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 Welcome to this week in Health IT News, where we take a look at the news that will impact health it. This is another field report where we talk to leaders from health systems on the front lines. 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.

As you know, we've been producing a lot of shows over the last three weeks and series. Healthcare has stepped up to sponsor and support this week in Health It, and I want to thank them for, uh, giving this the opportunity to, to capture and share the experience, stories, and wisdom of the industry during this crisis.

If your system would like to participate in the field reports, it's really easy. Just shoot me an email at Bill at this week, health it.com. Now on to today's show. Today's conversation is with, uh, Dr. Daniel Ren, the CIO for Boston Children's. Uh, good morning Daniel and Art Dan, and welcome to the show. Good morning, bill.

How are you? Good. Um, sorry if I messed up your name at all. We we're all moving. No, it's okay. We're all moving so fast. So you're, you're a practicing physician in the, in the Boston area. Um, and I, I appreciate you doing this. What we're doing is, uh, just this series on, um, field reports from the front line, and I, I appreciate you and, and bunch of your peers.

Volunteer to do these quick, uh, you know, 10 minute interview. So, um, so we'll just get right to it, you know, give us some context of what's going on at your system or, or in the Boston community. Well, we're, uh, we're obviously ramped up, uh, in a big way, just like everyone around the country, I would imagine.

Uh, we're not quite at that New York, uh, city levels yet. Uh, but things are definitely escalating quickly. Um, in the pediatric space, we definitely have had fewer, uh, cases than our adult colleagues around town. Uh, but for sure, uh, things are ramping up, uh, as well for us. Um, the additional really interesting thing, uh, that I've heard from.

Uh, from a number of other children's hospitals is that there's some strategizing going on around the country, around having children's hospitals serve as, um, sort of the home base with which adult facilities who also care for children could offload some of their patients if they really needed to, um, to create some more room in their facilities for, uh, for ill adults.

So we've been bracing for. More covid patients, uh, of our own, you know, in the pediatric world or just a, a big bolus of pediatric patients with all sorts of disorders, uh, that might be transferred to us from other, uh, adult facilities. Well, you, you may or may not be able to speak to this, but it already spun a question in my mind, which is, do we expect a significant amount of, of children, uh, cases within children or.

Well, it, it, it's definitely not the, not nearly the, the rates that we're seeing in the older population, but I will say that it's interesting, as we've seen around the country, there's definitely a, a, a sizable number of 20, 30 year old, uh, folks, um, that frankly I wasn't expecting, at least from the reports that I had originally heard.

Um, and so, you know, there's many, there's many pediatric facilities that do extend up into that early 20 year old range. Um, especially if they have other sort of chronic disorders that might predispose them to, to getting, uh, covid more so than, than a, a healthy individual. So we do anticipate seeing, uh, a fair number of, of, uh, affected patients in that age range and, and those would come to us.

And Boston has a really good community in terms of the health systems working together. Can can you describe how you've worked with the other systems within the, uh. With within the Boston marketplace to, to really get prepared for this? Yeah. Well, I, I can tell you at least at the IT level that we're all sort of constantly talking with one another, um, extending support, giving each other ideas of what, what we've done or not done.

And that's been super helpful. Uh, I also know, uh, that our CEOs and C COOs are. Are also talking on a regular basis, um, amongst themselves and, and doing the same, you know, trying to assist one another, um, getting ideas from each other. It's really been very collaborative and, uh, you know, any, any sense of competition and so on is out the window these days, as you would expect.

So, uh, so let's get pretty pragmatic here. What, what are some of the things you guys are have done and, and what are, what's like one thing that that, that we would be amazed that your IT team has been able to accomplish over the last couple of weeks? Well, I, I think, um, you know, probably similar to many organizations around the country that the two things that I've just been bowled over by are two things that we've been pushing for a long time and, and really trying to get adoption for.

And, uh, this was the, this was the trigger that really pushed it. And, um, those are first, first of all, telemedicine, uh, being able to do, uh, virtual visits with our. Obviously on the ambulatory side for less acute patients, we've, uh, I think the, the current number is about 30 x what we were doing before, uh, COVID.

Um, and just to give you a sense of volume, uh, we normally see around 650 to 700,000 ambulatory patient visits a year. Telehealth visit rates are, um. Approximate, approximating about 40% of that total volume. So if we were to keep this clip up for an entire year, we'd see almost 40% of our usual inpatient, I mean, in-person ambulatory visits, which is just a phenomenal number.

Now, I don't know if that's a sustainable number or if these are just quick visits, you know, in order to tide this over until this period's over. But regardless, the adoption has just been incredible. And honestly, the, the experience is good both on patient side as well as provider side. We're actually. Um, asking both patients and providers to rate their experience after each visit.

