Washington COVID19 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 14 hospitals and hundreds of clinics in our region.  I appreciate the continued interest and feedback on this attempt to share what we have learned/built.

In the past week, Washington has increased from 1376 to 3207 positive COVID cases with 147 deaths. As seen in the graph below from the New York Times, we are seeing a much flatter rate of growth compared to other states. However, we are still seeing a steady increase in cases and deaths. Shelter-in-place was put into effect this week in Seattle to help further reduce the outbreak. We are fortunate to have seen early interventions from our state government and large tech employers to help reduce this outbreak. There is also a bit of conflicted urgency compared to New York I felt and heard this week. Will we see a 10X surge in Washington for which we have to plan? Or, will we flatten the curve to where it becomes more of an endurance test of sustainability with the pressures of more apparent financial realities? The government passed a $2 trillion relief package this week, and over 3 million people filed for unemployment. Buckle up. 

My quote of the week comes from Dr. Anthony Fauci, “You don’t make the timeline, the virus makes the timeline.”  

 Week 4 Themes and Updates from the CMIO perspective: 

Telehealth Explosion 

• As clinic volumes have plummeted, rapid growth and integration of telehealth has occurred to meet the needs of the providers and patients. 
• Over 7,000 licenses added this week for our ambulatory clinics to use Zoom for telehealth visits. 
• Swedish and WA-MT clinics performed over 500 virtual crisis visits day 1 (baseline zero) 
• Telephonic visit workflows also developed 
• Gov. Inslee steps in to make sure visits are covered by all payors. 
• Seeing 20X increase in our Express Care Virtual Visits 

PPE supply challenges (masks, gowns, eye protection) 

• The global supply of personal protective equipment (PPE) used in the treatment of virus outbreaks is strained as a result of COVID-19. 
• This continues to be the most clear and present danger to our healthcare workers. 
• The faster your lab turnaround, the less PPE you will use in the hospital. 
• Providence launched the 100 million masks campaign to help with the shortage. Have seen a tremendous amount of community support.  

Lab 

• Reductions in turnaround times (TAT) lead to reductions in number of patients under investigation which saves PPE.  
• Several areas working to get analyzers to further reduce lab turnaround times. 
• Consistent efforts to reduce TAT across the board, which leads to constant tweaking of lab orders and results workflow.  
• Public Health testing through SCAN (Seattle Coronavirus Assessment Network) went live with the help of Amazon Care and the Bill and Melinda Gates Foundation. 
• Because of pressures on testing supplies, a new best practice advisory going live to support appropriate use of testing.  

Care in New Ways (updates) 

• We have several different varieties of drive-up testing clinics now live across the state. These have been well received and serve our clinics, community and our staff that need testing. Workflows have been smooth with SmartSet being used by MA and provider team to default options and provide standard note template.
• We have set-up several ED triage tents for respiratory patients across the state.
• A mobile mammography van was converted to COVID screening unit to help serve our transitional homeless population this week.  
• Increasing volumes in our TeleHome monitoring program (now over 500 patients have been enrolled). Highlighted here in our partnership with Twistle and Xealth. 
• Hospital-at-Home continues to be investigated to care for patients requiring oxygenation but stable to be monitored closely at home through a central team and integrated tools. Challenges in development in trying to care for an inpatient in an outpatient setting 
• In partnership with Microsoft, a COVID emergency response app was developed to help build situational awareness and provide decision support during the COVID crisis.  Tracking key metrics for COVID volumes, occupancy, staffing, discharge, ventilator utilization and PPE management.  
• We continue to evolve a number of dashboards in Tableau for tracking our volumes of COVID patients in hospitals, testing, incidence and other key metrics. 
• ChatBot for coronavirus screening has been used over 100,000 times on our websites.
• As the government deploys field hospitals, how do we partner with them on care in the broader region? How do we connect and effectively share information? In development. 
• Provider labor pools being developed for primary care providers to work in the hospitals (as an example). This model involves a hospitalist leading a team with PCP's acting as extenders to help with orders, notes and other duties. This will allow one hospitalist provider to care for many more in the ward. As we shift providers around to meet needs, this involves broadening accesses and training to use new tools.
• An interview with our CIO, BJ Moore, on some of the ways IS has stepped up to support the enterprise in this challenge. 
• Continue to see large numbers of growth and expansion requests as we try to increase capacity for cohorting our positive COVID cases and plan for potential surge capacity. Partnership with ops leaders, real estate, informatics and build team crucial to help translate, prioritize and expedite these requests.
• We have had several stories of patients using an IPad to see their families virtually while in isolation before passing away.

And now, to conclude, this humbling visual as the U.S. moves into the top slot for most confirmed COVID cases in the world: