Darren Dworkin, CIO of Los Angeles-based Cedars-Sinai, outlines the technology that will be most important to the health system as it emerges from the pandemic and why systems should still focus on innovation despite the shrinking bottom lines at many organizations.
Question: What have your top priorities been during the pandemic?
Darren Dworkin: Our No. 1 priority is serving the mission of our organization and the community as well as supporting our front-line care workers. I always knew that I worked with amazing people and now I get to see that in more direct ways. One of the things that I have been able to do is flex the IT staff to support the changing needs of our front-line workers, which has taken several forms.
First, for the non-direct care folks, we transitioned to a remote workforce overnight and now measure the work of more than 5,000 individuals remotely. It has been amazing to watch teams come together to put the infrastructure and tools in place for everyone to get their jobs done. For the caregivers, our efforts have been three-fold: No. 1 was flexing our EHR and other systems to support the new ways we were delivering care; No. 2 was focusing on figuring out how to reduce our need for PPE and use creative ways to connect with patients, including through video visits; and lastly, IT has really demonstrated its coming of age through our ability to put together real-time data for various groups as they engage in decision-making.
There is no doubt that real-time data is a helpful tool for decision-making and the cycle of decision-making increases in a crisis. It is great to see a rapid deployment of tools to make decisions, including those on staffing and critical care. Our efforts have included keeping track of our COVID-19 positive patients or suspected patients so we could track trends and scale the organization appropriately. We keep a close eye on the statistics in terms of supplies, understanding what our current inventory is and how the daily use rate is changing.
Q: What are your top concerns heading into the next 30 days?
DD: There is an interesting phenomenon going on. When the crisis first hit, we swung into response mode and had to make a series of decisions and put actions in place to support the issues immediately in front of us. But the pandemic is more like a marathon than a sprint. While we jumped into sprint action initially, we are now pivoting toward how to support the organization over the long haul.
For example, we saw a rapid rise in the adoption of video visits on the ambulatory side and now we have to circle back so we can solidify those processes and scale the solutions to support the team over a longer period of time. On the clinical engineering side, we have to manage equipment deployments to delivery care safely as we reach surge numbers; now that we are starting to have more time we are going back to make sure those solutions are as scalable as they should be. One of the dilemmas we face is to maintain our pace and work quickly to adapt to changes ahead while also adapting a keener understanding that this is a marathon that we need to scale to, so we have to keep everyone focused over a long period of time.
Q: Are there any cybersecurity issues that have changed since the pandemic hit?
DD: Prior to the pandemic, I was worried about cybersecurity and it hasn't gotten any easier given that we are aiming to be flexible as we accommodate this unique situation. We had to react quickly to enable remote workers to have access to our systems and we are doing what we can to make sure we balance that with security, but there is always risk. It saddens me that there are bad actors that take advantage of situations like this when everyone is working as hard as they can to support the community.
Q: How will the pandemic affect your strategy and areas of focus in the next six to 12 months?
DD: On the IT side, once you open the door on new technology and situations, it's hard to close it. If our remote workers are able to get the job done not being in the office, I don't think we will bring them all back full force. When the pandemic subsides, I don't think we will go back to the way things were; there will be a new normal of remote work. It's interesting to see myself and my colleagues work through video-based conferencing for our daily meetings, and I think we will find an equilibrium in the middle between onsite and remote work.
Telemedicine had its coming of age during the pandemic and I think a lot of people have seen it as an opportunity. While the amount of telehealth will balance out after the pandemic, it is clear that we have been able to deploy the technology at some scale and now that patients see the benefits, it will continue to take hold. Two things will be interesting to watch, one being how reimbursement will play out and the other is how clinician and patient satisfaction will land with virtual visits. Some visits, such as surgical follow-up visits, didn't drive revenue before so I think those types of visits will continue to be virtual. But we also want to make sure that clinicians and patients are satisfied with virtual visits and that our clinicians find them as clinically meaningful as in-person visits.
As we begin to study the effects and outcomes of video visits, we will learn a lot more about how to conduct them effectively. We have to figure out where telemedicine visits will fit in the spectrum or collection of tools for healthcare delivery.
There are other things we will have to fundamentally rethink as well. Before the pandemic, we were evaluating e-ICUs and other monitoring systems to examine the pros and cons of them as a standalone solution to caring for patients. Now having been through this event, we see the benefit of enabling video communication in all rooms and ICUs as a suite of solutions we want to pursue.
Q: How do you think COVID-19 will change healthcare delivery and what can health systems do to prepare?
DD: There are some cracks in the system that we saw clearly during the pandemic. Now with the awareness of these cracks, we can identify a solution for them. One of the cracks that comes to mind is managing our supply chain. Some healthcare organizations experimented with just-in-time inventories and other ways to manage costs before the pandemic, but then when systems were hit with shortages they began to look at inventory management in a different light.
Video visits and eICUs are another example of projects that have been pushed to the front of the queue. We will need wiring for video-enablement in our rooms and inpatient beds. I think people will be looking to create central monitoring and to add scalability for medical equipment as well as the ability to move around and configure beds in a way that will allow nurses to serve patients in more flexible ways.
One more area I’m sure we will see develop is data visualization and situational awareness that analytics provided during the pandemic. It is really going to be hard to down-staff those efforts in any way. We needed that information to rapidly deploy a bed command center to see where all staff were and fill in any gaps in real time based on patient flow. Those capabilities are here to stay.
Q: What are you doing to cut costs or be budget conscious?
DD: That is top of mind for us. It's interesting to note that we got many requests for urgent projects that IT needed to deliver on a tight deadline for the organization before the pandemic and now that we've gone through the pandemic everyone has understood that those other projects were put on hold and won't be delivered as expected. I think people are coming to the realization that the sky hasn't fallen by not having all their requests fulfilled. The pandemic is going to have an ever-lasting change on how we look at projects and what is truly urgent; that will sit against the backdrop of a now heavy financial burden for the hospitals as we have less income and fewer "want to have" projects as opposed to "need to have."
It's time for IT to rise to the challenge. Historically, IT has been week in producing return on investment for healthcare delivery prior to the deployment of major capital projects and that is something we need to take a closer look at. We need to plan for projects to move forward that will show a direct benefit for our patients and caregivers. The theoretical projects will have a tougher time getting approved.
However, I am concerned that healthcare delivery organizations have at times not been as aggressive as they should be in innovation, particularly around looking at new IT solutions that enable healthcare delivery. I worry that as healthcare organizations across the U.S. come out of their current state and have to reconcile finances and operational priorities, it's often easy to brush new experimentation to the side. I think it's going to be more important than ever to make sure we are being creative and using agile and nimble systems to delivery care in the best way possible.
If innovation gets deprioritized, we are in trouble. There was never a time when we needed to focus more on innovation and figure out how to "land the plane" in this new normal.