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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 Neil Patel, physician with a and CIO at Vanderbilt University Medical Center. Uh, good afternoon, Neil. Welcome, uh, welcome to the show.

Well, thank you. Thank you very much for having me. Well, I, uh, I know you guys are, are all very busy, so I really do appreciate the time. We, uh, we've been meeting with, uh, a bunch of, uh, CIOs and executives talking about, uh, the preparation. And I, I'd just like to really just get into it, but, uh, if you could just give us a little background on, uh, the, the University Medical Center.

What, what areas do you guys cover, what geography and, and, uh, a little background. That would be great. Sure. Uh, Vanderbilt University Medical Center is on the campus of Vanderbilt University in Nashville, Tennessee. Um, so we really, uh, cover, um, the Middle Tennessee area. Uh, we have patients coming in from southern Kentucky as well as northern Alabama, some from Mississippi, uh, tertiary ary academic medical center.

Uh, we have a close to a little over a thousand beds, uh, with a adult hospital, children's hospital, and a psychiatric hospital on site. We average about, uh, 200, uh, sorry. Uh, we average about, uh, um, 50,000 discharges a year and about, uh, 2.2 million, uh, ambulatory visits a year. Wow. And, uh, yeah, so Nashville was actually one of the areas that was starting to, uh, you know, starting to really escalate.

Has that continued or is it, is it, so the good thing, uh, that we had, um, was. Because of our, um, clinical leadership in infectious disease and, uh, vaccine development, the worry of coronavirus, uh, was actually, um, . Heated early. So we actually started testing, uh, for Coronavirus, uh, fairly early in our city. And so we have done a lot of tests and the confirmed cases have risen.

Uh, but the good part has been that thus far we have not seen the onslaught into our inpatient environment. Um, we've been preparing for the past several weeks, uh, in a variety of ways to, uh, to be ready for it. But, uh, we initially, our focus was to get rapid assessment centers and testing, uh, out there.

Now we're, uh, following close to five to 600 patients in as outpatients to follow their symptoms and hopefully keep them at home. And, uh, we're preparing our inpatient facilities to, uh, respond as. The numbers of inpatient, uh, uh, uh, admissions rise. Yeah. So you, I mean, academic medical center, you probably had a fair amount of technology in place.

What, what new technology have you spun up over the last couple of weeks to, to address, uh, address the needs? Sure. Um, well, several things. Uh, while we've had technology in place, it hasn't, wasn't leveraged as well as it has been in the past several weeks. Uh, first and foremost is what we're doing now, teleconferencing, um, using, uh, zoom and, uh, every other, uh, type of, uh, uh, platform has markedly increased.

Um, and everybody is saying that around the country. Um, we have, uh, obviously as many other, uh, medical centers have really transitioned, uh, clinical care, uh, in our ambulatory environment to telehealth. Uh, we had the integration, uh, we're an epic based EHR, uh, system here. We've had that in place for the past, uh, two and a half years.

Yeah. So there, there's a lot of different kinds of, of telehealth and I've, I've, um, really been pretty lax on the show to, but there's obviously the, the remote visits is important. There's also, uh, remote patient monitoring is another aspect of that. Do you guys have any of that going on at this point? Um, not yet.

Um, and I kind of, I agree with you. I've, I've, uh, been, uh, playing with the telehealth world for a while and I, telehealth is the big umbrella and there's really tele visit where you're interacting with a patient, uh, face-to-face. Uh, and so it's kind of like an ambulatory visit. There's also things like tele diagnotics with store forward, whether it's, um, EEGs or uh, re.

Pictures of, uh, retinas for, uh, diabetic retinopathy and those sorts of things. And then as you said, telemonitoring, what we haven't really gotten into that space as much. We have other tools, uh, that we have access to be able to visualize, um, the monitors remotely. And we wouldn't really classify that in terms of changing our apparatus where, uh, we're removing the provider from the bedside.

It's more of a surveillance and. Uh, uh, aspect by, uh, supervising attendings. How much, how much has physician to physician communication gone up via things like, uh, teleconferencing? Um, it actually has gone up, uh, uh, remarkably well. We have been on the journey to do that, um, uh, initially, uh, with . Uh, secure chat or secure texting, um, uh, to, uh, comply with the CLS regulations.

But now we have also, um, are beginning to leverage and see if Microsoft teams can be used, uh, to do virtual rounding and bring, um, desperate people to the same location, but also promote social distancing. Or we should actually more appropriately call it, uh, physical distancing, um, where individuals still need to collaborate on the care of a patient.

I, you know, I love working from home. I, you, you, you're giving me the full experience. I'm getting some background noise, some things going on back there, . Um, you're also using Zoom to its full capacity. If, if people are just listening to us on the podcast, you have the, uh, background going as well. Um. Do you find, so people are taking to this pretty well.

