When COVID-19 appeared in the U.S., Intermountain Healthcare was prepared with an enterprise disaster response. Leaders quickly activated their response structure and enacted a comprehensive plan for combatting the virus. They leveraged the organization’s aptitude for health care innovation to automate the plan where possible, efficiently test patients for the virus and prioritize whole-person wellness in trying times.
"We try to always prepare for the unexpected, so we’re ready to adapt and innovate in emergency situations,” said Diego Ize-Ludlow, MD, Intermountain chief health information officer. “This moment—when resources around the world are stretched especially thin—only emphasizes the need for thoughtful preparedness and innovation to drive safety and efficiency."
Enacting the disaster response structure
Intermountain leaders established recurring huddles across the enterprise and a virtual COVID-19 Hospital Incident Command to organize their pandemic response.
The health system’s IT organization hosts a daily bridge call to review COVID-19 projects and address questions, concerns or escalating issues. An event management leader drives the call and engages representatives from relevant teams, including clinical, technical, customer experience, training and communications. The meeting has dedicated times for attendees to share updates, but the Incident Command IT Section bridge call remains open all day to facilitate constant communication and ensure that someone is always available to assist if urgent issues emerge.
Reducing exposure with virtual care and online resources
Intermountain’s culture of innovation helped the health system quickly adapt to the pandemic. As caregivers began working remotely, teams converted scheduled appointments to video visits using a combination of their Intermountain Connect Care telehealth platform, powered by Amwell, as well as consumer and business videoconferencing tools like FaceTime, Google Duo and WebEx.
“We’re conducting more than 17,000 video visits per week—roughly 85 times more than we did before COVID-19,” said Craig Jacobsen, Intermountain’s assistant vice president of application delivery. “We’ve expedited plans for expanding telehealth technologies to additional clinics and service lines. In the meantime, we’ve deployed alternative technologies to quickly reach patients.”
The organization also launched a COVID-19 website to connect the community to educational resources and care channels. An online symptom-checker chatbot uses artificial intelligence to help people assess their risk for the virus and determine appropriate next steps, based on guidelines from the U.S. Centers for Disease Control and Prevention, the World Health Organization and Intermountain clinical protocols.
“The tools are designed to help us share information broadly while limiting exposure and conserving resources for people who need immediate care,” said Seraphine Kapsandoy, PhD, RN, Intermountain chief clinical information officer. “For example, we quickly deployed an ordering workflow with an embedded PowerForm to prioritize testing. Data from that PowerForm has been valuable as we evolve our testing strategy. We also extended telehealth technologies inside the acute venue to communicate with our patients while decreasing PPE use.”
Testing patients efficiently
To further reduce exposure and reserve urgent care resources for patients who need them most, Intermountain staff and Cerner associates developed a curbside testing workflow. Patients with COVID-19 symptoms engage caregivers through video or by calling the organization’s COVID-19 hotline for screening. If the patient requires testing based on an approved universal clinical decision support protocol built directly into the electronic health record (EHR), a COVID-19 hotline nurse places the order and directs the patient to one of Intermountain’s 27 curbside testing sites.
Patients follow three different workflows to curbside testing. Some receive a testing order in the EHR during a telehealth visit or hotline call. Others are screened by an affiliated provider, who faxes the paper order to an Intermountain testing site. Patients who have not had a video visit or hotline call can receive screening on-site.
Throughout the testing process, Intermountain teams use novel EHR workflows and clinical decision support to drive efficiency and prioritize care for critically ill patients. As caregivers enter COVID-19 test orders, a complex rule-based algorithm examines EHR data—including the patient’s symptoms, location, co-morbidities, degree of illness, level of exposure to someone with COVID-19 and other risk factors—then automatically assigns a numeric priority level to each test. After testing, laboratory services teams use an MPage® to dynamically direct tests to specific labs based on their priority level, lab capacity and test turnaround time—factors that can change frequently.
“The flexible process provides high volumes of testing, ensures continuity by using universal advanced clinical decision support, reduces caregiver exposure, markedly expedites the process and helps keep us organized while testing more than 1,500 people per day, on average,” said Tamara Moores-Todd, MD, Intermountain CTIS informatics project lead for COVID-19 testing.
The 27 curbside sites use FirstNet® tracking lists to maintain testing queues and document a patient’s progress through the process. After results are ready, caregivers use the Results Callback MPage in their Cerner Millennium® EHR to track patient follow-ups. Those who test positive for COVID-19 receive quarantine education and instructions for pursuing additional care.
Facilitating proper care documentation
Behind the scenes, the EHR helps caregivers expedite testing workflows by automatically creating a care encounter in conjunction with each COVID-19 testing order.
“We’re testing 1,000 to 2,000 people a day, so any time savings is significant,” said Moores-Todd. “Eliminating steps in the process helps us test and care for more people, safer and faster."
After seeing each patient, Intermountain teams ensure they’ve properly documented care using the latest COVID-19 diagnosis and billing codes from the Centers for Medicare & Medicaid Services (CMS).
"This situation developed so quickly that it took a few weeks for CMS coding guidance to catch up,” said Jacobsen. “A surge in clinical care generates a surge in claims, and it’s helpful having the option to slow chart reviews until we can properly code. Taking this step now improves efficiency by helping us avoid a surge in denials and corrections later.”
Prioritizing whole-person wellness
Intermountain’s COVID-19 response goes beyond patients’ physical care to include the well-being of caregivers and the community. The organization has a free Emotional Health Relief Hotline and publishes blogs with practical advice on topics like managing stress and sleep, staying active from home and practicing mindfulness during the pandemic.
Caregivers receive additional support, and the health care system redeployed caregivers from areas where work has temporarily slowed to areas where workloads grew due to COVID-19. The organization boosted agility by creating a single nursing role in its Cerner solutions, giving nurses across the enterprise access to any workflow they might encounter during redeployment.
Intermountain also adjusted its compensation policies to protect staff who might work less, as the organization delays elective procedures to help minimize transmission and conserve personal protective equipment.
“This period of rapid change has made preparedness, innovation and flexibility more important than ever,” said Ize-Ludlow. “We’re continuously adapting to fulfill our mission—helping people live the healthiest lives possible.”
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