In 2021, healthcare organizations are working to take stock and begin to heal from the upheaval that shook their core in 2020. Though it’s not over yet, to date, the public health crisis that has cost the United States more than 750,000 lives and hospitalized an estimated 7.2 million people forced providers to push forward, out of necessity, in ways they never imagined.
Particularly in the delivery of virtual healthcare, they had no choice but to move fast, regardless of existing capabilities. As health economist Jane Sarasohn-Kahn observed, “In 2020, no single sector was as shocked into new operating paradigms as healthcare.”
Extraordinary events demanded decisive action and compressed timelines. In many cases, these efforts ended up exceeding expectations and moving organizations a few steps ahead of where they thought they would be with technology.
Now, organizations are building on what they accomplished in the face of catastrophe, progressing with initiatives in spaces that look more digitally driven than the pre-pandemic world.
Hal Wolf, president and CEO of the Health Information and Management Systems Society, called this chapter in the sector’s history “one of the largest change management efforts that we will see in healthcare in such a short period of time.”
Much of the change management took place in the minds of healthcare leaders, who increasingly see technology and business as inseparable. Eighty-seven percent of healthcare executives in a 2021 survey by Accenture said they now consider business and technology to be virtually one and the same.
Here, six organizations (two small, two midsize and two large) share how they are solidifying their technology strategies to rebound from the worst of the crisis and carry on, more digitally committed and attuned.
Winona Health: Using AI to Reach Patients and Drive Value
Winona (Minn.) Health, with a flagship 49-bed acute care hospital, delivers primary and specialty care across the continuum to a service area population of approximately 50,000 in the southeast region of the state.
Located about 40 miles from Rochester, the provider has roots in the community going back 126 years. Despite that history, “we knew our volume-based delivery model wasn’t sustainable and that we had to transform the way we delivered care,” says Rachelle Schultz, president and CEO.
The independent, community-owned organization began a transition to value-based care seven years ago. It had accepted an opportunity through the Minnesota Department of Health & Human Services to participate in an integrated health partnership accountable care organization with other community. The ACO would focus on improving outcomes for the state’s Medicaid recipients. “We put a stake in the sand with this ACO,” Schultz says.
As with other ACOs, under the integrated health partnership, providers showing an overall savings across their population while maintaining or improving the quality of care would receive a portion of the savings.
The journey that began for Winona Health at the state level with public payers has since grown to include population health-based partnerships with federal and private payers as well. The access to claims data facilitated by these arrangements—combined with Winona Health’s increasingly deft use of the data-mining tools that are an integral component of its EHR—have enabled the organization to target its population health efforts judiciously and forge a value-based strategy that has led to shared savings based on significant decreases in readmissions and ED visits among Medicare and Medicaid populations and improvements in other quality measures, Schultz reports.
The organization’s overarching emphasis on value and population health management led in 2019 to the decision to further streamline care and reach more patients with the introduction of an asynchronous online service. Using their laptop or mobile device, consumers can quickly access Winona Health clinicians for a wide range of common ailments without the need for an appointment or video chat.
Patients complete an artificial intelligence-based questionnaire (which is updated as new findings change clinical protocols) about their symptoms, history and medication.
A Winona Health physician reviews the patient’s information and sends a diagnosis and treatment plan via email, typically within an hour. Prescriptions, if needed, are sent directly to the patient’s pharmacy. Though video contact is not involved, the patient may be asked to upload photos (an arm rash, for example) to aid in diagnosis. The physician’s note flows into the EHR.
The platform delivers convenient, cost-efficient care for everything from allergies to urinary tract infections; however, clinicians may fast-track patients to be seen by a physician if they determine that symptoms, such as chest pain, warrant an in-person examination.
The service evolved into a valuable time-saver and screening tool for Winona Health when it became clear that the coronavirus was spreading rapidly in the United States. To prepare, the organization updated the platform with a free screening questionnaire specific to COVID-19 developed by the vendor.
Along with a telehealth platform for virtual visits launched at the same time, the screening service “added to our repertoire of tools to give patients choices that made them feel safer and lighten the
load for our clinicians,” Schultz says.
Next steps for Winona Health include broadening the organization’s use of artificial intelligence to streamline in-office visits with “pre-visit planning,” in which patients provide information in advance, online, about their symptoms, history and medications—information that is normally collected during the appointment. The change is expected to reduce stress and save significant documentation time for physicians—time that then can be devoted to interaction with patients, Schultz says.
