Care is morphing to mix of real and virtual, powered by cloud and consumer demands. The desktop phone may be fading.
New realities in the wake of the COVID-19 pandemic are reshaping healthcare IT in ways that affect leadership, employees, and patients, according to a panel of healthcare system executives convened virtually during the recent virtual CHIME21 Spring Forum, presented by the College of Healthcare Information Management Executives (CHIME).
Various changes include:
- Moving to a hybrid of virtual and in-person meetings
- Shifting to certain patient monitoring and visits at home instead of in hospitals or clinics
- Consumerization of healthcare
- Accelerating a move to and dependency on cloud-based platforms
- Questioning the expense of traditional desktop phones
"As people are starting to go back into getting care, which is good, we're seeing virtual care numbers now going down," said Rasu Shrestha, MD, MBA, chief strategy and transformation officer and executive vice president at Atrium Health.
The approach Atrium has taken in response is not so much to hit the off switch on virtual care, but to launch what it calls its virtual edge initiative, where virtual and in-person care, as well as synchronous and asynchronous care, all play a role, Shrestha said.
"The continuum approach is what will make this not just an overnight success story, but sticky throughout the next decade or more," he said.
COVID-19 is a predominant reason for the acceleration of hospital-in-the-home technology efforts, said Jim Noga, vice president and chief information officer at Mass General Brigham. "It's looking favorable that [payers] are going to offer reimbursement that makes that possible," Noga said.
"It's better for the clinician, it's better for the patient, and it's better for the family," Noga said. "Being in an urban area, having a family member in the hospital, and the family having to drive in for an hour and a half and pay outrageous parking rates, basically wipes out their day. COVID was an opportunity to explore [patients in the home] more quickly. I think it's on every CIO's set of priorities that they need to address in the next six months to a year."
'It's All About Health Literacy'
Consumerization of healthcare is top of mind in the wake of the pandemic, according to Teresa Meadows, RN, senior vice president and chief information officer at Cook Children's Health Care System.
Care outside the walls of the hospital and office environment is "what our patients want," Meadows said. As part of building its new hospital, Cook is building a tech bar, where patients can be educated about and begin using digital apps as part of their care.
"It's all about health literacy," Meadows said. "We've built workflows where physicians will refer patients to our tech bar," where such patients will learn "how do I incorporate devices into my medical daily life."
The tech bar will also train patients how to use the Cook patient portal and to set up virtual visits. "This is where we're going to hope to address some of the health equity issues, and our Foundation will be able to give patients certain technology or hotspots…so they're being taken care of the way we think [they] should," she said.
Cloud Computing is 'Here to Stay'
Cloud computing in healthcare as a vital platform is a clear winner emerging from the pandemic, Shrestha said. "It's here to stay," he said. "The scalability, the elasticity is exactly what we needed more of as we lived through the pandemic."
Shrestha says Atrium today is able to care for more than 54,000 patients experiencing mild COVID-19 symptoms via its virtual observation unit. "I talk about the need for us to accelerate our digital acceleration strategies," he said. "Cloud is absolutely the right catalyst for us to do that."
"A lot of the strategies that we have in our digital arena are really based on cloud technology," Meadows said. "Cloud makes good business sense. Now, as we move into new avenues like mobile digital, we're saying, does it make sense to have an on-premise solution? The whole point of digital and mobile is to be fluid, and have the ability to test some things, and then turn [them] back down because it didn't work for whatever reason."
Noga cautioned that some legacy apps "just are unable to do a lift and shift to the cloud." Where it makes sense, cloud is appropriate, such as creating a Covidpass app where employees attest to their wellness every day, "we immediately went to [Microsoft] Azure on that," Noga said. "We needed to spin it up quickly.
The big tech companies that run cloud platforms do possess an edge over hospital and health systems, Noga noted.
"What they can invest in cybersecurity and disaster recovery, running out of different regions, is truly important," he said. But it also creates new dependencies within healthcare.
"A few weeks ago, [Microsoft] Teams went down for about 90 minutes. That was pretty painful," Noga said.
Additional Transformation is Underway
Virtual healthcare will also be healthcare that, fundamentally, never shuts its doors. "We're moving from episodic care models to more of the always-on, ubiquitous 24/7 care model," Shrestha said.
The mix of employees who will continue to work from home, or outside the traditional four walls of the system, continues to emerge, Noga said.
"In INFOSEC, we're recruiting people in different time zones, intentionally," he said. One challenge yet to be adequately addressed is helping remote workers feel less disconnected. Remote workers are not feeling they are getting the necessary time to express or show their abilities, he added.
One other new reality could be fewer desktop phones, Noga added.
"We have a massive desktop telephone refresh coming up—tens of thousands of phones," he said. "And now people are saying, 'Do we really need desktop phones, if we have soft phones on our laptops?' And if we're communicating, whether it's Zoom or Teams, we're actually hoping to eliminate 50% of our desktop phones as we go through the refresh."
“COVID was an opportunity to explore [patients in the home] more quickly. I think it's on every CIO's set of priorities that they need to address in the next six months to a year.”
Jim Noga, vice president and chief information officer, Mass General Brigham
Scott Mace is a contributing writer for HealthLeaders.
As virtual care activity subsides somewhat, the new normal appears to be a mix of virtual, real, synchronous, and asynchronous communication with patients.
Prospects look favorable for payers to continue to offer reimbursement for virtual care, said the CIO of Mass General Brigham.
Cook Children's is building a "tech bar" into new hospital, where physicians will refer patients for mobile, digital apps to manage their health.