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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 in health it.com. Now on to today's show. Alright, today's conversation is with Jamie Nelson, the CIO for Hospital for special Surgery, uh, a conversation I'm looking forward to having.

Uh, good afternoon, Jamie, and welcome to the show, bill. How are you? I'm doing well. How are you doing? I. I say, as long as I stake through the virus, I'm great. So yeah, it's, uh, you're working outta your home, but we were talking earlier that you have been in the hospital. Yeah, I mean, as late as y yesterday afternoon, I was up on the units with the team.

You know, rolling carts into the ICUs to, uh, to allow nurses to have some sort of visualization into the patient rooms, so when they come out. So we came up with an ingenious way to do that. So, um, I have been, um, at the hospital for many days now, so today was my first day to do low remote work. Well, this is, this is gonna be an interesting conversation because a lot of people are familiar with hospital for special surgery.

Um, but for those who aren't, give us some context at which will help people to understand how you guys have had to turn on a dime and really change everything. So, um, until about two weeks ago, three weeks ago, we were a, um, almost $2 billion orthopedic specialty hospital in New York City on the Upper East Side.

Next door to New York Presbyterian, Cornell campus, but not formally affiliated within. There are two completely independent hospitals, although huge clinical affiliation and we treated, uh, number one orthopedic hospital, uh, in the, in the world. Um, I would say we would have . 35,000 orthopedic surgeries a year.

Uh, and this is our, our normal thing, and we had a great year. We're doing very, very well. Um, a lot of growth looking at digital, all the normal things. And then on, I think March 15 or so, uh, made the, the decision that with the Covid crisis mounting in New York City, that number one, um, clogging up the system with non-essential orthopedic surgery.

Was not in the public health best interest, uh, number one. Number two, if we could empty um, those patients out of our hospital and not treat them, it would allow us to take patients from other hospitals, namely Newp Presbyterian, to allow them to take Covid patients. So our idea was stop our surgeries, which is nine non-essential surgeries is 90% of our business.

So the initial idea was to stop those surgeries, take. Critical care, um, very sick patients from New York Presbyterian, non covid so they could take care of the COVID patients. Uh, that lasted, I don't know, a day or two because we quickly understood that there was no patients coming into York City Hospital that were not covid, um, positive.

And, and I'm, you know, I'm exaggerating a little bit, but truly the hospital, Cornell did not have non covid patients to us. They really needed us to help with their covid patients. So we very quickly. Um, changed our whole inpatient from being an orthopedic surgery hospital to being a general medical surgical hospital that is taking trauma orthopedic.

We now take EMS patients, which we never have in the past, but right from the ambulances. Um, and we are taking, uh, patients either directly or from near Presbyterian who are covid positive and need critical care, so need ventilators. Um. You know, they, they come with DNR orders. These are not healthy patients.

These are very, very sick patients. Uh, I mean, the, the questions I have about 75 questions. I'm gonna narrow it down. Uh, you know, it's this week in health. It clearly I could ask a lot of questions around the situation in New York, but I don't wanna be insensitive to that. But I do.

You know, there's just question. I mean, if you're doing that, the, uh, the build in the EHR is pretty significant. Uh, you know, you're, you're implementing all new workflows and whatnot. Can you give us some idea of how you sort of triaged and managed all those builds and all that work? Well, I'll tell you, we just looked at the amount of hours that our staff have put on Covid projects in the month of March, and it's 6,000 hours.

And we only have 180 people in our IT department. You know, we're, we're a $2 billion organization. We have a fairly slim IT function. Um, so that's, that's an amazing amount of hours. Um, and I. I will tell you, you know, what we learned is to be agile and flexible, um, and a lot of the old processes are gone.

So for instance, I was in the hospital this past Sunday doing rounds, and one of our lead physicians looked at me and said, Jamie, we need an epic to have covid positive, pending and negative coded in the hr. So if we see red, we know what that means. Yellow, we know what that means. Green, we know what that means.

That's a Sunday afternoon, Monday afternoon. That was gone through our epic team, gone through our clinical content board, you know, all the necessary. So within 24 hours those changes were in normally our, my CMIO said that would take two, three weeks. So when I think of the, I think that's just an excellent example of the rapid speed that we're working at.

