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 Welcome to this week in Health It where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode, every episode since we started the Covid 19 series.

Has been sponsored by Sirius Healthcare. Now we're, we're gonna be exiting that series, and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show's efforts during the crisis and beyond. Don't forget, we've gone to three shows a week now Tuesday, we cover the news on Tuesday Newsday, and we have interviews with industry influencers on Wednesday and Friday.

All right, so Aruba reached out to me to be a part of their atmosphere Digital Conference, which is a virtual conference, which I guess all of them are right now. And I did a talk on the state of healthcare, which I'm probably gonna share next week on the channel. Uh, they also asked me to host a panel discussion on the movements that healthcare made during the crisis and its implications with

Two industry leaders, Dr. Zaffer Shari, SVP, and CIO of Seattle Children's, and Rick Allen, the CTO of Navicent. So here it is. Hope you enjoy. All right. Welcome to the Atmosphere Digital Conference. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. it. I'm gonna be the facilitator for a panel discussion entitled Healthcare at the Edge, the Convergence of Devices, data, patients, providers, and Care.

Hopefully you got all that. There's a lot to talk about and it's healthcare. There is a lot to talk about right now.

The AVP and CTO of Navicent Health. Uh, good morning gentlemen, and welcome to the panel. Good morning, bill. Well, I'm looking forward to this conversation. As you know, as everyone knows, healthcare went through some pretty dramatic, uh, events over, uh, over the last, uh, couple of months. I did the quick intro.

What I. Uh, is work off of that. Introduce your health system to, uh, to the audience and, uh, you know, tack onto that, how you experienced Covid-19 from a health IT perspective in your community. And, uh, zapper we'll, we'll start with, start with you. Thank you, bill. Thank you for having me. Uh, talk to you today.

Uh, so Seattle Children's Pediatric Health System, uh, predominantly in the state of Washington with . 46 sites across four states, about a $2.5 billion turnover. And we take care of kids, uh, in the region across the four states. In terms of Covid, COVID was interesting. I'm sure people won't be surprised to hear that there was a massive pivot to virtual in our organization.

We went from a hundred people working remotely to 3,500 people working remotely almost overnight. We had to start delivering outpatient appointments through telehealth, something we hadn't really done much work in. And so we went from next to nothing to thousands of current visits in telehealth that are currently happening in our organization.

So those are some of the areas we've been focusing on as, as we pivoted, uh, to respond to Covid. Fantastic. And, and, uh, Rick, give us, give us a little background on, on Navicent and how you guys experienced covid-19. So, Navicent is a four hospital system based in central Georgia. We are, um. The Southern most level one trauma center.

So we take care of, from the middle of the state all the way to the Florida line refers back to to us. So we're primarily tertiary care. We do have some small hospitals, outlying hospitals, rural hospitals that, that feed into us as well. Um. Covid was really interesting and it, and it kind of on a little bit, little bit smaller note, kind of echoes what, uh, Dr.

Choudry said was we went from basically no one working offsite to a thousand people offsite in less than two weeks, we, um, had to spin up remote testing sites and virtual visit locations. To be able to support some of the virtual visits we were trying to, trying to roll out and put in place. And then we were one of the sites that GMA for the State of Georgia, which is FEMA nationally, GMA built a, uh, field hospital and we had to spin up a field hospital, built out shipping containers just off of our campus, um, to be able to support all the covid people that were showing up.

Man. So it, here's what's interesting. So. You know, the, the, uh, Aruba Atmosphere Digital Conference, we're gonna talk a lot about, um, you know, what, what really has happened here is we, we saw massive demands on health it, that, uh, we hadn't experienced before. And we were asked to do them in times that we used to, but you know, they, they would say things like, Hey, can you spin that up in a week?

And it's projects that we used to take, you know, a full year, if not two years, to, to spin up. Work from home. Almost all of our nonclinical staff went home, telehealth, uh, remote patient monitoring. Um, just, just a lot of those kinds of things. I, and I think people understand this, safety becomes the primary driving force during a, during a pandemic.

And so we wanna reduce the number of touches and we, we stood up all those different things. But what I wanna hear from you guys is, um, you know, how, give us an idea of what it was like to receive those requests and how dramatic of a change. Was it from the normal operation, uh, for, for your IT organization?

So who, who would Go ahead. I'll go first. Sure. Um, you know, I, I, I, I'll take it back to one to one story that we, that really jumps out at me as we were going through this, is we, we were getting requests to be, to provide virtual family visits. You know, we had. Put constraints in place on who could come into the hospital.

And you know, people were going into the ICUs with no visitors because we were on a no visitation policy. We didn't want anybody non-essential in the hospital. So we were approached to within a day. Be able to provide virtual family visits and we worked up a solution with iPads on our wireless network, right?

