The COVID-19 pandemic has put the healthcare industry through the wringer. It's required new ways of working, new methods of communication, new solutions to old problems and innovative solutions to new problems.

Healthcare executives up and down the line have learned many valuable lessons from their experiences this past year. This feature story is the first in a series that will highlight how IT leaders managed the myriad challenges of 2020 – and how they plan to build from those lessons toward a better and more resilient future, this year and beyond.

In this installment, you will share in expertise from:

• Andy Crowder, chief information and analytics officer at Charlotte, North Carolina-based Atrium Health.
• Tina Esposito, chief health information officer at Advocate Aurora Health, based in Downers Grove, Illinois.
• Andrew Hamilton, RN, CIO and deputy director at AllianceChicago.
• Eric Jimenez, CIO at Artesia General Hospital in Artesia, New Mexico.
• Dr. Paul Testa, chief medical information officer at NYU Langone Health in New York City.

Making digital connection the new normal

The greatest health IT learning of 2020 in the face of COVID-19 has been the profound want of patients and clinicians to connect digitally, said Testa of NYU Langone Health.

"We experienced first-hand that this was never about a pivot," he related. "Rather, our patients, physicians and nurses have grown accustomed to digital health over years of incremental and foundational work, and all came rushing to make this the new normal."

"2021 will show that digital health from the patient and clinician perspective is so much more than video visits and remote patient monitoring."

Dr. Paul Testa, NYU Langone Health

NYU Langone Health experienced explosive growth in telehealth visits, online appointment booking, online physician finding, remote patient monitoring, and connecting via video inside the hospital when visitors could not be accommodated.

Moving ahead, Testa knows he and his team must make sure patients and clinicians must always be able to connect digitally.

"2020 showed us that years of commitment to digital health and, specifically, the digital patient and clinician experience allowed NYU Langone to scale to meet the needs of our patients as well as clinicians," he said. "2021 will show that digital health from the patient and clinician perspective is so much more than video visits and remote patient monitoring.

"In this new normal, digitally frictionless scheduling of imaging studies by patients in the right location for them, at the right time in their care, with the ability to electronically share those images with those they wish, is but one example," he continued. "We have shown our patients this all can be done, and we need to meet them with the consumer-grade digital experience they have rightfully come to expect."

From the single NYU Langone Health app – rather than half a dozen – to treating patients' preferences to which pharmacies to electronically send prescriptions to involving family and caregivers whom they want to be kept informed, the organization can do it, he added.

Empowering patients to themselves assign digital proxy in the app and enabling family and caregivers to be kept up to date with texts during an emergency department visit, a surgical procedure or a baby delivery are all elements of this new normal, Testa described.

Taking transformation to the next level

The digital transformation in healthcare was elevated to a new level in 2020 as the industry had to rapidly roll out digital technologies like telehealth and help move the workforce to remote work, said Jimenez of Artesia General Hospital.

"In the six years prior to the pandemic, we slowly were shifting healthcare IT at AGH," he reported. "We worked with different department leaders to see how we could improve their process within their departments and how technology could help them. Partnering with senior leadership at the hospital, we were able to roll out systems that kept us on the cutting edge of technology."

"The major realization for me from 2020 was the importance of a team that could adapt and evolve quickly to the demands of the world around it."

Eric Jimenez, Artesia General Hospital

When the pandemic was pushing the workforce off campus, the IT team was able to meet the demand within a second, he added. The team was able to roll out telehealth in days, compared with past projects that could take months to complete. Jimenez says it was collaboration that led to the success of these digital projects.

"As I look back at these two projects, the major realization for me from 2020 was the importance of a team that could adapt and evolve quickly to the demands of the world around it," he said. "The role of IT changed significantly in 2020. We were no longer just a department that handled technology issues. We were handling non-technology issues and helping change the processes."

Artesia General's IT team includes clinical professionals with many levels of education, from a master of science nurse to medical assistants. They played key roles in the deployment of COVID-19-related technology.

