Digital upscaling for long-term virtual care, innovation models: 4 details from Mass General Brigham's digital chief

The rapid acceleration of digital technology and decision-making during the pandemic allowed health systems to respond quickly to patients' needs. Now, systems are finding ways to scale those models for the long term.

At the 2020 World Medical Innovation Forum, a panel of experts, including Alistair Erskine, MD, chief digital health officer at Boston-based Mass General Brigham, discussed how digital health has become a pillar of the healthcare system. Dr. Erskine addressed the cost and workflow challenges of sustaining pandemic-time work and digitally upscaling for the future.

1. Health systems changed their decision-making process during the pandemic to accelerate needed changes and respond to patient needs. The rapid decision-making process was designed to be sustained for weeks, not necessarily multiple months or years. Now this decision-making model needs to be re-designed to accommodate nimbleness and a rapid response over for the long term.

"During that time, it has been really important to understand what critical capabilities we need to be able to have," said Dr. Erskine. "For example, we need to be able to adapt in uncertain times and make changes to digital health technologies on the fly; being able to rapidly deploy surge capabilities, whether it's the way the hospital is organized to turn one unit into an ICU or add a field hospital that needs to be built in order to accommodate surges of patients."

2. Virtual visits were scaled as a regular service line at the health system. Mass General Brigham added virtual visits as a standard venue in the care model like inpatient, ambulatory and post-acute care. The change requires a more robust and refined data environment, Dr. Erskine said, to reduce the amount of time it takes to generate insights based on data from the front-line caregivers. "It goes without saying that promoting research and innovation, and making sure that the things discovered on the front line [are embedded at] enterprise scale is incredibly important."

3. Technical debt incurred as a result of rapid change needs to be managed. Dr. Erskine defined technical debt as the number of standard processes and protocols that occurred from a maintenance perspective systemwide as a result of the changes; many departments had already begun fulfilling 2020 strategic initiatives that were abandoned during the pandemic and will be either terminated permanently or restarted again in the coming months.

"We had imagined our 2020 roadmap in terms of digital technologies that we were going to go forward with. We had existing enhancements to our system, and all those went on hold as necessary for the COVID-19 response," said Dr. Erskine. "As we calculate our time away from the standard work we did, it ranged anywhere from 15 to 40 percent from the time we needed to be stopped and the need to resume. This is work we had planned that will need to be reprioritized, and we will need to rapidly deploy COVID-19 technology and processes that were done at the point of care but now need to be done at scale, all while capital dollars are being dried up, while the supply chain is being disrupted, while clinicians are returning to their day jobs and the set of digital upscaling that requires for staff and clinicians."

4. Dr. Erskine sees much of the digital technology developed during the pandemic to remain as virus cases wane, and patients will need digital navigators that will be able to "shepherd" them through the virtual care offerings. "If you look at something like a virtual visit, which has had an extraordinary increase in utilization over the past couple of months…if a patient is unable to get on a video platform, for example, because they don't have the technology or because they can't afford it or don't know how, or aren't in a convenient place to conduct a video visit, we still need to be able to fall back on other modes of communication that are synchronist and receive the same payment for those visits so we don't hardwire inequity into it," said Dr. Erskine.