Stanford Health Care (Calif.) is in the heart of Silicon Valley and known for innovative partnerships with big technology companies as well as entrepreneurial companies to improve clinical care, research and innovation.
That mindset hasn't changed during the pandemic, says CIO Eric Yablonka, but now the system is doubling down on targeted efforts to manage the budget while focusing on what patients and staff need today. Here, Mr. Yablonka discusses how Stanford Health Care is navigating the pandemic and optimizing opportunities.
Question: What are the biggest challenges you're facing today and how are they different from the challenges you faced when the pandemic hit?
Eric Yablonka: We dropped almost everything when the pandemic hit and took an all-hands-on-deck approach to supporting the health system with technology and digital solutions. Most of our team had already relocated to an off-site location and the majority quickly transitioned to working fully remotely. Even before the pandemic, we had a mixed model of telecommuting and onsite staffing. We also employ people from around the country who were already working remotely. Everyone else — other than our biomedical teams and field services teams who needed to be at the facilities — worked from home.
We are continuing that offsite work model for most everyone on the IT team, but also beginning to consider what the “new normal” will look like. Our IT group has an initiative to assess future work models, which includes a cross-functional IT group partnering with the HR department to understand how we can maintain our strong and positive culture and identity while working remotely. We want to ensure that our staff feels engaged and connected even when they are not working in the same location. We’re also assessing our support models for remote work, as well as our virtual capabilities to understand where we may need additional technologies.
We are very proud of our team and how supportive everyone is of each other.
Q: How has telehealth changed for Stanford Medicine?
EY: At the height of the pandemic we were conducting well over 60% of our ambulatory visits virtually. As we’ve safely reopened, we are now steadily seeing about 41% virtual visits. We’ve taken every necessary step to ensure the safety of patients who require in-person visits, and continue to make virtual visits readily available when appropriate.
Q: Many health systems are operating on tighter budgets than anticipated at the beginning of the year during the pandemic. How are you thinking about your budget differently now than you did eight months ago?
EY: Managing resources to address revenue shortfalls is a challenge for every health care system during the pandemic. At Stanford Health Care, we've adjusted our IT plans, re-assessed our projects and identified the ones we will continue to invest in. We leveraged our IT governance and portfolio management process during that analysis, and deferred some work that did not rise to our new criteria because of the necessary investment or our new focus on recovering from the initial wave of COVID-19. We are now hardening the capabilities we did pursue and scaling them as needed.
A few examples of the projects we are still working on include telehealth, virtual work, contactless check-ins and the mobile health platform with 700,000 subscribers. Our team is also refining and scaling Stanford Health Care’s Occupational Health services and testing capacity; Stanford Health Care provides evaluation and testing for our staff and processes those tests at our own virology laboratory. The laboratory also supports testing for many other organizations.
Our top priorities over the past six months have been responding to COVID-19, reopening the organization, providing the safest, highest quality care to patients, and keeping our staff safe and healthy. We have been fortunate in Northern California not to have the same experiences with COVID-19 that they did in Florida, New York and Texas, but we are watching and working every day to make sure we are prepared and meet those challenges if they arise.
Q: What projects are still worth investing in? What can be put on hold for the moment?
EY: We are reducing capital spending to be mindful of our limited resources. We are pursuing implementation of a new human capital management platform and continuing to invest in multiple projects that are close to fruition. People costs are the No. 1 costs to the organization and having better insight and better staff engagement and analytics will position us to manage costs in a more insightful way. We did defer some important system implementations, but largely the deferments are projects that are not absolutely mission-critical.
We are very focused now on investments that are necessary for our recovery from necessary measures we took to prepare for a possible surge in COVID-19 cases, such as postponing all elective surgeries. For example, we are boosting our video visit capabilities, virtual health work, contactless health check-ins, mobile health platform (which now has 700,000 subscribers) and Occupational Health Services and testing capacity, as noted above.
We as a leadership team worked through which projects to defer together. IT was focusing in a collaborative way to align on our priorities. We have not cut anything critical to addressing or responding to the pandemic or safely reopening the organization, which is our highest priority.
Q: What partnerships have been most critical over the past six months?
EY: We have relied on core vendors and in many cases asked for support with things like video monitoring capabilities for inpatients, working with vendors to expedite the equipment acquisition or on COVID-19 response capabilities; Epic was an important resource in those efforts. Both at the University and within the School of Medicine, Stanford has longstanding relationships with technology companies, which helped paved the way during the pandemic for robust initiatives on testing and research.
There are also many investors who presented us with a multitude of opportunities, many of which we couldn't respond to during the height of the pandemic and had to set aside. But we're always looking at opportunities to accelerate clinical transformation — everything from analytics to diagnostics with major companies as well as entrepreneurial organizations.
It seems like now everyone is selling COVID-19 solutions and we must judiciously prioritize what is truly required to meet the needs of the organization and our community, instead of investing in technology for technology's sake. We were very fortunate that we had strong, existing capabilities in many areas, so our first 60 to 90 days in response to the pandemic involved utilizing and optimizing those strengths and then filling in a few gaps where we needed to.
Q: Where do you anticipate focusing your efforts in the next 12 months or so?
EY: It's hard to know what the landscape will be like in 12 months; I think we have the capabilities we need to respond to future COVID-19 surges, but that could change. Beyond that, there must be a sustained approach to virtual health. We have strong leadership with our CMIO and IT team, and we are maximizing our virtual health capability, enhancing it and looking to new models around consults, referrals and second opinions. Across Stanford Medicine, we are also developing a Digital First strategy.
We continue to explore new virtual health models and collaborations with organizations that provide tertiary and specialty care consults to patients outside the local area. Our priorities will continue to be deployment of safety capabilities, contactless check-in, and making sure it's safe and convenient for patients to return to the hospital or doctors’ offices.
Other things that will be important in managing our resources are continued ERP investments. We are working on our data center strategy now and looking to deploy robotic process automation for things like eliminating non-value-added process steps so we can reduce costs. There will be other kinds of use cases for automation support that will allow us to strip out work that doesn't provide value as well. That will be a big push in the next 12 to 18 months.
Q: How are you thinking about innovation in the coming months?
EY: From the IT perspective, we still plan to do enterprise architecture programs and enhance analytic capabilities and warehousing to continue to leverage technology with the School of Medicine. How can we enable innovation in research and education? As we look to fall, winter and spring semesters, we expect the medical school’s teaching approach to continue to evolve. Our Education Technology team pivoted quickly to support remote classes and our research tech support geared up and provided extraordinary support to quickly emerging COVID-19 related research.
Managing our response to both the pandemic and the coming flu season will ensure we have a lot on our plate for the next 12 months. By this time next year we hope that much of this is behind us and we can really focus on the continued growth and development of our capabilities in research and education.
We also have a very robust physician network with a community hospital as well, and fantastic ambulatory clinics. We will continue to develop those aspects of our system for care coordination and deliver great clinical outcomes.
Q: What trends concern you about the future?
EY: As the pandemic continues to stress our health care systems, this will be the most defining and troubling trend we are likely to face, possibly in our lifetimes. Extraordinary progress has been made in technology for health care, with the potential to make the system more efficient and more inclusive for many more individuals. Our goal is to continue to pursue progress despite the most challenging circumstances, as more people than ever now need us to support their care.