Health IT leaders at hospitals and health systems are fast-tracking major technology projects—some in a matter of days.
As coronavirus cases rapidly increase in the U.S., healthcare chief information officers (CIOs) and IT executives are facing an unprecedented situation with a demand to ramp up technology tools on multiple fronts.
Hospital CIOs are quickly putting up telehealth infrastructure and telecommuting capabilities for thousands of employees and also developing screening chatbots and tracking tools to help frontline healthcare workers respond to the coronavirus pandemic.
"The leaders out in the field, at clinics, nursing homes, and hospitals, they are working at a pace that is heroic at best. What they are doing is right now is pretty amazing," said Russell Branzell, president and CEO of the College of Healthcare Information Management Executives (CHIME).
"We’ve never experienced anything like this," Geisinger Health System CIO John Kravtiz told FierceHealthcare, noting that IT teams are working at "lightning speed" to support clinicians. "You get things done, you plan on the fly. We're providing resources to solve problems. We have a fabulous IT team here at Geisinger. I can’t believe what we’re doing."
One of the key ways that technology can help in the response to COVID-19 is to reduce exposure from person-to-person contact and to prevent hospitals from being overrun.
Geisinger has developed a chatbot to help triage and screen patients remotely and is setting up video chat capabilities for patients admitted to the hospital to connect with their families at home. The health system also is using existing tools such as e-ICU to manage patients across its campuses.
Across its service area, Geisinger also has set up 13 screening tents outside of its facilities to screen and test patients. "The screening tents are like a MASH unit, there are computers and printers out there and they are fiber-optic connected. It's amazing how fast we were able to turn those things around," Kravitz said.
Branzell, a former healthcare CIO, said IT leaders are quickly shifting from focusing on the day-to-day IT needs inside the hospitals to enabling community-wide integration, including home wireless and internet connectivity.
"What I'm hearing across the board is that organizations are making this stuff happen in days that could have taken years," he said.
Virtual visits and telecommute
As Pennsylvania has joined California, New York, and Illinois with putting restrictions in place to curb the spread, health systems in that state are rapidly setting up telecommute capabilities and enabling physicians to do virtual visits from their homes.
The University of Pittsburgh Medical Center (UPMC), which operates 40 hospitals, has pivoted its patient-facing telehealth services to focus on onboarding primary care physicians to address the flood of patients with potential COVID-19 symptoms.
"We're also recognizing that many of our healthcare providers may be potentially quarantined or may be COVID-19 positive and this enables them to deliver telehealth care from their homes. We have been focused on making sure they have appropriate technology at home," Robert Bart, M.D., chief medical information officer at UPMC, told FierceHealthcare.
The health system's IT network is currently supporting 30,000 concurrent connections, with about 18,000 to 20,000 of those remote users, Bart said.
UPMC's urgent care telehealth platform, AnywhereCare, has seen a six-fold increase in visits, from an average of 80 visits a day to 500 visits a day. The health system's ambulatory care telehealth platform saw visit volume in one 48-hour period equal to the telemedicine visits performed in all of 2019, according to Bart.
"On our peak day, we saw about 1,500 visits. That number is climbing and we expect it to go higher," he said.
The health system also is working to deliver telemedicine functionality to all its inpatient units and ICUs.
Bart said UPMC's IT infrastructure is robust and has the capacity to scale up to meet ongoing demand. "We're less concerned with infrastructure and hardware than the durability of the people to deliver the care," he said.
Geisinger is working to onboard 1,000 physicians for virtual care visits by providing devices, cameras and headsets to physicians at their homes, according to Kravitz.
Danville, Pennsylvania-based Geisinger Health System services over 3 million patients in 45 counties in areas of Pennsylvania and southern New Jersey.
The IT department also is working to support radiologists working from home who need significant technology resources including high internet bandwidth, high-resolution monitors, and voice-to-text capabilities to transcribe documentation and get it back into the health systems' electronic health record (EHR), Kravitz said.
The number of Geisinger staff members and physicians working from home has doubled compared to a weather-related emergency such as a snowstorm, from about 6,000 concurrent users to 13,000 users, he said.
Crisis driving innovation
As health systems respond to the pandemic, IT leaders are pushing forward innovative technology solutions. Developers are working on tools using Fast Healthcare Interoperability Resources (FHIR) APIs to share public health data, Branzell noted.
Geisinger has worked with its local health information exchange, Keystone HIE, to develop a "heat map" dashboard that pulls in data from the Department of Health and laboratories and provides real-time data on people reporting symptoms and coronavirus cases by county. Hospital emergency departments find that information valuable to better prepare for potential patients coming in, Kravitz said.
IT leaders are setting up these capabilities while also ensuring that systems are running at peak performance and maintaining strong cyber defenses. "Cybersecurity criminals will look for vulnerabilities and take advantage. The cyber-surveillance cannot stop or we run the risk of being attacked and having major problems on our hands in our crisis situation," Kravitz noted.
UPMC is taking steps to implement telemedicine capabilities on EMS ambulances. "If there is a potentially affected patient, we can bring the physician to the patient to decide whether a patient needs to come into the ED or not. That will be helpful to triage patients in near real-time and potentially allow patients to stay in isolation without the risk of exposure to other individuals," Bart said.
Branzell predicts that the technology advances occurring now won't reverse once the pandemic ends.
"With telemedicine and remote monitoring, this is the new norm and how we provide care going forward is going to fundamentally change," he said.