The COVID-19 pandemic changed the way healthcare teams operate. Priorities have been upended, resources have been stretched thin and teams are having to find new ways to provide the best care possible for patients. While front line professionals are the face of care during the coronavirus outbreak, healthcare information technology (HIT) leaders have driven the support behind these remarkable individuals to ensure our communities remain safe.

That’s why we decided to interview HIT leaders from across the United States and Canada to learn about how their organizations respond to COVID-19. During our conversations, these leaders shared their most pressing challenges, advice for colleagues and stories of hope and innovation from the front lines. 

Here are highlights from our second round of interviews, featuring insights from Canadian leaders Dr. Victoria Chan, Deputy CMIO and Director of Clinical Utilization and Data Analytics at Mackenzie Health, and Helen Edwards, CNIO at SickKids.

To date, what has your team done to respond to the COVID-19 crisis?

Dr. Victoria Chan, Deputy CMIO and Director of Clinical Utilization and Data Analytics at Mackenzie Health

“Our team’s response is to share the data for everyone to see. Prior to any patients coming in, we were monitoring the news of the pandemic coming in from other countries, so we had about a month or so to anticipate what might happen in the coming weeks. One of the challenges we had was trying to get ready before patients started coming in, which motivated us to make predictions based on the available evidence. 

Our team is always a supportive department, so when our leadership team says that we’re going to establish a dedicated COVID unit, our team’s job is to find a way to display all of the relevant activity.

What we’ve been doing to support different clinical programs is to provide them with a dashboard and the data. In fact, our senior leadership team hosts a virtual meeting with everyone every week, and our CEO reviews the latest data from our dashboard.”

Helen Edwards, CNIO at SickKids

“Overall, as a hospital, our absolute primary focus is to ensure that our staff, our patients and their families are safe. Some of the things we’ve done are pretty common in most organizations – restricting entries through one or two doors, limiting clinical activity, not allowing vendors into the organization and limiting bedside visitors. We screen all patients and families that enter to ensure that they’re not symptomatic or, if they are, that we have a way to help protect those around them if they do need to be in the hospital. All staff also have to sign an attestation to identify that we will only come to the hospital if we are healthy. If we are not well, we will stay at home and inform our occupational health department. They can then determine if we need to be COVID tested, and will make that accessible right here at the hospital to identify when we can come back to work. That has been a real stress reducer for our staff who feel confident in calling in sick.

Our Epic team has been incredibly busy. To date, they have implemented 153 COVID-related changes to Epic, and we know there will be more to come. The changes include things like the enhanced infection control screening tools that are required, decision support tools to alert clinicians if a patient or their family members have risk factors, clinic appointments converting to virtual visits, ordering and resulting of the COVID-19 tests and dashboards that are available to staff identifying key metrics (number of tests done, number of COVID patients, etc.)”

What is the most pressing challenge your team currently faces as you respond to the COVID-19 Pandemic?

Dr. Victoria Chan, Deputy CMIO and Director of Clinical Utilization and Data Analytics at Mackenzie Health

“While we’re trying to deal with this worldwide crisis, we’ve still got the day-to-day work of maintaining data quality. Secondly, we have the challenge of trying to figure out where we are going to be in two to four weeks. With a fast changing epidemic, everyday we need to prepare for scenarios that we hope we never have to see.” 

Helen Edwards, CNIO at SickKids

“The speed at which things are evolving, as well as the requirement to put solutions in place rather quickly. For example, our staff wanted mobile devices for professional use other than their personal devices. You can imagine if they wanted to do virtual visits with patients, it’s not really appropriate to share their personal number. 

Also, the worldwide PPE shortage is all over the news, and it’s no different up here in Canada. What are the mechanisms in place to try and preserve PPE, and what does that mean in terms of supporting others to work from home? The entire IMT department was basically seconded to help the people at home, man phone lines and talk through people who had never accessed the hospital systems remotely. 

Then, of course, there’s the need for data and databases: schedules for the screeners and leaders, as well as a skills inventory in the event we have to redeploy staff to different areas of the hospital. For example, I’m a registered nurse, but it’s been a little while since I’ve had a patient assignment. So, they would need to know that, although I’m an RN, my specialty is informatics, and that I would need some significant support if I had to go back to the bedside and care for patients. 

From a personal perspective, our staff feels vulnerable and scared. They are in the fray and could potentially be caring for a patient or family member that has COVID. They are feeling stretched. Families are having to juggle work schedules to be able to work and also provide care to their children or elderly parents. There’s just no escape from it. They work all day long to support the staff and the hospital dealing with COVID, then go home and it’s all about COVID again.”

As you look ahead to the coming weeks, what is an upcoming challenge your team is preparing for that you anticipate growing in importance?

Dr. Victoria Chan, Deputy CMIO and Director of Clinical Utilization and Data Analytics at Mackenzie Health

“We were going to create a virtual visit workflow for our two site hospital before the pandemic hit. It was originally planned to be an 18-month project. All of a sudden, we got a directive to get it up and running in 18 days. We didn’t complain. The team immediately got together to ensure that all of the video visits were ready to go inside Epic. Simultaneously, our project team reached out to all of the clinics to find out who was going to convert their patients over to video visits to decrease face-to-face interaction. 