I mean, obviously it's hard. We used to work in the office, we'd interact with each other. But are are, are the staff taking to this pretty well, are we figuring out ways to bring everybody together and, uh, and, and sort of break up the monotony and, and help them to, to stay focused and talking with each other?

We, we have been, and we're, we're learning as we go, obviously. Um, one of the big pieces that has been, uh, important. For our health IT team, we have, um, about 450, um, FTEs that, uh, very quickly had to transition to working from home when they were in the office. And I've been impressed with how, uh, professional and diligent, uh, they have been.

We have really, uh, utilized, um, uh, the communication platform in, uh, Microsoft teams to keep people, uh. Uh, communicating with each other, keep statuses up to date. Um, and really it's been interesting whereas before, uh, when we would quote unquote have Skype calls where everybody would just dial in and it was a glorified teleconference with the old telephone.

It's amazing how many more people are turning on their video because they want to see the physical interaction. Whereas we didn't do it as much when we're in the office, but still it was still a call with a bunch of remote people. Um, so that transition has been interesting. The other piece that we've done is we've held virtual town halls.

Yeah. Well, yeah. Tell me about that. So the, we've held two of them. This, uh, the first one was right, uh, as we started to work from home the week after where everybody was . Kind of naive to all of the actions that were taking place in the command center at the medical center. And how do you get that sort of information to the front lines and emails or, um, just, uh, giving updates, uh, in the written form just doesn't, isn't enough.

And so we were able to, uh, leverage our Zoom capability and the first, uh. Kind of did a update with, uh, what was happening, uh, nationally as well as locally and at our medical center, uh, providing the clinical background to our IT staff. And we have four 50 people, uh, on that. Um. Town Hall Virtual, uh, and it was amazing.

And we also used it for a little bit of fun. We had people, uh, submit, uh, pictures of their homework environment that they had to throw together. And so we got amazing, uh, uh, community, uh, building out of that, uh, process as well. I. And then the post, uh, survey of that town hall, people actually begged for more and they said, gosh, it'd be great if we had this weekly, or bought, uh, or every two weeks.

And so we did another one, uh, this week, uh, which was two weeks later. Um, and again, this time 460 people dialed in at 8:00 AM uh, which I found pretty impressive that there is a thirst for being together in some format and, uh, hearing, uh, a common message. And so. It's been gratifying to know that, uh, our team can come together and that people can share.

Uh, and despite all of us dealing with, uh. All the various things that we have to deal with with home life, uh, and, uh, worry about safety. Yeah. What, so what's, uh, over the last couple of weeks, a lot, a lot has changed. You know, what's, what's one of the things that you've discovered that you were like, may you, this is, this is a real good finding that, you know, might help others or, or just something you might wanna carry forward.

Sure. I think, um, I think most institutions are finding the, the fact that our frontline clinicians have. Transition to do telehealth visits when in the past they would've never considered such an option. Um, now obviously it's easier to do now because there is no other option and you're not having to switch back and forth between live patient visits and telehealth visits.

But the fact that there's, uh, there's been very rapid uptake, uh, and adoption of the technology, um, with, um. Very little, quote unquote teaching or educating, uh, has been rather impressive, uh, to us and it gives us the confidence that we can move quickly on certain things and not. To just let the enemy of good be perfect, which oftentimes we get in trouble with, uh, in terms of trying to perfect something or perfect a solution before getting it out.

Yeah. You know, I, I'll, I'll say it's the, uh, ci an acting CIO doesn't have to say, but there's a lot of barriers to telehealth before this. I mean, yeah, the, the compensation model, that barrier came down. Uh, even the security . You know, restrictions we had to go with very specific technology platforms. Um, the physicians, quite frankly, pushed back significantly, uh, at least when I was trying to roll it out.

They pushed back significantly on the fact that they had to do televisits, they had to do in-person visits. They, they workload was so, uh, you know, it, it wasn't designed to really take digital into account well. You know, all those things happen to fall away over the course of what, a week, two weeks.

Exactly. And I think that's the, so, you know, if there are gonna be silver linings around this horrible, horrible cloud, though, that's one of them, um, all the factors fell into place to actually get over that activation energy that's required for people to at least try it. As some of these obstacles or barriers rise up, we're gonna need to now, but at least think about how to overcome them as we move forward.

But the reaction from the patients has been the most impressive thing. The positive feedback that we are getting from patients is been absolutely tremendous. And that's sort of validation that the clinicians are hearing, uh, is pretty profound. Yeah, it's amazing. I just got off the phone with my mom, she's 80 something years old.

She's like, I just had a televisit. She was so happy. 'cause she listens to the show and she's just like, I now know what you're talking about. That was really good like, yeah. And I think that's what's gonna happen that that net promotor score on this stuff is so high that people are gonna go, they're not gonna wanna go back.

So we're, we're gonna have to figure between the telehealth tele and also we've had a. Significant uptake of our patient portal, uh, which is, uh, we had developed a homegrown one before we went to Epic, and then we just transitioned it, but branded it the same, which is called My Health at Vanderbilt. It's utilizing the MyChart functionality, uh, in Epic.

We are, uh, signing up 7,000 patients a week now. Uh, we were already closing in on 500,000, uh, patients, and now we're skyrocketing because the thing we did at each of our rapid assessment centers is that . Patients wouldn't have to call in for their results if they chimed in for the patient portal. 'cause result will show up as soon it.

That was incredible and people, again, found a reason to connect. Yeah. So it's, it's more than just the record. You're, you're giving them the results back pretty quickly. Yep. Um, can you schedule Televisits through there and actually instantiate 'em through there? Yeah. It's instantiated through the, through, through the portal.

That's how we do all the televisits, um, uh, using the platform. Yeah. I know , I, I know that at least back when I was ACIO, one of my . Uh, compensation goals was to get more people on the portal. This would be a great time. Telehealth and getting more people on the portal were two of the things I was compensated on.

this, this would've been like the perfect year for that. Exactly, exactly. I would say. Um, but I think people are gonna find that, those tools, you know, we've been talking about. You know, our Amazon moment or whatever, people are gonna experience those tools and realize that the health systems have the capabilities, they have the, uh, uh, the digital chops to make this stuff happen.

We just have to, and I, I, I hope that's the message that sort of gets to the state and federal government is if we get out of the way, if we move some of these things out of the way, uh. And, and now that people have experienced, it'll be interesting. Um, you know, I've, I've sort of framed some of these questions I think a little differently, but, um, talk to me about your team.

What, what's, what, what's one thing that your team has done that's really just been amazing? Well, the, I'll, I'll, I'll actually focus on two things.

Um, we very quickly had to change the structure of our inpatient beds, uh, in ways to create cohort specific units and such, and our, the agility of our team to coalesce partner with operations and be flexible because decisions would change from morning to afternoon, depending on new findings or new understandings.

And. Oftentimes it teams can complain, uh, uh, bitterly when operations or somebody changes requirements after they're already, uh, been uh, down a specific path. But knowing that we all had to come together and, um, be responsive, that level of collaboration has been just tremendous to see. And creating reproducible models so that we just didn't create a hero mentality of knocking it out this, just this one time.

But everybody realizing that they're gonna need to have this for the long haul as we evolve and creating, um, a what I've always pride, uh. Create a systematic approach ity, so that we can do this in a reproducible fashion without having to go through the same one path over and over again and relearn things.

And so it's been tremendous to see the teams, um, just embrace that. Yeah. You know, and this, this is the last, um, the last question really here, but I saw Stanley McChrystal talked about, um, you know, one of the things you wanna avoid in a crisis is heroes. Right? And it's interesting 'cause you would think the opposite.

'cause when we were growing up, we saw these stories of the crisis hits and the hero. But, um, the, you know, what he sort of communicated is you want more like nasa, a team of people solving problems, uh, you know. Coming together, operations, it and whatnot. And I, I'm glad you brought that up. 'cause I think that is a, that is a, uh, a key point to really getting through this.

And, and one of the things I, I mean, if you could talk a little bit about that, how the entire system has really come together around, uh, the, the needs of the community. Oh, absolutely. Um, from our operational, from enterprise leadership on down, um, I, everybody has command centers in every one of their institutions.

It's a, it's a, well-known term, but the key is how is the comradery and the, um, and the collaboration within the command centers, but also the willingness to, um, have robust, um. Discussions of what is the right path forward. And that's what I've been most impressed with, uh, between our leadership, between different leaders and experts.

Because this, uh, pandemic brought together different types of individuals that usually aren't in the center of, of the fray. Usually when you have a command center, it's because of a natural disaster or, uh, some sort of other issue. Uh. To have our supply chain leader, uh, uh, uh, addressing things to have our HR leader trying to figure out how to support staff and, uh, augment staff to have our infectious disease individuals having to rewrite policies on the fly, uh, and provide recommendations and get them communicated out.

Um, but to see all those individuals come together and. Just be in harmony in many ways, uh, instead of, of each struggling, uh, to figure out how to work together, uh, has been, um, just something to take pride in. Yeah, absolutely. Neil, I I really appreciate your time. We will have to have you back on the show at another time, you know, maybe in a couple of months and we'll see, you know, how much of this stuff.

Stuck. You know, how many, absolutely. How many televisits are we doing, uh, six months from now I think will be an interesting conversation. Well, um, I'll be glad to be back and, uh, report out and, uh, promise to be bluntly honest. , I appreciate it. Take care. 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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