"Their understanding of the technology and processes would help us implement telehealth within the organization and many other projects," Jimenez said. "I see the role of a CIO changing in the future. Reporting to the CEO, instead of the CFO, changes the role of technology and the digital transformation of AGH."

Technology plays a big role in healthcare – in rural healthcare, technology can have an even bigger impact on an organization, he added. In a smaller rural healthcare setting, the reality is having to do more with less – technology can help organizations improve patient care and do more with less, he said.

Applying lessons learned, Jimenez says, will require innovation, which has been a buzzword in health IT for years.

"We are looking into innovation more in depth than previously," he explained. "As I look back at 2020, innovation in the healthcare industry was accelerated. The digital transformation needs to be led by someone or a team that has a deep understanding of technology and operations. In my eyes, the role of information technology as a support function has come to an end in 2020. The role of the CIO and their team will change. Technology has a part in every function of healthcare now."

A great CIO must understand every part of the organization, he added. CIOs must continue to lead the digital transformation – and to have successful digital transformations, collaboration will play an important role in major organizational changes, he said.

A new IT timeframe: Urgent

Hamilton at AllianceChicago says the global COVID-19 pandemic has disrupted expectations regarding the approach and process health IT professionals follow to identify, select and deploy healthcare information technology tools.

"Prior to COVID-19, the overall timeline from the identification of need to the deployment of a tool could take four to six months. In a post-COVID-19 world, that timeline is no longer acceptable, given the urgent need to provide access to HIT tools that can support new healthcare delivery models," he said. 

"From telehealth visits, COVID-19 testing and now COVID vaccine administration, the immediate need for transformational HIT tools requires an agile process to ensure rapid selection, implementation planning and post go-live support."

Andrew Hamilton, RN, AllianceChicago

"From telehealth visits, COVID-19 testing and now COVID vaccine administration, the immediate need for transformational HIT tools requires an agile process to ensure rapid selection, implementation planning and post go-live support."

Hamilton believes healthcare will be using a similar framework in at least the first six months of 2021 as the impact of the COVID-19 pandemic likely will continue this year.

"COVID-19 testing, treatment, vaccination, along with continued access to primary care using telehealth and other digital technologies will continue," he said. "I do not think we can consider a post-COVID environment occurring until late 2021 at best. That being said, I think our organization will continue to evolve and refine our processes to support remote work, increase the use of technology to achieve a sense of a connected workforce, and provide more options to support mobility of our team."

His organization will scrutinize its processes particularly related to technology selection and deployment to increase the speed at which tools can be configured and deployed, he added.

Making the right investments for everything

For Crowder of Atrium Health, 2020 was "the year of everything."

"Virtual care, virtual hospitals, remote work – the organizations that excelled and were able to meet patient demands were the ones that already had picked the right vendors and made the right technology investments," he explained. 

"Because, if you found yourself in a position where you hadn't picked the right partners and made those technology investments, you couldn't take care of your patients anymore, and you couldn't engage with your customers in a meaningful way."

"We've seen a 2,000% increase in virtual care. And we actually don't see it going all the way back to where it was before, because now, providers and consumers trust it."

Andy Crowder, Atrium Health

Making the right infrastructure investments with the right vendors in the right emerging technologies is really key, he added.

"And sometimes that may be a little risky," he noted. "You're trying to make sure bets for things that aren't sure. But if you didn't make the right investments in your collaboration tools, and you didn't make the right investments in your digital and consumer front door and your virtual capabilities, you absolutely couldn't meet the needs."

Atrium Health made a significant portion of its workforce remote, and Crowder says they're never coming back.

"And we've seen a 2,000% increase in virtual care," he said. "And we actually don't see it going all the way back to where it was before, because now providers and consumers trust it. And it's actually, in many cases, their preferred modality."

Crowder and his team learned these lessons in the past year and already have begun applying them.