I think virtual visits are going to grow in importance because this is a new workflow for most doctors in Canada. The government stepped in quickly to say this is going to be an acceptable form of interaction for the provider and patient. The challenge now is that we need to get the hardware in place, make sure the connectivity is seamless, provide critical data drops and access points for our doctors and staff, ensure Epic integration and train everyone to make sure they know how to get on the platform. 

It’s funny. A lot of noise has been made complaining about millennials over the years, but it’s actually millennials who are saving us right now with their tech savviness.” 

Helen Edwards, CNIO at SickKids

“Maintaining the momentum. People are getting tired. It can be easy if you’re working from home to lose focus. If you’re still coming to the hospital everyday, it can also be easy to have your anxiety heighten as more and more news of the spread comes in. 

In the event that it gets so bad in a province and there are not enough critical care beds with ventilator-trained nursing staff, we would probably have to accept some of the younger patients from other hospitals into our intensive care unit. Even though we are certainly not there yet, we need to put plans in place for that as well. 

We’re worried about the supply shortages of PPE, but not only that. There are many countries that typically supply us from outside of Canada for things like IV tubing, syringes, different medications, etc. We’re already seeing some back orders on certain things and are trying to be proactive by contacting vendors. We’re asking questions about how worried we should be, if we need to consider bulk orders to prepare now and if we should be looking for replacement products that are more locally sourced so that we won’t be short.”

What advice do you have for your colleagues who may not be as far along in their preparation and coordinated response?

Dr. Victoria Chan, Deputy CMIO and Director of Clinical Utilization and Data Analytics at Mackenzie Health

“We’re dealing with a worldwide crisis. Everyone has to do the best they can. You have a tool box in whatever job you have, and you use it to help. For example, we have a family member at home who likes to sew. She has donated her time to make masks for members of a local long term care facility. My team is analytics, so we provide the data for COVID. Our neighboring workers are technical services; they have to provide the hardware so that we can do the virtual visits. It’s whatever you have in the toolbox to help, right?” 

Helen Edwards, CNIO at SickKids

“This is a marathon, not a sprint. This is going to be going on for a while, so let’s not get ourselves completely tired out at the beginning. Continue to focus on staff, patient and family safety; it has to be the priority, and it really is what drives good decision making. Use all the resources at your disposal. Although we are a hospital and of course our focus is providing clinical care to patients, all kinds of departments have great people who can step in in a pinch to be the lead on a project. For example, our plant and operations department built these amazing plexiglass enclosures to put on top of desks so that the screeners and leaders who would greet those who came into the hospital were really well protected and could look someone in the eye without wearing a mask. It was personal for the families. They could see a smiling face and be able to ask their questions. Strong, visible leadership is so important, including doing things like virtual town halls, sending thank you emails and really making sure all the staff understand the reasons behind decisions.” 

Can you tell us a story about someone making a difference in your organization or an innovative idea that has grown out of the challenges your team has faced in the past few weeks?

Dr. Victoria Chan, Deputy CMIO and Director of Clinical Utilization and Data Analytics at Mackenzie Health

“I think the further you are from the epicenter, the more you want to help. However, the closer you are to the epicenter, the more fear and anxiety you have. I think the uplifting thing has been watching the transformation of the front line from, ‘Oh my goodness, I don’t know if I want to go in there. I need to think about my own family,’ to “I can do this.” When everyone’s perspective shifted from fear to courage, they came up with a unique workflow to take care of patients without hourly rounding, which was wasting PPE with unnecessary face-to-face interaction. We’re using a combination of technology and ingenuity to make sure patient care is upheld.

Now’s the time that people can consume data. If the analytics departments do a good job, they can display the data in a way that even the public can understand. If the public understands the data and where it’s going, they will heed the public health advice. The one thing I would like to see is even more sharing and collaboration with all of the different institutions of the healthcare system.” 

Helen Edwards, CNIO at SickKids

“Due to our low patient volumes, we have staff that are not needed for shifts. They’ve volunteered to come in to support families that are struggling and need a break by sitting and/or playing with a child. When we walk down the hallways, everyone makes such an effort to look each other in the eye, smile and share that idea that we’re all in this together. The number of emails I’ve received from people saying, ‘Tell me how I can help’ is so amazing – and I know our executives have experienced the same thing. 

Here’s one little thing that I’ve shared in emails with my staff that I’ll share with you: Hope doesn’t have to make sense. It can be tiny, the smallest most fragile glimmer in the darkening sky. It just has to get you to the next moment. Right now, I think hope is so important, and I look at that quote many times a day. It really helps me.”

The Pandemic Response Continues

Thank you to all of the HIT leaders who took time out of their busy schedules to speak with us about their efforts to support the front lines during COVID-19. Stay tuned for more updates from the front line as we discuss pandemic response with more HIT leaders.

As your team formulates their response to today’s changing healthcare environment, Alidade Group is ready to help. Our experienced consultants are available to assist with enhancing systems and workflows to meet your evolving needs.. If you’re looking for a partner to help meet these challenges, contact our team at https://alidadegroup.com/contact-us/.