Connecting them and setting up either Zoom meetings or teams meetings between the family member, the nurse would go in and, and coordinate setting it up with a family member and then having the tablet there with the patient for the family member to be able to interact with the patient. Um, we had one that, it was an end, it was an end of life, um, situation.

and the family actually got to spend time with the patient up until end of life. The nurse leaned over and told the family that, I mean, told the patient that her family loved them, and was able to capture all that on camera. Um, so even in a bad situation where we couldn't have anybody in the hospital, we were trying to provide that high touch and do that using technology and turning it around quickly.

Yeah, absolutely. Uh, Zaffer, you know, for, um, for a children's hospital, you have a lot of, uh, acute care situations. How did you continue to care for them when you had. The potential for Covid patients right there in front of you? Well, I think our, our story is similar. You know, we, we were asked to stand up services that we weren't used to standing up with a very short timeframe.

Telehealth being one of those big services. But you know, what we sort of found around that space was.

A large percentage of the IT team was still required to be on site whilst trying to support those services. So, you know, there's this mixed model of nonclinical people working from home, and those would typically be your IT folks, but there is still a percentage. Of it, people working on site, putting on the PPE, supporting the clinicians with the new equipment, the laptops, the iPads, the training that's required and, and we hadn't used Zoom before, so we were traditionally a WebEx house.

And then our clinicians that are University of Washington clinicians who'd been used to using Zoom, so they wanted us to use Zoom. So we had to do all of that training, physical training on site. To support that model. The, the interesting thing I've seen around it workers and the ability to shift very quickly to solve these problems is we're all very well suited to do that as it professionals, but what I've seen in my team that they weren't well suited to do is the strain that it would put on them mentally from all the things happening around them plus.

Having to support all of these services. And that's what I've taken away as as a learning event to say. I think we have great people who can pivot very quickly, and that's what agility is in technology. But we don't always look at the human factors when it comes to what is the impact. And what we've also seen is when parents realized that COVID was an issue, we actually seen a drop in utilization in our emergency rooms.

So what we were preparing for the worst, but people were only bringing in their kids if they truly needed to bring in their kids. And therefore, we haven't had the levels of volumes that other hospitals have seen in terms of, uh. Utilization. Yeah. No, and it's interesting that, you know, both of you go to the heart of healthcare, which is, you know, people serving other people at their, at their time of need.

And, uh, and that's the gap that we are, uh, constantly aware of and constantly, uh, bringing to the forefront that, you know, health it, while we're not . Uh, in the room potentially with the, uh, patients. Uh, we're the best supporting actor in the, uh, in the delivery of care. 'cause everywhere you look in that room, there's some aspect of technology that's supporting, uh, you know, supporting that, uh, that, uh, care event.

Um, let me, let me talk to you guys about this. You know, I know as ACIO. They're, you know, they used to the old cliche of, you know, what keeps you up at night? Well, I think what would've kept me up at night. During the, uh, pandemic would be that we just shook things up significantly. Right. We sent people home.

Some people, you know, were working on, uh, company issued computers, some were not. Uh, you had, uh, just, I mean, again, you had different devices that, you know, zoom coming in when you used to only have WebEx and whatever. We just changed the environment so dramatically. So how did you keep a handle on the controls and how did you keep a handle on the performance of the.

Of the overall network and delivering the quality of service that everyone was looking for. And Rick, I guess, we'll, we'll start with you. Um, you know, I, I, we, we had some fairly decent choke points to ensure that we. We pushed everybody in through one of three solutions, right? We had a very, a fairly small VPN that we brought people in across.

We had, um, some technology from VMware and some technology from Citrix that we leveraged to be able to, to enable remote access for the bulk of our users. So we pushed everybody in through us, you know, through that, that one, those three small pieces, which kept the, you know, the attack vector fairly small.

We didn't have to open, open things up too broadly to be able to send people home. Where we have run into issues is around performance and you know, network monitoring. And the network team has worked probably I. You know, the desktop and field support team have worked a lot. The network team has worked as much, if not more, to ensure that we have the performance to be able to enable all those people to work from home that were working in the office before.

You know, the traffic patterns on your internet link completely shift the traffic patterns on your internal networks completely shift because now as opposed to anything east west or anything, go. Going out, everything is coming back in and making sure that things are architected to be able to support that has been a ma a massive amount of work for, for that team.

Yeah. 'cause your, your networks weren't really designed to function this way, , where they, I mean now you're, you're dealing with, uh, carriers to the home, so you're dealing with the, I don't. Whatever, and, and you're trying to manage performance all the way down to, to that level, I would assume. Right. We've, you know, we have some people that we've sent, you know, we sent like a wrap home with just because it was the easiest thing for them to do was send a remote access point, let it plug in, connect back across their internet, just to make it simple.