"The feedback loops that we have in place today, we always thought we knew where the friction spots were in digital consumer journeys, but we hadn't hard-wired those spots," he explained. "Even with the right type of feedback loops for our contact centers, we hadn't hard-wired things into our caregivers' ecosystem. We're now doing that, so we don't have to wait for another mass pandemic to occur."

Atrium Health has been getting plenty of feedback about those consumer journeys, and that feedback already was part of its strategy for connected-care everywhere.

"We're a lot more focused and leveraging predictive analytics on the next best thing the consumer needs and what they want from us," he said. "We were forced to do that, because things weren't based on a human interaction. You had to leverage those data pathways, where in the past you fell back to maybe some of your old processes – and you couldn't do those in the pandemic."

Crowder does not see the organization going back.

"I don't think of all of this technology as a replacement for patient care, and the human experience, and touch. There are places where you have to have it," he said. "But I believe we now have broader adoption to leverage it in a more meaningful and holistic way."

Coordination is the key to everything

Esposito of Advocate Aurora Health has a simple but important lesson learned from the past year: Coordination is everything in HIT.

"Literally everything changed, and so we were only as good as our plan, which changed constantly in 2020," she said. "In addition to the mass move to remote, and significant COVID-19 surge, our system was approximately halfway through a move to a single EHR platform. Prioritizing needs as they came, being nimble in response, and ensuring a balance of both short and long games were key. This made constant communication and collaboration from our leadership team down to each work team and analyst vital."

"No matter what the challenge, ensure you are communicating – particularly the uncertainty – and coordinating effectively across large teams. What seems like a small tweak in workflow, build or reporting may have a large implication downstream."

Tina Esposito, Advocate Aurora Health

From a data and analytics perspective, Advocate Aurora Health redeployed the majority of its team to focus on ensuring the organization had what was needed to run the operation. Coordinating among operational leaders and incident command ensured that what was being produced was meaningful and helpful in decision-making.

"Our efforts needed to ensure appropriate situational awareness, validated volumes and counts for external submission, and a level of foresight to understand what may be tomorrow's reality," she noted.

"We listened, we communicated, we coordinated, we attempted, we learned and ultimately we delivered."

Now it's moving ahead with these lessons top of mind.

"As we work toward mass vaccination efforts and beyond, the lesson continues to resonate," she said. "No matter what the challenge, ensure you are communicating – particularly the uncertainty – and coordinating effectively across large teams. What seems like a small tweak in workflow, build or reporting may have a large implication downstream, and likely not fully understood within one team or function."

More focus on cybersecurity

On another front, the CIOs at AllianceChicago and Artesia General Hospital are in agreement that a big lesson learned from the past year has been the need to put more focus on cybersecurity.

"The days of an annual security assessment/review and remediation will be replaced with a continuous assessment and improvement process as security threats continue to evolve," said Hamilton of AllianceChicago. "This year, our plan is to implement a series of technical and workforce changes to address the increasing risk of cybersecurity attacks."

The team also plans to develop new ways to engage the entire workforce, since they are the front lines, relative to security efforts.

"Everyone from providers and care team members to the administrative teams that support the enterprise are important to ensure we are vigilant in regard to the use of technology and promising practices to mitigate against these threats," he said.

As healthcare pushes digital transformation, provider organizations cannot look past the importance of data and its security, said Jimenez of Artesia General Hospital.

"Data became very important in the fight against COVID-19," he said. "As we were building data dashboards to help our team make the right decisions, we needed to focus on securing the data. The remote workforces were making it harder to make sure our data was secure. It is not an easy task managing data security."

Ransomware and zero-day attacks are on the rise. Hackers have been taking advantage of the national crisis, creating COVID-19 fraud schemes and phishing attacks. The COVID-19 pandemic did not slow down hackers. It seemed to fuel the fire.

