Washington COVID-19 CMIO Blog: Lessons to share

This is a weekly update and “lessons learned” on the novel coronavirus COVID-19 and its impacts on our health system in Washington State. As the regional chief medical information officer for Swedish and Providence Washington-Montana in the Providence St. Joseph Health System, I help support 17 hospitals and hundreds of clinics in our region. 

In the past week, Washington has increased from 3207 to 6585 positive COVID cases with 262 deaths. We continue to see the flattening of our curve overall in Washington, but still a doubling of our cases and deaths in the past week. Swedish hospitals now have over 100 patients that are COVID positive admitted to the hospital. Providence hospitals in Washington showing slow growth this week as well. Surge projections have moderated. Early social distancing/sheltering works. Governor Jay Inslee just extended our sheltering-in-place shutdown through May 4th.  

Unemployment shot up by over 6 million people this week. New York continues to suffer with around 100,000 cases and 2,500 deaths. The world has passed 1 million cases, and the U.S. now has almost 250,000 cases confirmed.  

Fear about the virus permeates and is causing increased anxiety and stress, as our caregivers worry that their protective equipment is not good enough to protect them on the frontlines of this battle. We battle the losses of our patients with stories about how our caregivers have gone above and beyond to help our patients and their families in these final moments. We buckle in for the long fight. 

Quote of the week from Lt. General Todd Semonite Commanding General of the Army Corps of Engineers, who were deployed across the country to build out temporary hospital facilities: “This is an unbelievably complicated problem and there is no way we can go in there with a complicated solution. We need something super simple.” Wise words as we all approach this work. 

Previous blog links: 

March 6      March 13     March 20     March 27 

Week 5 Themes and Updates from the CMIO perspective: 

Telehealth broadens and operationalizes 

• CMS continues to level the playing field and updated regulatory guidelines this week  
• Operational workflow algorithms developed to help providers integrate into practice 
• Shortage of headsets and webcams nationally putting pressure on IS to supply devices 
• Result, how to quickly integrate personal devices into workflows and seeking outside donations.
• How to prioritize shortage of available laptops for ambulatory visits versus acute care patient needs a key discussion.  
• We had to build a grid summarizing all of the use cases for Ipads/communication devices and approved solutions 
• If you do not have a solution, people will create one with tools they know 
• Patient-Family (Many options), Patient-Provider (Acute/Ambulatory different), Provider-Provider (Teams), PPE Reduction focus in Reg/ED/Behavioral Health/Spiritual Care 
• Telephonic visits and virtual video visits grow exponentially this week. 
• Results in some backend work to make sure all of the codes being used are mapping correctly downstream. 

Lab testing 

• Reductions on lab turnaround time seem to be key to help reducing the person under investigation (PUI) numbers in the hospital which reduces PPE burn 
• There are many testing solutions coming available, but they are unable to be scaled quickly due to a lack of reagents (of which 40-50% of initial allotments need to be used for set-up/testing). 
• Symptomatic patients of average risk under 65 were designated at low priority in our lab order in accordance with department of health guidelines, and we are not testing many in this category as a result 
• We built high priority reasons (and a button for the low priority) into our lab order for clinical guidance 

Data and Analytics 

• We built a tableau report to monitor lab turnaround times across the enterprise 
• There have been a number of dashboards built by the teams for infection prevention, COVID tracking, visit volumes, labs, epidemiology and more. 
• Most of these fully integrated with Epic and automated 

Bed/Department Management 

• We have had to make over 1,000 bed reconfigurations and remodel several ambulatory departments 
• Surge planning resulted in having to build out virtual departments for rapid scaling. This week we had to explore how to make some key interface connections to that build for things like ventilators and monitors. 
• Cohorting of COVID positive patients currently. Exploring ideas of cohorting in certain hospitals in the metro area which could result in more shuffling. 

PPE/Universal masking 

• Continued pressures from lack of personal protective equipment. 
• Donations from the community and supplies from the federal government have helped ease the burden a little this week. Thank you to the 100 million masks campaign and to folks like Kaas Tailored who partnered with Nordstrom and have helped in our time of need 
• Not specifically related to IS, but the persistent pressures of reduced amount of PPE, balanced by the changing recommendations for universal masking was a primary focus of operations this week. Building an effective mask re-use policy and procedure was interesting. 

Connecting with each other 

• Microsoft Teams has served as our platform for communication. Daily meetings can chat with each other between sessions to quickly close gaps in communication or share information rapidly 
• Sharepoint has helped us build a foundation for consistent communication and reference 
• We discussed a more formal rollout of Epic’s Secure Chat feature to expand its use to aid in rapid clinical communication about patients 
• We have built a number of Epic tools to ease documentation burden as well as provide consistent communication to our patients. OpenNotes are turned on for all of our patients across inpatient and ambulatory. 
• A Wellness page and movement has also been put into place to help our caregivers with behavioral health needs, peer support and community resources 
• https://providence.org/easeyourway 

Care in New Ways (updates and links) 

• Our epidemic risk screening tool used for all patients at check-in or admission was updated to add loss of sense of taste or smell this week, other additions in the pipeline 
• Drive-up clinics continue to see steady volumes serving symptomatic patients and healthcare workers. 
• At Swedish, a mobile mammography van was converted to a mobile testing unit to serve the homeless population and has been making the rounds. Labs funnel back to a monitored pool. 
• Increasing volumes in our TeleHome monitoring program (now over 750 served) with oximetry and thermometer data being entered through our Xealth and Twistle partnership. 
• Hospital-at-Home continues to be investigated to care for patients stable to be monitored closely at home through a central team and integrated tools. Very complex workflow and operational development searching for simple solutions to lift off the ground. 
• Labor pool tools built in Excel to quickly match caregivers to opportunities 
• The Disaster Response App built with Microsoft has given ops teams at Swedish better situational awareness of several key metrics at-a-glance 
• ChatBot for coronavirus screening has been used over 100,000 times on our PSJH websites