Um, because. You know, these, these truly are life and death things that we're doing. Um, again, not something that we're used to in an orthopedic hospital. Um, certainly our colleagues in, in the general hospitals, especially those with large ICUs, are, are used to this. Um, but I don't think anybody's used to this, even in those hospitals, they're not used to the pace of, of change.

'cause this virus is different than any clinician has seen at any time. So, um, you know, it's, it's just a whole different paradigm and Bill, I'm hoping that some of the changes we're making now in terms of our processes, um, will stick after we're back to our, our new normal because I think there's a lot of good we can take out of this very, um, very difficult situation.

Yeah. What, what do you think are some of the things that, just one or two of the things that you've discovered that you, you hope stick over? You know, once we're post covid, which doctors, like doctors and patients like telehealth, , that, that's another great, uh, I think we have about 300 physicians in our, between surgeons and, uh, medical doctors in our, in our organization.

And again. Last month. Where are we? April 8th. Yeah, so about this time last month, we had maybe three or four clinicians actively losing telehealth. We now have two physicians signed up for. We have physical therapy appointments now in telehealth 'cause we do a lot of rehab. So, um, I would love that to be something that sticks.

I apologize about the dog barking outside. Uh, that's something that I really hope sticks going forward. Uh, now of course we have to have our, our clinicians and the workflows down that, um, they wanna continue doing this. We also need to. We also are hoping that the third parties who are now paying for things that they weren't paying for a month ago will not rescind those changes.

So, you know, there's structural changes within the physician offices, how patients are reacting, how the payers are reacting. If those things stay, you know, that'd be something that that'd be wonderful to keep. And by the way, we did these 200 doctors in two weeks. Again, that would've taken us, you know, a two year methodical plan service line to service line.

It is amazing what you can do when you have to. Yeah, when you have, when you have focus, the, um, you know, I'm thinking through. Telehealth, um, telehealth. 'cause I did get the question today. I was talking to somebody, um, offline and, and we were talking about, you know, what's it gonna take for this telehealth thing to stick?

And I'm like, well, you know, the reimbursement, if the reimbursement goes away tomorrow, that's, it's gonna fall. Yeah. We're, we're gonna, we're gonna snap back a little bit, but I'm not sure we'll see that from the federal side. But we might see it from commercial payers. We might see it, who, who knows. But the commercials, the commercials generally follow Medicare.

Yeah, which would be, which would be great. Yeah. So if Medicare sticks with this, I think the commercials, um, would be hard pressed to do anything differently, which would be fantastic. And then you, uh, and, and you guys are in specialty care, which is the other question that I sort of got, which was, you know, I, they, they were sort of saying, well, we, we see this sticking here, but I, I, I see now that, um, you know, physical therapy is now reimbursed telehealth and.

And and very practical actually. Yeah. And, and we're very careful clinically deciding who is a, who is, um, who would benefit from a telehealth visit and who would not, who has to literally come into the organization. Um, but I think that, uh, with those clinical screens, we we're doing an excellent job. We have surgeons doing their initial

Visit their pre-op visit with a patient. Now they've already done lots of screening. They've looked at, um, at films, at MRIs. They've, they've done a lot of pre-work that they, that they normally do to screen patients and, and, um, bring patients in really who are needed needing our services. So, um, the fact that they're able to do that initial visit, um, virtually is just amazing.

And then post-op. You know, you we're in a tri-state area, but some people have in the Tri-state area, have to travel over an hour or two to get into New York City. Right. So for that post-op visit, for a patient who's doing really well, to have that done virtually is, is great for the patient. Really much better for patient care.

So what are you doing for the 10%, you said 90% of our patients, you know, we're, we're sort of pushing off the elective surgeries, but the 10%, they're still emergencies. They're. Their emergency is an urgent, and yes, they're, they're coming into the hospital, so our ORs are working, our surgeons are taking care of those patients because some patients cannot wait.

Um, so we're taking care of those and then we're taking care of injuries. Traumas. So, um, and as I mentioned for the first time in our 150 some odd year history, we are taking direct ambulance to HSS. Normally, patients are brought by ambulance to another facility, stabilized in their emergency room, and then if they need our services, they're transferred over.

Now we're taking them straight off the ambulances, which is very, very different. So what's, what, what's what's been the most challenging thing to sort of, you know, turn this thing on a dime? Uh, from, from where you sit. Um, you know, I hate to use this old adage, but it's very much changing the wheel and the tires.