Schultz envisions tools such as these being used as a potential strategy for dealing with the physician and healthcare worker shortages that will intensify as the population ages. “I don’t want my doctors, nurses or staff doing non-value-added work or getting burned out doing repetitive things if there’s another way. If we can leverage technology to redesign workflows, we can get our clinicians back to focusing on the work that’s high value.”
White House Clinics: Technology That Serves Patients and Providers
A federally qualified community health center, White House Clinics, Richmond, Ky., delivers primary care, dentistry, pharmacy, behavioral health and substance use disorder treatment from nine locations across five counties in the south-central portion of the state. Situated in the Appalachian Mountains, the service area lacks public transportation and has large pockets of isolation that make reaching the nearest tertiary care center, Lexington’s University of Kentucky, difficult for many of the area’s residents.
White House Clinics fills that gap. As a health center committed to meeting its rural communities’ needs, “we do our best to deliver the maximum amount of care that we can locally,” says Stephanie Moore, CEO.
The organization intentionally chose to establish a series of clinics offering a broad scope of services, including a large service line dedicated to guiding patients toward resources to address food insecurity, housing and other social determinants of health. The 311-member team includes 15 physicians, 19 nurse practitioners and physician assistants, nine dentists, seven dental hygienists, eight licensed clinical social workers and 13 pharmacists, who also consult regularly with colleagues through the University of Kentucky’s support line for community practitioners.
Unlike many other rural providers, White House Clinics did not have the luxury of time to gear up for COVID-19. A nursing home in one of the service area’s counties experienced a rapid increase in cases early on, and case counts in surrounding communities rose fast.
To get telehealth services off the ground, Moore, CIO Mike Neal and members of the IT team found themselves doing the equivalent of a mock telehealth visit with clinicians at home to familiarize them with the steps involved. The health center had acquired a healthcare-specific telehealth platform but, like many organizations, had only dipped its toe in the water with virtual care.
To manage the delivery of medical services to non-COVID-19 patients, the health center conducted a high-level triage. The behavioral health team transitioned immediately to virtual care, while the health center prioritized seeing the sickest patients in person and prescribing a month of medication refills to the moderately stable to tide them over until they could be seen virtually or in person.
Moore notes that telehealth is not an option for most residents, especially elderly individuals, as they do not have internet service or mobile devices.
Despite these challenges, strong analytics that pull valuable population health data from the EHR serve the health center well. That data supported prioritization of patients to receive the COVID-19 vaccine and is providing alerts on tests and screenings patients missed during the pandemic.
The clarity and reliability of those alerts did not happen overnight. The system was clunky until a thorough “scrubbing” of the data and development of standardized documentation processes in 2015 yielded a health maintenance and chronic disease management process that providers know they can count on. “We’re pulling our patients in to us, using this data to reach out to those with chronic diseases to tell them that now that the world’s a little safer, it’s important that they come in so we can assess how they’re doing,” Moore says. White House Clinics recently received a private grant to implement a comprehensive remote patient monitoring system. The organization is in the process of risk stratifying patients and identifying those for whom lack of connectivity and a device might be a barrier.
It’s also stepping back to look at how telehealth can be deployed most effectively going forward. “There are a lot of gaps that telehealth can fill. We want to make sure we develop a platform that allows it to be easy,” Neal says.
Now that telehealth’s value is evident, the organization is examining where else it can be used such as scheduling a second shift of providers to do virtual visits on weekends.
“Technology should be a tool that facilitates patient care, not the driver of patient care and certainly not a barrier to care,” Moore says. “The question is how can we titrate and monitor patients and improve their outcomes without them having to come to us each time?”
Opelousas General Health System: Moving to a Virtual Hospital
Like many community health systems, especially those outside major metropolitan areas, Opelousas (La.) General Health System often found itself stymied by a shortage of specialists after hours and on weekends.
Located 30 minutes from Lafayette, an hour from Baton Rouge and two-and-a-half hours from New Orleans, the two-hospital, 197-bed system turned in 2019 to telemedicine and its cooperative relationships with some of Louisiana’s major medical centers to address coverage problems in the ER and ICU, particularly for stroke and heart cases.
The solution came in the form of portable telerobots that allow specialists to examine patients and communicate with hospital staff from afar.
A session begins when a nurse initiates a virtual handshake from the hospital’s tele-robot, which enables the physician to establish connectivity with the mobile device via high-speed internet. Once connected, “the physician can see and do virtually anything remotely with these devices that they can do at the bedside,” says Jared Lormand, CIO.