We did have, you know, to. The way that you described it earlier, we did have a decent sized number of people that didn't have either internet in their house or had, because a lot of our people live in rural areas, had something slower than DSL as their internet links. So it's not like they had anything high speed.

If it was, you know, six down, four up, that was excessive speeds for 'em. Um. That trying to manage through all that, which is why we push people through ZenApp. We push people through, you know, some level of VDI to offload a lot of the demands, keep it internal to something that we could control and we could support.

So, Dr. C Childry, did you guys have to change things, uh, dramatically or, or was it just moderate changes here and there for your environment? So from a networking perspective. We didn't really have to change anything. We would, we were already embarking on a journey to increase our bandwidth because we believe that remote working from home was coming anyway, pre pre covid.

So we monitor our network. Our network capacity was good. We have multiple links to the internet, diverse routes, multiple companies, we'd already put that in place. We'd closed our data centers down, we'd moved to private cloud, uh, at 90%. So we'd already taken steps before this came. And we're AVDI shop using Citrix as well.

And so that wasn't a problem. We were able to have 3,500 VDI connections on our net scale. No problem. The challenge came from the home environment, from the perspective of end user training. So what was interesting to me was people working in their homes didn't have the correct setup at home in the first place.

So people had bought massive bandwidth connections with Xfinity CenturyLink, you know, 200 meg, one gig connections into their home. But the equipment that they placed on top of that. Was terrible. You know, people, people had bought the $30 router from Amazon, popped in on their one gig connection, and then they had 17 people in their house trying to do a Zoom connection at the same time.

And the feedback we got was, it's all children's fault because we have an internet problem. And so we very quickly pivoted to education. We created a website for our staff where we produced . Quick cheat quick guides to how to correctly set up your home wifi, how to actually put a password on your home wifi, how to buy the right router for your home wifi.

And when we started to do that, we saw massive improvements with people's experience at home just by shifting router equipment. We didn't send, you know, we, we thought about sending the. One box to connect, but at the time, the, the ability to deliver goods in Seattle wasn't great. So it would've been a, a huge delay trying to get that equipment to people.

Yeah, that makes sense. Um, I'm, I'm gonna shift this to talk about the future in healthcare, if you guys are up for it. You know, we've, um, I, I, I think how I'm gonna frame this is, you know, we, we had a move to mobile. We, we put all these mobile devices in the nurse's hands and the doctor's hands. We have them moving around and whatnot.

Then we had this conversation around cloud and I, I wanna give people a picture of where we're at on each of these mobile cloud and how we're thinking about Edge, if we can. Right. So, uh, how mobile is healthcare today? You know, Dr. Childre, we'll start with you. How mobile are, how mobile are you at Seattle Children's?

So I think we've started our mobility journey, uh, in terms of on the units using solutions, handheld devices, whether it's tablet based or mobile based is definitely something we're already doing with our clinical information systems. And we're doing the same on the patient side, but there's definitely more work to be done.

Currently we're in a model of, we provide equipment, people utilize. We want to be able to shift to more of a, bring your own device type of environment. And that's in the hospital space. Uh, in terms of connecting up remotely, what we've learned through Covid is the future of delivering what I call ancillary back office services is remote.

You know, there's no need to build new office buildings in downtown Seattle and. Fit them out when actually people can work from anywhere in the country as long as we have solid networks in place. So we are looking at our networking partners to figure out how can we do this in a box? What solutions can we give those employees to enable that to happen, whether they're clinical or not.

That's certainly what we're doing. All right. So, uh, you know, Rick, give us an idea of where we're at on the cloud conversation for healthcare. Are we, you know, where, where is healthcare today? Um, we're moving that way, I guess is the, is the probably the easiest way to describe it. You know, Dr. Chadrick said earlier that they were at 90% private cloud, um, and close their data centers.

We're working toward that. We're not even close to that level of being into the cloud, but, um, I, I, I see that there'll be that hybrid cloud look across the board, that there'll be some things that we consume from a public cloud provider, some things that we build into the pri in, in as a private cloud and move all of those things offsite.

I think that, you know, most IT organizations really want to get out of the real estate business and out of the facilities business of managing power and cooling. Let's let somebody else do that and let us do what we do best, which is manage the infrastructure and applications that that run there. Um, so I think that over the next, and this is going to be a driver, I think Covid has been a driver.

I think over the next 18 to 24 months, you'll see some really huge steps and some huge organizations moving from on-Prem into the cloud because of the experiences they've been able to hit over the past three months that we've been doing this. All right, so let's, let's talk about, you know, 'cause we said in the title we were gonna talk about the edge.

