There are times when we must endure difficulty. In those times there often emerges a silver lining. People rise to the challenge, introduce hope, and produce work that allows us to cope with our troubles, which improves the quality of life for all. Healthcare is experiencing one of those moments right now. During the COVID-19 crisis we have witnessed rapid innovation, adoption, and benefits from technology-enabled healthcare organizations and opportunities for those yet to adopt to consider the advantages.
January 2020 unleashed a storm unlike anything we had seen since the Spanish Flu of a century earlier. In meeting this challenge, we found ourselves better equipped than ever before. Technological advances have allowed us to provide contactless care, analyze and communicate tremendous amounts of data, and manage limited resources efficiently.
Reeves, et. al, from the University of California celebrated their pandemic accomplishments in a JAMIA April article. They used technology to enhance patient screening, standardize management, communicate rapid changes to their team, present data, monitor their status with analytics dashboards, and perform virtual patient encounters and online self-guided learning. Their experience is like many Canadian technology-enabled healthcare organizations.
Humber River Hospital, known as “North America’s first fully digital hospital,” leveraged their command centre and electronic health record (EHR) to identify patient needs in the community and manage flow of patients through their hospital. They developed an infectious disease screening widget for their EHR summary screen to bring key information to the foreground for their clinicians. Orders for isolation status transmitted electronically from the patient chart to room side monitors, ensuring immediate access to appropriate infectious protocols prior to patient contact. Virtual care was scaled up within the organization, enabling care team members to interact with patients using cameras in rooms to minimize risk of transmission and use of limited personal protective equipment (PPE) supplies.
Tasleem Nimjee, MD Physician Lead for COVID Emergency Response, Senior Director of Medical Innovation and Transformation, and Humber River Emergency Staff Physician shared her story and perspective, “When you have a hospital that is digitally enabled, you have readiness, appetite for innovation, and high expectations as your baseline. I think that makes you uniquely positioned from the start. Your clinicians know they can demand more from a digital system to support their needs.”
Dr Derek Garniss, CMIO and Medical Director of Emergency Medicine for Sault Area Hospital, provided a list of tools his team easily implemented in their EHR platform in response to COVID that included standardized COVID order set templates, screening tools, and documentation templates. They expanded upon these foundations by developing a COVID surveillance board allowing them to visualize the care of all suspected and confirmed COVID cases in their hospital. His partner in their shared EHR, Dr. Kevin Gagne, CMIO of North Bay Regional Hospital Centre, celebrated the functionality of their system to help them drive their campaign to document goals of care on all inpatients. Dr. Gagne says, “Without our EMR, it would have been near impossible to run audits and help guide physicians.”
Victoria Chan, Director of Utilization and Analytics, Deputy CMIO of Mackenzie Health, reflected on the last few months saying, “COVID is one of the most life changing events of our lifetime. The pressure from the press, from every aspect of our lives made the public data driven.” Fortunately, as a HIMSS stage 7 organization, they were well positioned to meet the demand for data. They leveraged their system to visualize testing and screening statistics, pushed key patient information to providers and patients via their patient portal, and tracked their ventilator utilization predicting availability daily. Their analytics tools provided them with geolocation of their cases in the community, allowing them to partner with public health to concentrate efforts in those areas.
Yaariv Khaykin, CMIO of Southlake Regional Health Centre, and his team participated in the COVID stimulated pivot to virtual care by collaborating with their EHR vendor to pilot new virtual visit functionality. Dr. Khaykin’s team was not alone in adopting virtual platforms. The Ontario Telemedicine Network received over 22,000 requests for new accounts since March 1st and has performed over 740,000 virtual encounters since that time.2 In addition to patients and providers having more opportunities to interact through video, Southlake Regional Health Centre inpatients benefited from access to bedside terminals that allowed them to stay connected with their families without risking exposure.
Patients found other opportunities to celebrate technology enabled care during COVID. A patient shared her experience in a COVID testing centre, at The Ottawa Hospital “I knew when and where to go because of the Provincial online screening site. When I got there, I found an arena converted into a streamlined processing centre. There were computer stations for staff to gather information and well-cleaned waiting areas in between. I felt safe and confident in the process. While I was waiting, I was given instructions on how to register for the patient portal. The next day I received an alert on my phone the minute my results came back. I didn’t have to wait for a phone call or wonder if no news was good news.”
While clinicians and patients benefited from technology-enabled organizations, IT departments worked tirelessly to meet our needs and ensure safe and secure environments. Southlake Regional Health Centre managed to make some tough decisions around limited resources during a prolonged period of heightened pressures. Actions that led to success included focusing on strong technology security basics, doing the maximum amount with the tools available, making tough leadership decisions that required understanding the clinical implications of technology decisions while balancing the risks, and strengthening available core services. “Ultimately, we are stronger through collaboration, especially when challenges are ongoing,” says Sam Fielding, Southlake’s CIO.
Analytics competency was also a benefit to coping with COVID. James Moolecherry, CIO at William Osler Health Systems shares, “Prior to the arrival of COVID-19, we were actively working on data driven decision making and continuous learning. When COVID hit, Osler was well positioned to be able to provide meaningful information dashboards. A variety of stakeholders, ranging from front line care to senior leaders, were managing the crisis and each group had different information needs. Those needs were used as an opportunity to demonstrate and showcase some of the new capabilities in the form of customized applications and multiple information dashboards.”
Organizations that did not have a strong multifaceted foundation in technology at the onset of COVID, may have struggled keeping up with the demands for virtual care, home monitoring, data exchange, analytics, and privacy and security. For these organizations, finding pauses in the storm as opportunities to invest in a technology foundation will prepare them for agility in times to come. Organizations that began the journey enabled with technology managed to pivot quickly and showcase their advantage.
For all of us, as the COVID pandemic marches on amidst a myriad of other catalysts for change, the notion of addressing whatever clouds are on our horizon may leave us with a sense of foreboding. May the glimmering promise of silver linings help us forge ahead.
 J Jeffery Reeves, Hannah M Hollandsworth, Francesca J Torriani, Randy Taplitz, Shira Abeles, Ming Tai-Seale, Marlene Millen, Brian J Clay, Christopher A Longhurst, Rapid response to COVID-19: health informatics support for outbreak management in an academic health system, Journal of the American Medical Informatics Association, Volume 27, Issue 6, June 2020, Pages 853–859, https://doi.org/10.1093/jamia/ocaa037