From their remote location, physicians can manipulate a romote-controlled camera and monitoring system and view high-definition MRIs and other images in real time. “It’s a huge time-saver for the physicians and a powerful quality and safety tool,” Lormand says.
The health system’s timely access to advanced clinical expertise using telemedicine has bolstered its ability to deliver prompt, potentially life-saving treatment for emergency conditions. The initiative earned Opelousas General the Digital Health Most Wired recognition in 2019 and 2020 from the College of Healthcare Information Management Executives.
Opelousas General found unexpected new purpose for the mobile telemedicine equipment and virtual-care platform when the coronavirus hit. “We were fortunate to have a technology in-house that we could scale for the treatment of infectious disease,” Lormand says.
The platform’s design was flexible enough that it could be expanded to create a full virtual hospital, but “we decided to scale gradually at first in response to demand,” Lormand says, pointing to the cost efficiency made possible by having the option to add mobile units one at a time based on the number of COVID-19 patients who were being admitted.
The system also modified the digital communication and patient education platform it had in place to include reminders and remote support for those who’d been treated for COVID-19. The system was initially used by Opelousas General to stay in touch with patients regarding their care both before and after hospitalization. Once the COVID-19 vaccine became available, the health system partnered with a virtual scheduling platform to provide a quick and seamless online vaccine appointment option for patients and community members. According to Lormand, this system reduced the time required for patients to be onsite for their appointment by an average of 20 minutes per patient.
During the pandemic, Opelousas General began the transition to a new cloud-based EHR platform specifically designed for budget-conscious community and rural hospitals. The new platform will operate as a shared domain between multiple similarly sized health systems and hospitals. When the transition is complete, Opelousas General will see expanded system functionality and have the ability to implement new technologies that had been unavailable on the previous EHR platform.
The new system functionalities included with the cloud-based EHR will allow Opelousas General to offer medication-scanning from telecommunication devices; monitoring alerts from smart devices; secure texting capabilities for physicians; multi-functional devices for use by nurses at the bedside; point of care devices for ancillary staff; and tablets with signature functions for consents and other documents to simplify processes and reduce paper.
In addition, Opelousas General has applied for CARES Act funding, which will allow the health system to expand its telemedicine capabilities and develop a 150-bed virtual hospital, giving local and consulting physicians immediate access to their patients. Each of the 150 patient rooms will be equipped with high-definition telemedicine equipment and operate on a customized HIPAA-compliant platform.
The telemedicine platform and associated equipment are expected to take six months to implement. When fully operational, the virtual hospital will provide efficiencies across the board for the hospital, providers and patients. As a Rural Referral Center, Opelousas General treats a high number of complicated cases across a large service area. Having this new technology in place will give patients faster access to specialty care, reduce patient and family travel times and staff workloads, and increase patient throughput within the health system.
“Patients will appreciate seeing their physicians earlier in the day, nurses will receive their orders in a timelier fashion and physicians will have the flexibility to structure their day so they can see patients in three cities without having to drive across the state,” Lormand says.
Technology has allowed Opelousas General to thrive during the worst of times without sacrificing quality. Lormand encourages organizations to “create a strategy that’s scalable but think of your endgame at the beginning. Know that you may only be able to introduce part of a technology at first, but that it can be expanded later.”
Akron Children’s Hospital: Creating a Virtual Front Door
With approximately 1 million outpatient visits, 10,000 inpatient admissions and 100,000 ED visits each year, as well as a primary care network of 32 practices, the freestanding Akron Children’s Hospital is Northeast Ohio’s largest pediatric provider.
Like many other providers for patients under the age of 18, the 289-bed hospital treated children who were seriously ill with multi-system inflammatory disorder due to COVID-19 but never experienced the surges of COVID-19 cases seen at hospitals across the country.
Rather, Akron Children’s felt the pandemic’s impact most acutely when an eight-week statewide shutdown of elective surgeries and in-person office visits stopped children across the hospital’s 25-county service area from receiving their on-site primary and specialty care.
The hospital had made an initial foray into telehealth when it launched a direct-to-consumer platform called Quick Care Online in 2019 to give families a virtual option for urgent care. Available to anyone under age 18 in Ohio, even if they are not an Akron Children’s patient, the service connects patients with pediatric providers from 8 a.m. to 10 p.m., seven days a week, 365 days a year.
What the hospital didn’t have was a comprehensive telehealth operation enabling the hospital’s 700-member medical staff to see established and new patients remotely.