And uniformly it's up in the eight or nine range out of 10 for, for both of those, um, uh, parties, both patients and providers. So really strong there. Um, but the other place that we're using virtual visits, which is really neat, is in the inpatient space as well. So that, uh, uh, providers are, are not, uh, exposing themselves potentially to, to patients, uh, with covid and vice versa.

Frank. For the patients to not, uh, be exposed too much. Um, we're using video to interact with patients inside the room. So, uh, for that consultation that needs to be done or that quick question that needs to be asked of the patient without donning, uh, you know, all of the PPE and, and utilizing PPE, we're preserving that and, uh, and reducing exposure.

And, you know, we've gotten creative in what technologies we're using for that. I. Variety of different efforts around the country, but that's really neat as well. And, and that got put together very quickly. So virtual visits is one big place. Um, and then the other big place is just in, in remote work. You know, here I am at home, uh, we've got over 50% of our, of our staff, uh, that work normally at Boston Children's working, uh, remotely now and, and scaling that up quickly, um, and effectively has just been incredible thing to watch.

I get the, the, so talk to me a little bit about the telehealth, and I know we're coming up on our, our timeframe here, but, um, were you able to just scale up what you already had or did you get really creative and come up with just new ways? A little bit of both. Bill, we, we did have to scale up, uh, both from a licensing perspective as well as hardware perspective to make sure that the infrastructure was ready, but we also had to branch out a little bit.

So, as an example. Platform didn't provide the ability to have multiple clinicians participate in one visit. And for our patient population, we have, um, um, many, um, instances in where multiple providers need to participate in a, in a visit. Um, we've got many patients who need interpreters, and so bringing them into a visit.

Um, so that was a little bit tricky for us using our existing platform. And so this is where the, the HHS, uh, sort of HIPAA relaxation really came in handy for us because we're using things like Zoom and, and other technologies to, uh, to enable those kinds of visits as well. Are, are you surpris? I, so I'm doing, all these recordings are on Zoom, and I've been surprised.

I, I haven't had a hiccup, I haven't had a performance de degradation or anything. Um, have you experienced the same thing or has it been Not really. Just a few edge cases where sometimes the call quality, especially if people dial in with, uh, with, uh. Cell phone, uh, rather than using, you know, internet audio.

Uh, but really other than that, and for big, big meetings too, we have these big town hall meetings for our entire, um, organization to, uh, to be able to listen in on. And with thousands and thousands of people participating, it still works incredibly well. Uh, what's a, so last question. What's the one thing, uh, in the prep process that you wish you had done earlier in the process?

I, I totally underestimated the need that we would have to get people computing devices for their home environments to do remote work. Um, I thought, well, gosh, everyone's got a laptop or at least one that they could utilize at home. Um, sure it might be a personal one, but we could, you know, en en en engage our staff to.

Um, there's plenty of people who don't have one who just simply are using their phones on a regular basis, and I was, uh, completely caught off guard by that. And so our ability to, to provision, you know, um, laptops very quickly. Obviously supply chain constraints have made that even more difficult. Um, but that was one that

I wish I had sort of rethought early on and, and had, uh, started the process of of getting machines and, and getting them distributed and, and built out for folks, uh, earlier in this. And you're letting people use their personal machines, non-work machines at this point? Yeah, we are. Yeah. We, there was just no other , no other way to, did you just send them to Best Buy and say, look, expense it.

Go get something. Uh, we didn't quite go that far, although some people took it upon themselves to do that. Um, much to my dismay, but no, we're, we're trying to still, uh, constrain it to devices that we, you know, control and, and, um, and can provision appropriately. But it has been a little bit, um, uh, rough and tumble, I'd say as, as we've gone through it, but it's working is the bottom line.

Uh, any, any last words for maybe children's hospitals across the country as they prepare for this? Well, I think just, uh, as I mentioned before, there have been discussions I know, uh, around the country about, uh, the need for, for us to serve as that aggregating place for, for children's care, uh, COVID or not.

And, uh, that makes a lot of sense to me as. Again, as we look to New York and seeing how overwhelmed they are and knowing that that's likely to to be the case everywhere, uh, it does make sense that those pediatric patients would find a home, um, at the children's hospitals where there's, uh, the most expertise in, in being able to care for them.

Absolutely Dan, thanks. Uh, thanks for your service and thanks for taking all this time. I appreciate it. I appreciate it. Likewise. Thanks Bill for the opportunity. That's all for this show. Special thanks to our channel sponsors, VMware, Starbridge Advisors, Galen Healthcare health lyrics, and pro talent advisors for choosing to invest in developing the next generation of health leaders.

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