients to the hospital every day in March, then got COVID himself in April and nearly died. After many months of recovery, he is now back on the job. I had tears listening to the COVID-19 briefing on Monday. My emotions were a combination of sadness and anger as I listened to the experts unfiltered and thought about all the lies and misinformation and ignoring of science that we lived with the past year. We know the pandemic didn’t have to take the toll on this country that it did. 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 →

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 →

400,000 lives lost – finally a national strategy

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On December 14 with the first frontline workers in the U.S. starting to receive the vaccine there was great optimism and hope that we had entered a new chapter of this pandemic. But six weeks later over 100,000 more people have died of COVID-19 and only 16.5M of the total 36M vaccine doses distributed have been administered. 5% of the U.S. population has been vaccinated though only 2.1M people have received the full two doses.

On Tuesday night, on inauguration eve, the new administration held a National Moment of Unity and Remembrance. A simple ceremony in front of the Lincoln Memorial to mourn and honor the over 400,000 people who have lost their lives to COVID-19 in less than a year. President Joe Biden and Vice President Kamala Harris spoke briefly, an ICU nurse from Michigan sang Amazing Grace, and 400 beams of light were lit up along the reflecting pool in front of the Washington Monument – one for every 1000 lives lost. Across the country bells tolled and buildings were lit up. It was a simple yet moving and much needed moment for all of us.

Five hours after President Biden took the oath of office on Wednesday, he was signing his first set of executive orders. Three of them including the very first were directly aimed at the pandemic – “100 days masking challenge”, rejoining the World Health Organization (WHO), and creating the position of COVID-19 response coordinator. Dr. Anthony Fauci is the U.S. representative to the WHO executive board and joined his first call on Thursday. Jeff Zients, who served as chief performance officer under President Barack Obama and led the rescue of HealthCare.gov, has begun his work as the COVID-19 response coordinator. Zients is “ready to manage the hell out of it”, as Biden said last Friday.

The new administration is getting right to work, and the pandemic is a top priority. A National Strategy for the COVID-19 Response and Pandemic Preparedness was released yesterday. Continue reading →

Health leadership and priorities in the Biden Administration

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Over the past several weeks, we have watched as President-Elect Joe Biden has announced his cabinet nominees and other senior officials. He has done it one major area at a time. The health nominees and appointees can be found here. They are an impressive, well qualified team.

The CDC appointment may be one of the most important and consequential of all given the pandemic and how confidence in the CDC has eroded over the past year. Dr. Rochelle Walensky is ready to turn that around and I for one am both excited and optimistic. You can get a sense of who she is and how she will lead the CDC in a recent In The Bubble with Andy Slavitt interview: Meet the New CDC Director (with Rochelle Walensky).

Getting the pandemic under control is the top priority of the new administration. Biden has outlined a $1.9 trillion stimulus plan that includes more than $400 billion to fight the pandemic directly. The COVID-19 portion includes $20 billion for a national vaccine plan, launching community vaccination centers, deploying mobile vaccination units in hard-to-reach areas, $50 billion for testing expansion, funding 100,000 public health workers for vaccine outreach and contact tracing, funding for health services in underserved populations, and $10 billion for pandemic supplies.

We all know that health IT is critical to healthcare transformation. In a December 15th letter to President-Elect Joe Biden, HIMSS identified the following as key health priorities for 2021 and beyond and pledged to diligently work with Biden and his administration on the issues that require immediate action beginning in 2021. Continue reading →

January 6th reflections   

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I could not write about what happened on Wednesday at the U.S. Capitol any sooner. As I have watched the images on TV the past few days and tried to process it all I wondered what I could say that would make any difference. What would a tweet, a retweet, or a like matter on social media?

I have written posts on significant events and political issues in the past – the 2016 election, Black Lives Matter movement, racial disparities in healthcare, separating families at the border, gun control, gay marriage and more. I try to come at it from a health IT perspective, somehow. I’m not sure how to do that with this one so I won’t even try.

As a leader in my profession and industry, and as someone with a social platform, I decided that I can’t be silent. What I have seen this week only strengthens my commitment to continue to lead by example and help develop the next generation of leaders who are competent, decent, caring, fair and serve with integrity. And to ensure our children know that what they saw on Wednesday was very wrong.

I had tears when I realized how bad the assault on the Capitol could have been. Contrast that to my tears of joy when the first black man was inaugurated 12 years ago on the steps of the Capitol. I remember watching President Obama’s inauguration with my colleagues at Brigham and Women’s Hospital where a large screen had been set up in one of the largest meeting rooms for employees who wanted to watch. From housekeeping staff, to nurses, to VPs – we were there, watching, and filled with hope.

I had tears of sadness in 2016 when Hillary Clinton lost to Donald Trump, but I accepted it. I was willing to give him the benefit of the doubt. But the divisiveness that has been perpetuated these past four years has hurt our country for years to come. I feared his re-election in 2020 and had tears of joy again on December 7 when it was clear that President Elect Joe Biden had not only won the popular vote but also the electoral college.

What happened on January 6 had been building for four years and more intensely for the last two months. Continue reading →