Akron Children’s had been planning to broaden the urgent care platform to include virtual wellness checks and primary and specialty care, but the shutdown of office visits kickstarted that plan, ramping up what might have been a relatively unhurried rollout into one that was accomplished in three weeks, according to Lisa A. Aurilio, RN, FACHE, COO, who described it as “an acceleration on steroids.”
As a result, the hospital went from 200 telehealth visits in 2019 to 50,000 in 2020, reports Sarah Rush, MD, chief medical information officer and director of neuro-oncology.
Bringing thousands of patients and hundreds of physicians on board with remote care in an unusually tight time frame presented a hurdle for the hospital, which zeroed in on giving end users the tools and training needed to ensure access and get them over the initial hump of knowing how and when to use an unfamiliar technology. “People vaguely knew what telehealth was but hadn’t used it, so it was a little scary for them,” Rush says.
As with telehealth consumers across the country, however, the apprehension faded as families experienced telehealth’s ability to meet their needs while lifting the burden of taking time off from work or pulling a child out of school for an appointment.
Building on this momentum, the hospital is currently focusing on creating a “virtual front door” for consumers that uses technology in new ways to facilitate access. One example of this effort is the online appointment scheduling rolled out across several specialties in response to research showing strong consumer preferences for this approach.
“We’re thinking about delivering healthcare in a way that not only meets patients where they are, but also serves them in a way that they need,” Aurilio says.
Internally, a series of clinical initiatives that were put on the back burner with the pandemic are back in full swing, Rush reports. These protocols earned Akron Children’s a Healthcare Information and Management Systems Society Davies Enterprise Award in 2019.
They include an EHR-based quality initiative that analyzed data on prescribing practices among orthopedic surgeons to develop standards for reducing narcotic prescriptions—an effort that is being expanded to other specialties; the integration of population health management tools into the EHR to raise lead screening rates and provide timely care for affected children; and standardization of surgical care for patients with idiopathic scoliosis to improve pain control and expedite recovery. The protocol reduced costs by 12% and decreased length of stay by 50% without an increase in postoperative complications.
Hackensack Meridian Health: Maintaining Momentum
The largest integrated delivery network in New Jersey, Hackensack Meridian Health saw the state’s first COVID-19 patient on March 3, 2020, and has treated more coronavirus patients in its 17 hospitals than any other system in the state. “There were some dark days in New Jersey,” remembers Pamela Landis, vice president of digital engagement. “What was happening in New York was happening here.”
Landis also remembers witnessing an esprit de corps among the staff and leadership in the face of uncertainty that was both humbling and breathtaking. The system administered more than 610,000 doses of the vaccine at 24 sites, including a mega site that closed on June 24.
Along with the dedication and courage of front-line staff, Hackensack Meridian’s robust existing technology infrastructure enabled the organization to mount a strong response when the pandemic caught the country off guard.
The bedrock of that infrastructure was the single EHR system that spans the network’s facilities. The system’s cohesiveness and interoperability bolstered quality, safety and efficiency as COVID-19 patients moved through the hospitals and back into contact with their physician offices. That foundation “let us listen to the care being provided and dig into the data to nail down what was happening across the network,” Landis says.
Hackensack Meridian already had other business supports in place as well, including a business intelligence team that mined the data on COVID-19 patients and created real-time dashboards to support informed clinical decision-making.
Basic research at Hackensack Meridian’s Center for Discovery and Innovation also led to the rapid development of a COVID-19 test kit “in that first month, when there were not enough tests and people were literally lining up outside our ERs and urgent care centers because they thought they had the virus,” Landis says.
To combat the disinformation about COVID-19 that was spreading as quickly as the virus, Hackensack Meridian created a website in late February 2020 to spotlight answers to common questions and concerns, current safety guidelines, and emerging research. “We took it upon ourselves to pivot our website, marketing and social media to become a hub for accurate information,” Landis says, noting that the site has had 5 million visits per month (up from 1.5 million before the site was created) and that visits soared to 25 million per month in January and February 2021 during vaccine deployment. “It was important to us to be a trusted source of vetted clinical information.”
Other tools deployed during the pandemic included a centralized COVID-19 call center and a chatbot, launched in April 2020, to help direct people to the right level of care based on their symptoms.
Activity levels on the chatbot, website and social media unexpectedly became predictive tools when the network discovered that significant increases or decreases in activity consistently presaged surges or dips in COVID-19 admissions.
Those connections “showed the power and value of getting the tools and information out there,” Landis says.
