For all of the weight healthcare disruptors throw behind the idea of innovation, there's something to be said about moving too fast and breaking too many things. Adoption of new digital tools should never lead to an interruption in patients' care.
COVID-19, however, wasn't the type of disruption that health systems had on their calendars. A shift away from in-person visits and a skyrocketing demand for consultations from the sick and the "worried well" alike threw many providers' operations into disarray, particularly during the early months of the pandemic.
For those on the front lines of this emerging disease, "everything was innovation," Emily Kagan-Trenchard, VP of digital innovation and strategy at Northwell Health said during a recent HIMSS (MobiHealthNews' parent company) Accelerate Health virtual discussion.
Repurposed CPAP machines and EHR-based treatment-outcomes analysis certainly played a key role in reimagining acute care, but "the real stars of the tech response during the pandemic were those technologies we didn't think so much about, but got to shine," she said.
For Northwell, that took the form of Playback Health, an asynchronous video chat and multimedia app it had invested in and implemented a couple years prior.
"You had these patients, you had a provider, and then you had a family member, and the three weren't always in the same place to communicate about the care of that patient," she said.
"This platform allowed for messages to be recorded by the patient from the loved ones and the family members and sent to the doctors, and for doctors to record messages to send to the patients – and most importantly to do that asynchronously, because we can't always schedule time to be on a Zoom call together.
"That app really was a great example of a technology that wasn't necessarily bleeding edge per se, but a use in healthcare that was just so apparent during this pandemic," she said.
Health systems' challenges extended beyond acute care. On the other side of the country, Providence St. Joseph Health had treated the country's first COVID-19, and the members of its surrounding community looked to the hospital for reassurance en masse.
"There were just a lot of unknowns," Sara Vaezy, chief digital strategy officer at Providence St. Joseph Health, said during the session. "Folks were, candidly, kind of freaking out. ... Every person who had sniffles was wondering if they had COVID."
To handle the influx of low-acuity patients, Vaezy said that Providence created an end-to-end process from scalable technologies it either had on hand, or with more novel tools that it had already been in the process of developing.
Facing the brunt of the storm was an information hub with COVID-19 education resources and a link to an AI triage chatbot Providence built alongside Microsoft. The chatbot could evaluate patients' symptoms and escalate them to live video chat if necessary.
Those whose conditions didn't necessarily require a hospital admission received a "low-tech" home monitoring program that included a thermometer, pulse oximeter and thrice-daily SMS check-ins.
Vaezy stressed that, with the notable exception of Microsoft's chatbot, the program's various tech components weren't especially groundbreaking. Rather, it was about scaling up the services they already had (visits through the video telemedicine offering "scaled 30X overnight," from "1,500 visits a month to that amount in a day"), and removing portal logins and anything else that added unnecessary friction.
"We took all that out and really simplified it, took a very consumer-oriented approach and tied all the pieces together," she said. "And it worked really well in terms of keeping the folks who didn't need to come in in their homes, keeping them safe and reducing exposure, keeping our [clinics] open for those who really needed it, and supporting our caregivers."
In both responses to the pandemic, Vaezy and Kagan-Trenchard stressed the importance of flexibility, limited complexity and an understanding of what resources the organization already on hand. Complex technologies may have a lot of value to offer, but simple technologies that speak to a core need are the safer bet when under pressure.
"A lot of times we think that a tech innovation has to come from IT and be blessed because it's the new hottest thing that we saw at HIMSS and it's super exciting," Kagan-Trenchard said. "Sometimes the most important tech is the ability to put a tablet in someone's hands and say 'I don't know, what do you want to use it for?'
"And we saw that a lot in this crisis when patients were alone. We put tablets in their hands, there was Zoom on them and other things, and then we figured out how they could then help facilitate other types of applications that could keep them connected, give them information, etc. And [it was] the same thing with text messaging."
Still, larger health systems like Northwell and Providence are playing with a different hand than smaller hospitals or private practices. With fewer resources immediately available and little opportunity to develop a new innovation strategy from the ground up, Vaezy said that groups shouldn't be afraid to reach out to their larger peers for guidance during a time of need.
"The name of the game is partnership. Just reach out ... to the folks at Northwell and the folks at Providence," she said. "When we created the initial COVID chatbot use case around symptom assessment working with Microsoft, we basically put the templates out there for the world to use. And Microsoft worked extensively with the CDC to make it available. Basically, any health system can use that for free."
As the health system inches closer to a full year of pandemic response, the initial sprint of rapid change has given way to a marathon. While certain processes or isolated components of a provider's operations may have adapted to the emergency, "that [doesn't] mean that the rest of everybody's infrastructure was ready to take that on, or make that sustainable for the long haul that we're on," Kagan-Trenchard said.
Providers should still be taking a long-term view of how they could improve their workflows, she said, and sometimes an emergency pivot can highlight which processes were necessary and which could be trimmed down. When looking at virtual visits, for example, her organization realized that not every form needed to be filled out ahead of time, and certain intake questions or administrative tasks shouldn't be handled by busy clinicians during the appointment itself.
This type of process improvement can work alongside automation or tool adoption to improve long-term workflow, Vaezy said. What's most important though is that teams begin to think about the \changes their emergency responses brought about before their extra burdens get out of hand.
"Let's look forward. How do we actually incorporate the workflow much more deeply?" Vaezy said. "Understand what's appropriately done via telehealth both episodically as well as longitudinally, and then build a care model around it that's more sustainable for the providers. That's our goal. Immediate workflow changes are – whatever, you do whatever you've got to do to get it done. But what's important is what you do next to make it sustainable for your providers so they can actually build their practices around it."