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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 Darren Dwe and the CIO for Cedar-Sinai in Los Angeles. Good afternoon, Darren. How's it going? It's going great.

How are you, bill? It's interesting times. Uh, it is interesting times. Give, give us a little context. What's going on in la What's the, you know, what's going on? What's the mood, what's, you know, are people congregating yet or is it still, uh, shelter in place? Yeah, you know, I, I think it's, uh, becoming more and more of a cliche, but I think still applies.

Um, this is unprecedented times and I think that it would be fair to say that, you know, I've never seen anything like this in la. Um, I'm not a, I'm not a native, um, so I can't sort of go that far back in history. Uh, but I have never seen la uh, function in the way it's currently functioned, which I assume is similar to the way other people are observing their, uh, localities.

Um, the good news is that the, uh, shelter in place and the social distancing, uh, really seems to be taking effect, and it really does feel like people are listening to the guidelines and following sort of the rules and . Doing sort of the best they can. Um, and I think everybody's just, you know, trying to adapt in terms of sort of what this quote unquote, new normal looks like and feels like.

I. Do you have a, uh, is your shelter in place? Are the parks still open or are people generally not on the streets when you, uh, you're obviously in the office. When you came into the office today, were, were the streets pretty empty? Well, let me, uh, just first say, because I am in the office that, uh, we've, uh, strongly encouraged, uh, all of our employees to work from home.

That was a massive effort. Uh, in itself. Um, and, uh, I frankly actually have the luxury to work from the office because, uh, I believe I'm the only one on the floor today. And so, uh, you know, they're, uh, we, we've, we've really, really tried to, uh, get, uh, folks to sort of, to stay where they are, stay in place, work from home, uh, and, and just sort of, uh, sort of be where they, uh, can be and sort of be safe.

I think that, uh, we really are seeing that, uh, your question about the parks, um, they are closed. Um, really just pure essential services. And I would say other than, you know, a few, uh, missteps here and there, uh, most people really do seem to obey it. Um, the part that I think we're a little bit worried about is, um, as the weather starts to get nicer and nicer, um, you know, cabin fever starts to, uh, develop and everybody starts to think that, well, maybe I can go outside a little bit.

But, uh, uh, we're, we'll, we'll keep our fingers crossed and hope that people, uh, stay and obey the orders. Yeah, I'm, you know, I have this series of questions I've been asking. I'm gonna steer this one a little bit. Talk to me about your work from home experience. So, what we anticipated would happen if, if we were to talk like two years ago, we would anticipate if we pushed everybody to home, that the productivity levels would go.

Significantly, significantly. What's, what's been your experience? I, I would imagine productivity's pretty high at this point. Yeah, I mean, listen, uh, you know, it, it's been, uh, unbelievable to sort of watch, uh, sort of this force change take place. Uh, so practically overnight we went from maybe two, 300 people, uh, in our workforce working from home on a regular basis, uh, to well over 5,000.

Um, and you know, that's had its growing pain. So if people have had to figure out how to use Zoom and uh, WebEx, uh, I think the word mute, uh, might be the most uttered phrases in all meetings these days. Am I on mute and I off mute? Uh, I've gotten to meet employees, dogs and, uh, gotten to understand a little snippet of their homes and, you know, see sort of where people live.

Um, but I think people are, are adapting and, and trying to figure out. You know, what makes sense? Um, I think, uh, I get the most feedback from, uh, managers and leaders, um, how hard it is for them to adapt in terms of managing and leading their teams. Um, a lot of folks are just very used to this sort of line of sight and sort of managing sort of, uh, you know, literally what's in front of you in terms of tasks or people.

Um, and it's just a very different experience to schedule things and, and work through. Uh, you know, a world in which, you know, we're using the technology. Um, it's also been interesting to watch folks . Um, having to adapt to just sort of certain things that, you know, they're, they weren't used to doing. So, you know, we were, uh, as a academic medical center used to long meetings.

Um, you know, we've sort of adapted to sort of huddles and sort of check-ins and trying to sort of have sort of more frequent, shorter meetings. And that seems to sort of, uh, be the, be the thing of the day. Um, and then people are just working through the barriers. Some of them are just learning curves. So in terms of how to use the technology, others are real things.

Uh, for me, you know, I find that, uh, at home it's difficult to get the right bandwidth just because of the area I'm in and availability I. I also happen to have two teenage kids that are doing, uh, video schooling. And so that's competing for bandwidth, uh, during the day. And so it's things that you should've never otherwise sort of would've thought of, uh, become sort of, uh, real issues and problems.

And was there anything from the, uh, from the technology side for, in terms of standing it up? I mean, there's an awful lot of stuff that happened in a very short period of time, and when we, when you sort of. You put that many people outta the house, were there, were there things that were not anticipated?

Of course. And, and you know, I'll touch on sort of, so one of the silver linings is, uh, and I'll back up a little bit. Um, I've been in healthcare long enough to have sort of watched us go through sort of ebbs and flows of work. And one of the things that always amazes me about our teams is when we go to one of these very large go lives.

Of everybody sort of coming together and how much we get done in such a short period of time. And I think the analogy to go lives are when crises like this pandemic sort of arrive. And it's really amazing how much people can get done by sort of sheer force of will and, you know, can do. And you know, we were, we're not gonna let, you know, small things sort of stand in our way.

And so, you know, projects that ordinarily probably would've taken us months, uh, measured in sort of long timelines with lots of check-ins. We really sort of, you know, put in place over days. Now, you know, some of those things were a little bit tricky. I think that we had to make some early compromises, uh, in some of our policies and some cybersecurity things.

We've quickly sort of had those catch up and sort of get as many. Uh, back into places we can, and we're still living in a little bit of sort of a, a balanced mode between what are, might be some of the best practices, uh, versus uh, what is the most practical I. And finding sort of that balance has, um, started to find a little bit of sort of a normalization.

But, you know, some of those early things where, you know, not everybody has computers. Do you let them use home computers? Do personal computers now connect to the network? Do you let people take computers from your facility over, do you deploy new computers? I mean, it was just a, a lot of things that we quickly had to think through.

Um, and . Had to sort of keep balancing sort of the imperative and the practical with what were, you know, important policy decisions. Well, and I'm wondering if like, somebody's walking around with a little pad and you're going, here's our new policy, we're gonna do this, and they just write it down and it becomes like a policy within minutes kind of thing.

Yeah, and, and you know, I think similar to my go live analogy, I think what happens when you're in these sort of high pressure situations is, um, you know, you. Rely on people to do the right thing, the right way. Um, and you hopefully empower people to make the right decisions at the right time. And when sort of all that sort of stuff gets sort of thrown to the pot and, and you know, it's time to sort of execute, um, that's really what you're sort of counting on.

Um, and I think that, you know, what you start to do is the dust settles and you start to hit a little bit of a normalization is you start to look at, okay, how do we start managing sort of the edge scenarios and the things that. We're maybe a little too creative. So talk to me about telehealth. You have a lot of specialists, academic medical center, um, Cedars, world renowned, but a lot of those things didn't used to lend themselves to telemedicine, but that sort of changed overnight.

So talk a little bit about your journey there. Journey your, your couple week long journey. I guess it's, yeah, listen, uh, it, it, it, it was a journey and, uh, it, it still continue along sort of, uh, that, uh, that, uh, timeline. Um, look, you know, I think the, the first and most important thing to say is that, um, we're not at normal.

Um, which is probably sort of stating the obvious. For us at Cedars, uh, you know what that meant, uh, was a cancellation or postponement of just about all elective, uh, procedures and surgeries and visits, and quite candidly, as much as we could, I. Um, we were very much in sort of a, a, a crisis mode of trying to preserve PPE, trying to preserve, uh, contact, trying to really sort of hunker down and create sort of a small of a circle as was practical.

And that's resulted in a significant amount of canceled and postponed visits. And so our overall ambulatory volume has dropped more than 50%. Um, that's sort of the difficult news. Uh, what we're going through right now is that the decision making that went into what, to postpone or cancel when we thought it was gonna be a week or two is very different than you, and you think it's going to be a month or two.

And so we're starting to now re-Look at what that means. You know, somebody brought up to us yesterday, um, which I'd sort of heard for the first time, it made a complete a lot of sense, is that, you know, even the word elective surgery or elective procedure, for those of us sort of in the bubble of healthcare, we understand what that means.

But to patients, they don't use the word elective the way we look, use the word elective. And so, you know, we're probably even using the wrong terminology in terms of having to slice and dice, uh, sort of which things are gonna happen and which things aren't. We've never really had to go through that exercise before.

And so we're starting to do that On the video side though, which is a question that you asked, um, I guess the good news front. Is that of the 50% drop of what was sort of left? Um, we have but half of those still happening in person, uh, because they are critical and important and, you know, are uh, sort of uh, uh, very sort of urgent.

Like things that require face-to-face interaction. The other half of the half. Um, have gone virtual, uh uh, some of those are telephone, some of those are video, and we've been watching that number change. Uh, when we first, uh, moved, uh, that those things to virtual, we saw a big, big increase in the use of telephone visits.

Again, for the, probably the very same analogy that we're seeing executives working by telephone first 'cause they're more comfortable. And as you try your first couple of video visits and you start to get a little bit more of a, of a feel for it, we're starting to see those sort of rise. And candidly, I think we've got better at rolling out the tools.

Maybe some of the very early quick roll that rollouts were, um, uh, they were working but maybe not optimal. And so as you sort of clean up the edges, we're starting to see that sort of rise today. Uh, probably about 25%, maybe a little bit more. Of our ambulatory visits are, uh, happening, uh, video, um, oh maybe 15, 20% more telephone.

Um, and the rest, um, is sort of still happening on sort of an urgent basis, uh, in person. 'cause it's the nature of sort of what they are. And probably when you dig into those visits, they require, uh, you know, something that is sort of a, a human touch. The biggest growth though, and probably, uh, the most helpful, uh, televideo has really been on the inpatient side.

And so, uh, the most spectacular part to me has been watching our teams deploy and watching our clinicians adapt to almost overnight, um, EICU happening sort of throughout the facility and, uh, even broader than EICU, um, uh, offering, uh, video help into our med surg rooms, um, that are acting as ICU like, and, uh, that's really been phenomenal to watch.

Um, and then alongside that, we've rolled out an amazing amount of what we've called video visitation. Um, and so when you think of the, you know, the, the true heartbreak and sort of just the really difficult situation of what it means, uh, to, uh, uh, restrict visitors, uh, into an acute hospital, uh, offering back our patients and families some way to stay connected has been a big priority as well.

And so, uh. That has had a, a large, uh, use and a large adoption. Yeah. So, um, you know, part of part of I wanna wanna ask you is you, you generally have a, uh, core group of vendors that you work with. You're, you're a true believer in not having a million vendors, but having a few, that's an efficient way to run an organization.

Talk to me about how. Uh, you were able to team with your vendors to really move it forward. You're obviously shop

you this again, off script and

what that, what experience, what were for, from how you interact. Yeah, look, I, I, I think, you know, the, the euphemism that, uh, one often uses is, you know, our vendors are our partners. Um, and I think that, uh, one of the things that in exercise, uh, like this sort of demonstrates, I. Is really sort of who are your partners, um, and you know, where they were willing to sort of step up and sort of what ways were they willing to step up?

Um, and I'll say we sort of saw, um, sort of two things sort of emerge. Um, and, and I don't want to sound jaded at all by it because I, I think, um, it really, really was genuine. I think for the, uh, for the most part we got, um, tons of really sincere . Legitimate offers of, wow, I can only imagine what you're going through.

Here's some services we offer. If they can be helpful to you, please, um, take them and let us know if there's an easier way for us to give 'em to you to consume them in smaller bite-sized chunks. Um, we've got a lot of that. Um, a lot of that naturally came from vendors and partners that we've never really interacted with before.

Um, and I think for us, uh, what we found was that scaling existing platforms and existing partner relationships was just easier for us given the speed and the scale by which we had to get to, right. Um, there was a few exceptions where we took on some, you know, net new, uh, vendors that we hadn't sort of worked with, but for the most part, especially when it came to technology.

Uh, it just was easier for us to sort of jump in, uh, with our partners and, and I'll say a few of them really sort of stood up. And if you don't mind, I'm even gonna name them. Um, you know, at t was one of them. Um, I'm sure, uh, somewhere in my past I may have said a negative word about I. At and t service at sort of some point.

Uh, but I gotta say, um, that, you know, one of the first things we realized was we needed some agility in our, uh, telecommunication lines and how they were configured. And especially with phone in terms of, uh, where our capacity was. And at and t's only concern was how to help us as quickly as they could and they'll figure out the contracting and the rules and sort of all of that sort of stuff later.