Along with physicians everywhere, 3,000 members of Hackensack Meridian’s medical staff quickly climbed on board with telehealth. The network’s next step will be to integrate the telehealth experience with the EHR and patients’ online medical records. “We know telehealth works. Now, we need to make sure the experience is topflight,” Landis says.
Hackensack Meridian will soon introduce online scheduling for primary care practices and explore ways to harness data from online devices and systems—the Internet of Things—to help people with chronic conditions manage their care.
Despite these strides, “technology is not a panacea,” Landis says. “Though the pandemic taught us that patients are embracing digital tools, there are a lot of people who don’t have these digital tools. For pockets of people, it’s not an option.”
Still, “our clinicians understand how valuable these tools are for delivering care,” she says. “We learned from this crisis that we don’t have to go slowly with technology in healthcare. Now, we have to maintain the momentum because our patients demand it.”
CommonSpirit Health: The Art of the Possible
CommonSpirit Health, formed by the merger of Dignity Health and Catholic Health Initiatives in February 2019, was only one year old when the pandemic began. The implementation of a digital intercommunication platform enabling synchronous, location-agnostic collaboration among the system’s 150,000 employees and third parties at 1,000 care sites in 21 states had begun, but it became a priority when the crisis hit, says Suja Chandrasekaran, senior executive vice president and chief information and digital officer. “Communication in our hyperdistributed environment became paramount in the crisis,” she says.
As with virtually every other health system, the rapid creation of a platform and training for the delivery of virtual care and, later, digital support for administration of the “COVID-19 vaccine, took center stage as well. Technology also helped drive efficiency in everything from management of the personal protective equipment supply chain to support for the additional nursing staff recruited to meet increased demand. “We were in surge mode in every geography at some point, and sometimes in all geographies at once,” Chandrasekaran says.
CommonSpirit Health, which currently ranks as the largest nonprofit health system in the United States, didn’t stop at merely keeping its head above water with technology implementation as the pandemic stormed on, Chandrasekaran says. It forged ahead with a cultural growth opportunity to support its mission of delivering healthcare with an emphasis on reaching the most underserved members of society.
“Technology can enable the scaling needed to focus on the vulnerable,” Chandrasekaran observes. “We are the secure and compliant operation capabilities and innovation platform for our ministry. Our mission is to enable a healthier future for all as the world becomes increasingly digital. We do that by transforming to disrupt before we are disrupted.”
Some of the organization’s growth occurred with the discovery that, when challenged by the pandemic, the young system could accomplish more and move faster than anticipated.
A second layer of learning came as the organization underwent a shift in mindset, necessitated by the uncertainty of a major public health crisis, from a focus on the perfect to a focus on the possible.
That meant giving up the need to drive toward a perfect solution. Too much was happening too quickly and changing too fast during the crisis to cling to a vision of flawlessness.
“We started thinking about what was possible to satisfy a given need and how to progress based on more pragmatic expectations,” Chandrasekaran says.
Several proof points emerged in the success of the system’s intercommunication platform and in the introduction of a strategic framework for creating frictionless digital consumer experiences spanning the continuum of community, ambulatory, acute and post-acute care, including hospice and palliative care.
That comprehensiveness and ease are essential in digital services delivery because “the consumer is not just thinking about an isolated visit. They’re thinking about health, lifestyle and their whole family,” Chandrasekaran says.
One aspect of this framework is the system’s virtual intracollaborative care model, or VIC, which allows the organization to bring together teams of providers and specialists from remote locations to address a patient’s medical needs. “The biggest shift that took place during the pandemic is that now remote technology is woven into the fabric of our clinical care,” Chandrasekaran says. “What were shiny objects have become the mainstay. They’re strategic, pervasive and well-run.”
More than 4,000 expectant mothers, a majority of whom are women of color or Medicaid recipients, are enrolled in a virtual care program that provides opportunities for bi-directional engagement and assesses social determinants of health.
The technology experiences and lessons learned during the pandemic have, in turn, shaped the system’s technology strategy going forward. That strategy incorporates, among several other elements, plans to employ artificial intelligence and analytics at the point of care and in all nonclinical operations, and to use digital technology in the service of human experiences and the development of relationships between providers and patients.
The unprecedented use of data and analytics across sectors in developing the vaccine and bringing it to patients, and the heightened use of data and analytics by CommonSpirit Health and other providers to drive decision-making throughout the pandemic, “is a new muscle that is not going to atrophy going forward,” Chandrasekaran says. “The changes the sector has gone through are profound. The genie is not going back in the bottle.”
Susan Birk is a Chicago-based freelance writer specializing in healthcare.