Emily C. Webber, MD, FAAP, FAMIA is chief medical information officer at Riley Children’s Health and associate chief medical information officer for Indiana University (IU) Health, the largest health care provider in the state. She’s a practicing physician, board-certified in pediatrics, pediatric hospital medicine and clinical informatics. Dr. Webber is an affiliate scientist at the Regenstrief Institute and chairperson of the American Academy of Pediatrics Council on Clinical Information Technology. Having worked on many IT implementations, her work is now focused on optimizing health IT, applications to improve care quality and patient safety, and promoting the health of Indiana children and communities.
Undoubtedly, the COVID-19 pandemic is one of the greatest challenges we’ve faced in modern history, and the response of the health care system will help shape and define policy and practice for years to come. At this point, the death toll in the U.S. is over 115,000 with more than 2.1 million cases.
“So much of what we’re doing now wasn’t on a strategic plan or a roadmap; yet many in health care feel we’re making faster decisions under the same pressure to preserve the same level of safety, quality and effectiveness.” – Emily C. Webber, MD, IU Health
In the face of this tragic and incomprehensible loss, those of us in health care have an unprecedented opportunity to adopt more agile methods of caring for patients. For years, health care has been seen as lagging behind what patients want and need to use technology to improve their health with the same ease they do in other industries.
To prepare for COVID-19 response, necessity spurred action. The urgency of decision-making and new ideas during the last three months has led to so much change, that we now refer to it as “COVID time.” Deploying or providing telehealth, clinical care models and technology are all endeavors that would have taken months to implement prior to the virus. So much of what we’re doing now wasn’t on a strategic plan or a roadmap; yet many in health care feel we’re making faster decisions under the same pressure to preserve the same level of safety, quality, and effectiveness.
At IU Health, these innovations have enabled us to scale our screening, virtual care and testing. At this time, we’ve performed more than 40,000 free virtual COVID-19 screenings in our online hub; our lab has completed more than 71,000 tests; and, we’ve successfully treated more than 1,200 COVID-19 positive patients. We’ve cared for hundreds of our own team members and patients using more automated technology and remote home monitoring. And, like many other health systems, we’ve supported an exponential increase in virtual visits.
As we and the rest of the health care system transition out of an incident response mode and into a recovery phase, can the speed of these innovations be sustained after the urgency fades? Additionally, what guiding principles have been established?
‘Health care provided outside the clinic and hospital as a norm, not an exception’
Many patients, doctors and payors say that the “genie is out of the bottle” in terms of adoption of telehealth and virtual care. Patients, and the various payors, have experienced some of the efficiencies of lower-cost models, and it’s unlikely that they’ll want to completely return to business as usual. I hope the necessity of telehealth and remote home monitoring during the pandemic has permanently moved us toward an era of patient-generated data as a norm, not an exception. This will depend on the direction of laws and resources that health systems run on. Larger systems and those with support from U.S. Centers for Medicare & Medicaid Services (CMS) grants will be able to stay afloat while others may struggle. Some of the barriers to telehealth that were removed in March 2020 will have to stay in place if the new models of care are to be sustained.
Collaboration and data sharing as a key function, not an add-on
Health care IT providers are bringing forward everything from new video streaming platforms, to electronic health record tools for collecting and sharing data, to even contract tracing from phones – all in an effort to support the quick collection and knowledge sharing of facts about a disease we’re just beginning to understand. At the American Medical Informatics Association meeting in May, Karen DeSalvo, MD and chief health officer for Google, said “allies can be found everywhere” among technology giants.
Amid the pandemic, CMS regulations meant to help promote interoperability and provide patients with more control of their data were released. We now have a very real working knowledge of how these new laws are critical to containing this disease.
“Interoperability is now necessary in an urgent way (both in scale and time) to respond to public health and safety. Public health has always needed this type of information, but now on an unprecedented scale. We actually can exchange this data in real-time and guide decisions that will shape the lives of citizens.” – Emily C. Webber, MD
When you simply don’t have the tools or ability to do things the same way you’re typically accustomed to, you’re given the freedom to embrace each new problem as a chance to try something different. Ideas shared on collaboration calls at IU Health are in place by the following week – and the groups are sharing the outcomes as a matter of survival. Perhaps most compellingly, interoperability is now necessary in an urgent way (both in scale and time) to respond to public health and safety. Public health has always needed this type of information, but now on an unprecedented scale. We actually can exchange this data in real-time and guide decisions that will shape the lives of citizens.
The chance for clinicians to influence the technology we use every day to provide care, and even to take some risks on experiments, has empowered us and our patients to find out what works. Has the agile rate of change we have experienced in the COVID-19 pandemic “unfrozen” us enough to address urgent needs like technology implementation and clinician burnout, escalating cost and social inequity in health care?
It feels like the industry has accomplished more in the last three months than in the previous 10 years. I know I’m not alone in hoping that the next phase of the pandemic response sustains the same commitment to sharing data and removing barriers to care, exhibiting the same innovative spirit we’ve seen in the last three months. Our patients and our care teams deserve nothing less.
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