You're going 80 miles an hour down the road, so, you know, getting, we're getting very quick. Requests from physicians, from our nursing leadership. So, um, being able to get back to them, get clarification, turn things around really quickly, um, we have to be, you have to not be afraid to bother them because they really are the ones making the requests and going back and and forth with them.

They're, they're absolutely wonderful. They don't mind. But that's a, a real change in mindset that we have to be able to just very quickly go back and forth, um, a much more agile way of doing things. Um, so really quite different. Alright, so talk to me about the communication. I think this will be the last question because I know you're, you're busy and I appreciate the time.

But talk to me about the communication between, uh, health systems across the New York area. How is that being coordinated? Um, how are you working with your peers and you know, I assume people are getting stuck and they're reaching out to each other. Well, uh, you know, of course the greater New York Hospital Association and the New York, uh, state Department of Health.

And the City Department of Health are really coordinating efforts and they're doing an excellent job. Um, we have the, um, we have a very strong, in this case, governor, who's done an excellent job of. Really taking charge of the situation, dealing with some data and some facts. Um, the governors, the office speaks with our, um, CEO, the mayor's office speaks with our CEO, so there's a lot of direct conversation with, with authorities and then they bring the hospitals together.

Um, and then really initially there's so New York Presbyterian Healthcare System has so many covid patients that we have not had to look any place else to fill our own. Um. Helping Cornell, um, uh, New York Hospital, Queens and New York Hospital downtown. Those three campuses, that's really where we're taking patients right now.

And our clinicians go back and forth literally between the organizations. They physically walk back and forth. We've credentialed so many New York Presbyterian physicians now on our side. We've given them access to epic quick training. Um, it's just. Again, things that it would've taken weeks, months, years to do.

Um, we've, we've done, uh, very quickly to support these other organizations. A any, anything you would say to another health system that's maybe preparing for Surge that you guys are going through? Um, I think, um, trying to think ahead, uh, we, you just can't. Respond to this request, you have to think a couple of steps forward because, um, that those few steps forward, unfortunately usually are going to happen.

So you really have to be thoughtful about, um, taking care of what's immediately in front of you. But, but thinking a few steps ahead, our CEO operates in that matter, so it's really easy for the rest of us to do that. Um. So I think, um, listening to your peers, seeing what's going on around the country, um, being very thoughtful about preparing is important.

Um, making sure that your staff know that this is actually . Um, a fight that they're in with the rest of the clinicians. I would, our IT department has been absolutely amazing in terms of rising to the challenge. You know, working nights, working weekends, we have a group of staff that are remain at the hospital who are going into these covid units, into these patient care areas.

We have them donning and doffing like their caregivers, so they're safe. But, um, there's a real, a real sense of we've gotta beat this with our clinicians. Um, and, um. Making sure that your IT departments understand this, but you know, that's what it's about. You know, we are here to, to solve problems often.

So this is just a, um, an extension of that that, that many of my colleagues, um, have with their departments as well. But, you know, things change all the time. And the things we figured out in New York are gonna change as the disease progression changes in other cities. So I think being prepared that things are fluid and you have to be flexible and, and just ready to move and zigzag to move forward is, is really critical.

I. Yeah, absolutely. Jamie, thanks for, uh, taking a couple minutes out of your day. I really appreciate it and really appreciate the work you guys are doing. I look forward to, uh, catching up with you after this, uh, slows down a little bit because on the other side of the mountain, we hope. Yeah, and because you're gonna have to, you're gonna have to change the whole thing.

Back at some point it's gonna be, yeah, well, well, um, the hospital and it, um, have returned to, we call it return to new normal. But one thing, one of the things that our CEO Lee Shapiro did, which of course is you know, really wonderful, is while many of us are fighting this fight, he has a group of leaders.

Who are just thinking about, okay, what's it gonna be like when this is done, when we return to normal, what, what are we going to do? Um, so we have some people on that committee, but we're even with an IT are thinking about what's the return to normal goal look like? What are we going to have to do, what are gonna be the steps?

So, um, and that's wonderful 'cause that also keeps us looking at the positive future, not just mired in this, this, um, very typical present. Yeah. Because this, this will.

Absolutely. Well, thanks again, Jamie. I really appreciate your time. My, my pleasure. Bill, stay, uh, stay healthy. 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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