Pandemic Response Tests Agility of Hospital IT Teams
Pediatric hospitals have not seen the spike in volume of COVID-19 patients that adult hospitals have. Nevertheless, responding to the pandemic has required their IT teams to make drastic changes to how hospital systems operate. During an April 7 presentation in the Harvard Clinical Informatics Lecture Series, three IT leaders from Boston Children’s Hospital detailed their response efforts, including using telehealth in the inpatient setting to preserve personal protective equipment.
Marvin Harper, M.D., chief medical information officer, began just by listing the breadth of IT projects required for the hospital’s response to the pandemic. He noted that as the hospital set up a command center, no one from IT was there initially. “It became clear that a lot of projects were going to roll out in three or four weeks” so they appointed a project manager for IT COVID requests, and Harper and the hospital CIO Daniel Nigrin joined leadership huddles. They also instituted regular IT-wide update meetings to make sure everyone was kept in the loop.
On March 16, when thousands of employees were told to work from home, IT had to support them in using the virtual private network (VPN) to access Citrix, Epic, Cerner and other applications remotely. Many staff members did not have computers at home. That required a process for identifying need, approvals, and prioritization of getting them PCs.
In normal times, the number of staff members using the VPN to securely access their own file folders each day topped out at around 700. Today there are between 4,000 and 6,000 per 24-hour period. The use of Zoom has increased the same way. In late February there were 600 to 700 meetings per day. Now there are more than 3,000 per day on weekdays and almost 600 on weekends.
People who staff the call center required additional setups for home computers to support remote telephony software. IT also responded to a request for a call center chat bot. IT had to support drive-through testing for COVID-19, which meant extending wi-fi outdoors and providing computers on wheels.
Decisions had to be made about halting ongoing projects that contractors were working on, and the potential side effects of stopping those.
“There were reports from other medical centers of using 3D printing to create supplies. We had to determine if that was hype or reality and if we could implement it locally,” said Harper, who is also a senior associate physician in Medicine, Division of Emergency Medicine. The hospital has 3D printers but not ones that could scale up to mass production, and they had 3D printer vendors offering to sell them more.
Finally, the IT group created an infection control app that reports and tracks staff exposures and allows them to report symptoms. They also developed an app that allowed staff to use their badge to tap attestations on arrival to the clinical campus that they don’t have a cough or fever.
Chase Parsons, D.O., a pediatric hospitalist and physician lead for prescriber education and clinical decision support, described the normal change control process for clinical IT systems. A change request is reviewed closely for any impact it might have, and if approved, it might take three to four weeks to be implemented. In this time of crisis, that process has been sped up, but is still done in a reliable and safe manner, he said.
Parsons showed examples of how clinical decision support and order sets have had to evolve over the past month as the situation in terms of testing and protocols such as isolation precautions have changed. “We have made a bunch of iterations very quickly to meet the demands of infection control, and to make it simpler in terms of the user interface. We are getting very agile. We know who the stakeholders are and we have become a one-stop shop for providers.”
Jonathan Hron, M.D., a pediatric hospitalist and physician lead for inpatient informatics, closed the presentation by focusing on telehealth. He noted that the hospital did have a telehealth program before the pandemic, but it usually involved 20 visits per day. “On March 16 we made the transition to close all clinics for non-emergent cases and we saw telehealth explode,” he said. “It took an enormous amount of work to initiate that expansion and maintain it. We have trained 500 users since pandemic began, and we had to pull people in to support it. They are now seeing more than 1,000 telehealth visits per day.
Boston Children’s also worked through the process of expanding the use of telehealth in the inpatient space. “The goal is to minimize the use of PPE, which is in short supply, and promote physical distancing in the hospital,” Hron said. “From a pediatric center point of view, our patients have not been terribly affected, but our work force is at risk, so keeping them safe is critically important to help us get through this.” They transitioned to using telehealth for rounding and for remote consultations, for instance, between anesthesiologists and surgeons. The team created a unique meeting link for each bed space in the hospital. Each space has it own link and the patient, family and care team were provided a password when admitted, so that both provider and patient could easily access the meeting. 10 iPads available initially. Patients can use their own devices or iPads distributed by the hospital. They are currently seeing 30 such inpatient Zoom meetings per day.
The pandemic is not impacting all areas of the healthcare sector or all regions of the country in the same way, yet all health system IT teams are being called upon to support drastic changes in operations. This detailed description from Boston Children’s Hospital reinforces the need for strong IT leadership and agile project management teams.