Um, Cisco was another great partner with how they worked with. Thus with WebEx, which was sort of our predominant platform that we use for video conferencing. Um, epic, of course, was wonderful in terms of helping us, uh, uh, scale some of our systems. Boy, I think about, uh, some of the six and eight and 12 month epic projects that we had and things that we've deployed in the matter of days.

I don't know, I don't know how I'm gonna go back to my, uh, clinical colleagues and tell them that yes, that's a really good idea. I'm gonna put them on a list. It's a four month project. Uh, people just moved really, really quickly and sort of helped in, in, in great ways. Um, and then some new partners, uh, you know, we don't do a lot of business with, uh, folks like Polycom, uh, but they were very helpful to us in terms of, uh, getting us some video carts that we needed for some of our tele ICU Apple applications.

Um, apple was phenomenal in terms of getting us iPads, uh, probably on a more priority basis. Um, sincere calls from folks like the CEO of Salesforce and Dell and sort of others. . Really sort of looking for, hey, how can we help, uh, in ways that sort of don't get in the way and, you know, help you sort of, you know, get to the goals that you have.

And so it was all very, very nice decision. Fantastic. I, you know, uh, I appreciate you giving us a little extra time and, um, you know, the, the last question, and you could feel free to, uh. I'm sort of wondering, uh, you know, we're looking at the numbers. It, it seems like, uh, I mean, according to the, the model that we're all looking at, it seems like you're two days away from your search and that number's pretty low.

Um, you know, how are you guys trying to make that decision of when to transition? Are you take a state lead or, and, and this is this.

Move off or, or move or continue with this? Yeah. I, I won't even, you know, sort of try to sort of, uh, jump into, uh, sort of the guessing of sort of where things are going and how things will sort of play out. Um, other than to say that I think our general strategy, um, and I'm proud to sort of see our organization go through that, uh, is one of, and, and not one of, or.

Um, and so when it comes to, you know, what do we do, um, it's been, uh, focused on trying to be as prepared as we possibly can, um, and doing as many plans, uh, in place as necessary. So, you know, I think it's okay for us to think about, uh, the planning of what would it take to ramp up, uh, more surgeries and more procedures and caring for more patients.

While at the same time, deeply planning for how would we scale to doubling the number of ICUs we have and taking care of more critical patients, um, as need or should the need sort of arise. And what we've told folks is it's, it's okay. You don't need to feel guilty about, you know, praying for and feeling for that, hey, you know, this is the peak and it's, you know, gonna get better.

Uh, but you know, that can't be our only plan. Um, and you know, one of the things that, uh, you know, has been really, um, uh, important for us to stay focused on is that, uh, we have a lot of patients in our hospital today that are non covid. And, you know, a lot of, uh, very important lifesaving things happen, um, in our hospital, that our community depends on us and we have to make sure those services, those essential services,

Are continuing. So there's lots of planning going on in our cancer service lines and in our heart service lines and neuro service lines around all of those things that the community needs. I. And, you know, we've told people it's okay, it's okay to plan for those. Uh, but it's a, it's the business of, and in addition to that, uh, let's make sure that we really sort of are as prepared as we can be.

And thus far, um, you know, we, we think that we're doing, uh, you know, the best job that can be done given in the circumstances. And I would be remiss if I didn't work this in some way. Um, you know, is wonderful. Uh, and as proud as I am of the IT teams for all the enabling technology that they've deployed.

Um, watching my friends and colleagues in the front lines who I, I've always had an admiration for, but now just an unbelievable extra admiration in terms of being able to see what they do, um, and how they're doing it and watching them sort of run to the danger, not away from the danger, um, really is sort of spectacular and

You know, I think that, um, on the administrative side, I probably spend more time than I should on the business side and the planning side and the technology side. Uh, but you know, it's easy to sort of lose, uh, you know, what healthcare delivery is sort of all about. And watching these folks, um, sort of do what they do, um, is really sort of the, the mission and, and really sort of the objective of why Cedar Sinai exists for the community.

So it's been wonderful to watch . Absolutely. Darren, thanks again for your time. I really appreciate it and uh, yeah, I look forward to catching up with you a little later and, and we'll see how this progresses. You bet. Thank you Bill, and thanks for what you're doing. 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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