So, you know, the, the biggest edge cases for us are gonna be, uh, you know, the, the, the home as a, a place of care, the home as a place for aging in place, the home as a place. For, um, you know, for following up on, on the visit, um, you know, maybe built into the, to the television where you're doing physical therapy with somebody and those kind of things.

We're seeing all sorts of use cases be talked about. But I want you guys to be really honest, how is this, are, are we talking futures? Are we talking, you know, there's, there's definite movement here. Where, where are we at in healthcare? Are we gonna see a lot more devices in the home? And a lot more care being done out of the home.

I. Covid would indicate that, you know, telehealth is a possibility, but it's more than telehealth. It's, it's, it goes beyond that. Dr. Childry, we'll start with you. So I think it starts from, there needs to be a shift in reimbursement for the shift in services, right? So I do believe that we will be moving towards more use of equipment in the home and, you know, care in the home.

But where you sort of see the blockers is. I can deploy 15 devices in someone's home, but if I'm not gonna get any reimbursement for that, how am I supposed to run my health system? And we've, we've only seen a slight shift in Covid where health insurance companies have allowed us to do telehealth visits and actually pay for them, but they still won't pay for the facilities fees.

They just pay for that visit. So there's that level of investment you have to make, and you need to know that you're gonna get some sort of return on that investment. And therefore, I think it's still a slow journey. And then secondly, if we do put devices, equipment in people's homes, how do we actually make sure they're secure and they're not hackable, et cetera.

And that's a piece of work, certainly us as an organization. Are thinking about, but haven't really figured out how we're actually going to do that, when that, when that takes off. Yeah. That's interesting. Uh, Rick, what are your thoughts on, on. I'll agree with both of those. Um, and add one more. And it's around workflow.

You know, um, the physician practice workflow has been honed over forever, that you go in, you see a receptionist, you move to a tech, then the physician comes in once most of the work has been done to b to bring his expertise to it. And then he moves on and somebody else steps in and takes over until we can get workflows built.

That can leverage a lot of the telehealth technologies. I think that you'll st that you'll still see some slow adoption and, you know, you throw the workflows, the reimbursement, and then sec, you know, for me, security's the biggest nightmare of the bunch. 'cause I can't necessarily fix a workflow and, um, I can't necessarily fix the way that the payers are going to address it.

I can address the security of it, and that's where most of the work that we're doing today. Lives in, how do we put something into a patient's home that we can keep secure and ensure that the data is private end to end and immutable from end to end. Yeah. You know, I, so this is gonna be my closing question for you, and it's gonna be around, how does your mindset change having gone through a pandemic.

I know I talked to some people who went through, uh, hurricane Sandy in New York and they told the stories and they said, this will forever change how I think about disaster recovery. And, uh, and I followed up with some of those people and it really has changed how they think about disaster recovery, uh, and how they, how they function.

What do you think the, the mindset shift will be for you as a, as a health IT leader coming out of this pandemic? Um, still. Sorry. Go ahead, Rick. No, I was gonna say, I, I, I think to, to me, the biggest thing is around, is around the ability to pivot, to be flexible. Um, you know, 'cause we talked, like we talked when we first started, there were projects that normally would take, you know, two or three weeks to kick off and then take several months to implement that.

The expectation was that you've got a week to make it all happen. And I, I do think that that's going to be the biggest shift in my mindset is we have to become much more flexible and be able to move on something much more quickly than we have in the past. Yeah. Dr. Childry, and from my perspective, I think what we've learned is that as it professionals, we must work in multidisciplinary teams and we must work at a pace.

Is more agile than we've ever seen. So for the very first time, my people have experienced that we are in true partnership with clinical staff, with nonclinical staff. The fact that patients need us to pivot. Very, very quickly. It's something we weren't used to before. So I agree with Rick. You know, we were used to this model of let's spin up, let's do a pm, let's do this, let's define the project, and then let's have a timeline and a roadmap.

And what I'm seeing now is that people are more multitasking. You know, if you are jumping into this mu multidisciplinary team and a clinician needs you to be the project manager to. Herd the cats around the technical pieces, then you'll just do that. And we weren't doing that before. Before we were trying to define pieces and work with those pieces.

And I think we don't want to go back to that old ways of working, want to continue to to learn and pivot with this agility. This agility, which I think is exciting. Yeah, it really is exciting. I, you know, gentlemen, I really, you know, I, I wanna thank you for your time today. I know this is a really busy time for you guys.

This was a fantastic conversation and I, I always enjoy learning from people who have, uh, experienced the things that you've experienced. So close to the front lines. Thanks again for your time.