Mount Sinai is fortunate to have strong leadership and an Emergency Operations Center (EOC) team to coordinate our COVID-19 response across our eight hospitals and hundreds of ambulatory care locations. Within the context of this partnership, the information technology (IT) team has been able to gain situational awareness, understand the needs of the organization, and respond rapidly to support those needs.
Within the EOC structure, IT was designated as an essential support function, along with other non-clinical departments such as human resources, supply chain, facilities, marketing and communication, and government affairs.
IT established a command structure with leads for infrastructure, applications, and academic IT and a cadence of operations with an AM check-in for the smaller command team and a PM check-in and update for broader IT leadership and hospital site directors. Within that framework, we have grouped the work into 13 primary workstreams:
1. Remote provisioning of staff who can work from home. Mount Sinai has approximately 40,000 employees; prior to the pandemic, we averaged 1,700 concurrent remote users on a given day. Within two weeks of the governor’s order to minimize travel, this number increased to nearly 10,000 remote users. Planning for this surge included infrastructure upgrades to improve system redundancy, provisioning key personnel with secure equipment at their residences, staffing up our help desk, and modifying our two-factor authentication provisioning.
2. Virtual care and telehealth. Mount Sinai uses multiple vendors for different telehealth use cases, including on-demand video visits with an emergency physician, follow-up video visits between patients and their established providers, remote video consultation to emergency departments and inpatient location, and text-based structured e-consults for primary care doctors to specialists. We saw a tremendous increase in demand for all of these platforms, with 100-fold increase in some cases.
3. Support for alternate care locations. With the number of COVID-19 positive patients exceeding our capacity, the hospitals needed to identify additional care locations and repurpose existing space in PACUs and ambulatory care areas. This required changes to our electronic health record (EHR) facilities structure, billing work queues, and provisioning for clinicians who had not previously been trained to provide inpatient or ED care.
4. Mount Sinai staff collaboration tools. With physical meetings either discouraged or impossible, the need to support remote work was critical. We leveraged collaboration tools such as Microsoft Teams, Zoom, Yammer, and shared Outlook email addresses heavily.
5. Command center support. Important for the early stages of the pandemic response, before the health system and hospital-specific command centers largely virtualized. This is standard emergency response support, including setup of laptops and emergency phones.
6. EHR and IT software tools. New orders, lab tests, reports, data requests - our EHR support team was busy! With some of our support coming from outside the organization, we had to address the possibility of losing that support if the offshore vendor was unable to provide staff due to local conditions.
7. Cybersecurity and readiness. Just because we were focused on one risk doesn’t mean that other risks go away. We reminded our staff and organizational leadership to be on the lookout for new phishing attempts, and continued to perform regular patching of our systems.
8. Patient communication tools. Patients are hungry for information. Clinicians, marketing teams, and leadership want to get it to them. We used multiple channels – patient portal messages, email, text, website, and social media.
9. IT hardware needs. We used this category as a roll-up for all of the hardware we needed to support the requirements spread out across the other workstreams. It could include everything from a remote vital sign monitor to an iPad stand.
10. Forms creation. Our business partners found all sorts of reasons to ask people to “please fill out this form.” For employee health, human resources, and our volunteer sign-up, we leveraged REDCap for forms creation and data management.
11. Human resources operational support. A month ago, our business systems did not include “out of work - paid quarantine” as a valid employee work status. As our HR team defined new circumstances for our staff, our payroll systems team made the necessary updates.
12. School and research community support. The Icahn School of Medicine at Mount Sinai teaches medical students, nursing students, and learners in degree programs across the health sciences. Where necessary, teaching had to be virtualized in order to empty the classrooms. We also needed to provide data to the research community to allow them to fast-track approved research protocols and analyze the information as quickly as we created it. It is what permitted us to rapidly develop a test for antibodies to the virus, and then use them for treatment.
13. IT staff wellness and communication. In a pandemic, every employee is a potential patient. We used Yammer, email and Zoom town hall meetings to reinforce messaging from organizational leaders and to highlight the outstanding support from our team. We also made sure that IT staff members had access to information about how to keep themselves and their family members safe, and how to proceed if any of them developed concerning symptoms.
During this time of intense, sustained work, we made a few general observations about what worked well and what didn’t:
1. The value of "high speed, low drag" communication was magnified with most of the team working in separate locations.
2. IT equipment will be required with very short notice and with incomplete information to make perfect decisions. Work with your infrastructure and finance teams to front-load orders for equipment you can reasonably expect to need, especially if the equipment can be warehoused and used over the next one to two years if not needed now.
3. IT platforms that were in proof-of-concept or pilot phases of use at Mount Sinai generally scaled surprisingly well. In contrast, technologies that had not yet been tried within the organization were tougher to launch.