Health System Frontline Reports and Tips – Coronavirus Response

A large Midwest health system with a medical school:

Optional daily huddle from noon to 1 p.m. Monday thru Friday. We are all working remotely and can’t walk to desks to have a conversation, but have new challenges. A dedicated time to discuss any concerns has helped many times.

Continuity of command structure. Statistics show that as much as 30% absence rates could be realized. We have been asked to document our command structure at least three levels deep.

A Boston health system:

A patient does not exist in Epic until they have a visit or a bed. With new tents being added, lobbies being bedded, and new ICU beds being planned, Epic builders and managers, physicians, and leadership are working overtime getting it all built.

The command center has been fully operational for nearly two weeks.

Telemedicine visits were built and rolled out in record time, hundreds and hundreds of them Monday.

I am not sure anyone outside of the Epic world understands how much work this takes,  but it has all come together safely with the hope of improving the health of well-being of our providers and patients. I’m sure Epic was busy themselves supporting us and all the other hospitals (and my Epic contact was working at home, btw).

Keep on keeping on. Endless time at home nowadays to work, work, work.

Small, rural health system in the Pacific Northwest:

Agility matters. Stay hyper-informed about what is going on locally and nationally. Literally try to guess what is going to happen next and keep planning for worst-case scenarios, which so far have been proven to be the case every time.

Keep it simple. A quickly deployed 60-70% solution is better than nothing at all. Suboptimal is the new normal.

Focus on telehealth. Our system has a limited number of providers who cover wide geographic areas. The fact that some of them are either infected or self-quarantined means we have to figure out how to get them to be able to have access to patients from wherever they’re located.

Expect and plan for a big support overhead with telehealth and work from home from all levels of IT. Set expectations on support levels, be transparent in how you’re prioritizing support, and be evangelical about focusing on providers and patients.

Expect all of your technology partners to be fairly overwhelmed. If you are looking for hardware, you are going to have to be creative in your sourcing. Don’t be too proud to reinstall decommissioned hardware or to move things around between environments to the most critical areas such as networking or desktop provisioning/support. Also, look to the cloud.

Stay engaged with your clinical and operational leadership. Force your way into any and all planning and response meetings, ask for a seat on all incident response teams, and continually give risk assessments and rational resource constraints.

Dust off your disaster plans and business continuity plans. They can be a great guide for remote workforce management. Keep your CISO and compliance officer close at hand. Don’t do anything stupid in your rush to facilitate what your clinical and operations leadership needs to accomplish.

We have been a user of Webex for years. Didn’t realize we had a limit of 200 users until we started doing town halls for staff. Have asked Cisco to expand to 1,000 users, which should be enough.

North Carolina health system spanning urban and rural areas:

Big investment in telehealth capability – network upgrades, training Investments in telework for non-essential personnel. Dashboards to track cases in house, pending tests, supply projections, vent availability.

Bay Area system:

It’s a strange mix of prepared process and optimistic feeling. We’re doing everything right – ramping up work from home, limiting visitor access, etc. But there’s still a general business-as-usual vibe from everyone that feels almost a little surreal for me. I get that it’s a lot better than blind panic, but it still makes me wonder how well everyone is going to mentally adjust in a few days when it gets really bad. Still, I’m happy to be somewhere that started taking precautions very early.

This is not the time to be particular about work from home. Everyone who can should, with as little “proving” and red tape as possible. Just do it! Maybe people will be less productive — there’s a pandemic on, that’s what happens. For essentials who need to be in, try to at least spread out the load so the density is lessened.

Make sure you know what your reporting looks like when you exceed bed capacity NOW, instead of learning as it happens. Be prepared for helpdesk to be a pinch poin, and try to find ways to lessen their burden by socializing fixes to common problems.

National hospital system:

This past weekend, we conducted an IT checkout process for 300+ employees to ensure staff who we are sending home were well prepared. Lots of them were familiar with email access, but less so with a soft phone Avaya routing of their desktop phone to their computer (avoids using a second port off your switch when forwarding phones directly) and various other IT tips. This avoided a flood of calls to the IT help desk, letting us take calls from our hospitals as normal.

From a cleaning perspective, we are just now purchasing relatively inexpensive dry hydrogen peroxide cleaning devices that can clean airborne and surface viruses and other contaminants. This should allow us to have increased safety in rooms vacated by patients positive with the virus.