One year of COVID: Vituity's CMO on how the vaccine changed everything

Editor's note: It's been a year since COVID-19 changed everything. We take a look back at some of the pandemic's biggest impacts.

Gregg Miller, M.D., and his wife popped a bottle of champagne the week after he received his second dose of Pfizer's COVID-19 vaccine. 

The emergency room physician had been saving the bottle for just that occasion after nearly a year of living under the cloud of the virus. Since the first COVID-19 case came in during one of Miller's shifts at a Seattle hospital, he and his co-workers lived with the fear they might contract the virus at work and potentially bring it home to their families.

The vaccine, he said, changed everything. 

A headshot of Gregg Miller
Gregg Miller, M.D. (Vituity)

"It's so much better. It's night and day," said Miller, who is also the chief medical officer of Vituity, a healthcare and medical operations company.

While he still followed his routine of changing his clothes the moment he came home, he said he felt far more protected. At work, he and his colleagues felt more comfortable being close to patients and interacting with each other.

"You can just feel it in the ER, too. The staff is a little bit more relaxed. We're able to talk with each other a little bit more. We're able to have more people in a room. We're able to get together a little bit more in person in the hospital than we were before," Miller said. "That's been really nice to have that human connection with your patients, who you can be closer to physically, and with your colleagues and especially at home knowing after the vaccine, the risk is so much less for transmission."

In many ways, he said, it feels like we can see the end of the tunnel.

"When it comes to COVID-19, I think we're at the beginning of the end," Miller said. "I think the big question mark is, will there be a COVID-21? Will there be a variant that mutates even further where the antibodies we have from vaccines and antibodies we have from prior infection just don't work? If that happens, we'll be back to square one with where we were this time last year."

He said he does not believe that is likely. 

"But even if we were back to square one, I think we're much more prepared as a society," Miller said. "We're definitely much more prepared as a health system." 

RELATED: COVID-19 Special Report: Lessons in delivering emergency care in new settings

Here's a look at three of Miller's biggest lessons in healthcare from the pandemic and why we'd be better able to take on the next pandemic.

1. Competitors realized 'we need to cooperate'

In theory, the health system has recognized the importance of coordination.

But in practice, as the federal government tried to coordinate with state health departments or private hospitals coordinated with county governments and home health agencies, the fragmentation of the system came under a stark spotlight. 

"Where we had successes, it was because all these different players came together and sat around the same table. It was the same virtual table, but still the same table. And they had conversations that they never would've had before," Miller said. "Sometimes, it was competitors coming together and realizing, 'We need to cooperate because it's the right thing to do for the patient.' Sometimes it's partners that never would've seen themselves working together—hospitals partnering with tech companies to offer virtual care services."

In his own experience, the emergency department where he works began coordinating with home health companies for the first time to get patients out of the emergency department on oxygen. 

"It's something we've never done before. Typically, if a patient needs oxygen, they'll stay in the hospital," Miller said. "But now, emergency departments have learned we have relationships with home health care companies to get patients oxygen. It seems so simple to do something like that. It's a small example of how we've come together to partner with other agencies we never would've talked to prior to the pandemic." 

2. COVID-19 exposed healthcare's weakness meeting patients where they're at

One area where Miller said the health system was flat-footed was finding ways to ensure patients had timely care where they were. The problem is, the model has always been that patients have to come to the clinic or to the emergency department if they need help rather than healthcare coming to the patient, he said.

"And with COVID, patients stopped coming. Our organization sees more than 6 million patients a year in emergency departments," Miller said. "The one diagnosis that increased last year, year over year, was we saw more dead people come into the emergency department than ever before."

People were waiting too long to seek care, Miller said. It was people with COVID-19 who were dying at home, he said, but it was also patients with heart attacks and strokes who were waiting too long to come in for care at the emergency department, he said. 

"We have to figure out, how can we reach those patients where they're at both during COVID and after COVID. We need to be able to connect with them and push our services into their house or into their nursing home or wherever it is where those patients are at. Whether it's through telehealth, whether it's through visiting nurses and home (physical therapy). We need to do a much better job as a health system meeting patients in place and caring for them in place, rather than asking them to come to a brick-and-mortar facility." 

While some of the emergency department volumes across the country have rebounded somewhat, they are still down significantly year over year. Miller said he does not expect some of the low-acuity volumes to come back, and the patient mix and acuity of the patients coming into the emergency department will be much higher in 2022 and 2023 than they were in 2018 and 2019.

RELATED: ERs have been quiet during COVID-19. What happens when the patients come back?

"Hospitals and emergency departments will need to adjust for that," Miller said about how hospitals benchmark to prepare for resources and staffing.

3. Data sharing reached previously unseen levels

The entire healthcare system also began sharing data in unprecedented ways.

"A year ago, if you had asked the (Centers for Disease Control and Prevention) or if you asked any type of central organization, 'What is hospital capacity like across the entire United States?' We'd really have no way of knowing that for last year, let alone where are we today," Miller said. "Now if you ask that question, we know from various different tracking projects what an individual hospital's capacity is at, what their ventilator capacity is at, what their ICU capacity is, how many people got vaccinated across 50 states yesterday."

Those are data streams the U.S. never had in place before, he said. 

"Knowledge is power. Now that we've got these data streams in place, we would be much better prepared to recognize when this disease is flaring up, we'd be much better able to marshal our resources and focus them where they are needed," Miller said. "It's not like the next version of a pandemic would be a walk in the park. It would be hard. But I think it won't be as hard as it was in March of last year."