"Looking at the threat landscape and the impact an incident could have at AHG, in 2019, we had our first cybersecurity incident," Jimenez recalled. "The incident affected about 20% of our patients. The lesson learned from the cybersecurity incident helped us implement new security technology, but it still left a sour taste."

Jimenez made it a mission to educate and promote cybersecurity in the hospital. He embarked on a yearlong research project to help understand cybersecurity.

"Cybersecurity always has been in the back of our minds, but this past year I took a deep dive into the subject," he said. "Cybersecurity should be an important subject that all healthcare IT leaders should clearly understand."

Moving forward, Jimenez says cybersecurity is weighing heavy on everyone's minds. The lessons learned from the past year will help healthcare organizations get better prepared for any issue that comes along, he said.

Digital health part of mastering medicine

As a medical doctor, Testa of NYU Langone Health had a different take on another lesson learned in the past year. He says he has seen it demonstrated that clinicians want to engage in health IT and digital health when there is a mutual understanding of mastery and respect.

"Meaning that health IT can partner with clinicians and frame the use of digital tools – like video visits within an app or the electronic health record – as very much part of the mastery of their clinical field and not reduced to obligatory training," he explained.

"There are miles between training and mastery. Complementary to mastery is respect – respect for a clinician's time, expertise and valuable insights into the digital provision of care."

If clinical informaticists are asking clinicians to treat the use of digital tools as part of the mastery of their clinical field, then clinical informaticists must treat their efforts with tremendous respect, he added.

The vision, therefore, this year and beyond is to create the best digital experience for clinicians – one that is a joy to use, exceeds their expectations, elevates their practice and enables world-class patient care, Testa said.

"Essentially, our goal is personalizing technology while pioneering care," he stated. "While many acknowledged the importance of the patient experience, we firmly believe one cannot address the digital patient experience without acknowledging the impact of that upon the digital clinician experience."

Taking care of yourself

On a very different note, a lesson Crowder of Atrium Health has learned is that, under the unusual circumstances of the past year, healthcare professionals really must take care of themselves.

"Whole-person self-care and practicing your own great self-care rituals are very important," he said. "It was really important in 2020 to take time to actually have a break and reflect, because you could be in these virtual meetings for 16 hours a day. And you need to put in some of these rituals to make sure that you are well. These are simple things – rest, reflection, time with loved ones."

Professionals have to be deliberate about this, because many are now sleeping where they work – at home, he said.

"There used to be guardrails around your personal time and your family time. These have become incredibly important during the pandemic with working from home," he said. "And when we think about our virtual teams moving forward, many of us are not going to go back to brick-and-mortar for it. You're going to see us move 100% virtual. We've got to have safe ways for people to disconnect."

Additionally, managers and leaders do not have hallway conversations anymore. So it is key that they stay connected to frontline staff in a way that they get a broad and diverse group of perspectives.

"In the virtual world, I actually find myself being connected to more teammates than I did in the past," he noted. "But for some people, they may revert back to just a few people they interact with, and I think that would be a mistake. So, making sure you have balance in your life is really important, and then finding a way to make sure you stay connected to your teammates, so your culture is really intact as we move forward, is going to be really important."

Showing gratitude

On a related note, Esposito of Advocate Aurora Health exclaims one word: "gratitude!"

The past year "was unprecedented, unimaginable, insert your own superlative here, [but] was also a lesson in deep gratitude for colleagues and peers," she explained. 

"The impact health IT can have in supporting those at the front line was never more visible and direct than in 2020. This direct line of sight to the mission also allowed for a reengagement of many – evident by the mountains moved in a very uncertain environment, and with an incredible amount at stake, both at work and at times at home."

As healthcare professionals reflect on how teams pulled together and made the impossible possible, they should recalibrate their perspectives on colleagues and team members, she added.

"We should use this information to tackle problems differently," she concluded. "Far beyond organizational structure, there is newfound knowledge on how to tackle problems with team members that have differing opinions, experiences and skill sets, and because of those differences, anything is possible."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.