Italian, German, and British HIT Leaders Discuss Challenges Amid the COVID-19 Pandemic

March 24, 2020
HIMSS International sponsored a webinar on Monday on the challenges that have faced health IT leaders in Italy and Germany, as the COVID-19 pandemic has surged across Europe and globally

HIMSS International, a division of the Chicago-based Healthcare Information & Management Systems Society, presented a webinar on Monday, March 23, “Italy and Germany Facing COVID-19,” in which Italian, German, and British healthcare IT leaders discussed the current situation in hospitals in Italy, Germany, and the U.K., and healthcare IT leaders’ participation in finding process, operational, and technological solutions and creating supports for clinicians, as the pandemic spreads across Europe and the world.

Charles Alessi, chief clinical officer at HIMSS International, led the webinar discussion, welcoming two presenters, one from Italy and one from Germany. Elena Sini is CIO at Humanitas Research Hospital in Milan, and is a HIMSS Europe board member, and chair of the HIMSS European Governing Council. Henning Schneider is CIO at Asklepios Kliniken Gmbh, a Hamburg-based patient care organization with six hospitals and 150 sites of care, including medical clinics, across Germany, and is vice-chair of the HIMSS Board of Directors in Germany. In 2015, the German magazine Computerwoche named him CIO of the Year for innovative leadership while CIO at the Universitätsklinikums Hamburg-Eppendorf (University Medical Center Hamburg-Eppendorf).

Alessi began by asking each presenter to briefly sketch the situation in their country. “How has the experience of the virus translated into the running of hospitals, and what lessons have you learned so far from managing this situation?” Alessi asked.

“You know, Charles, it’s been a month since February 21, since we received our first coronavirus case,” Sini said. “In the following days, we realized that the virus was invading our country. Since then, it’s been a struggle. I’m currently the CIO of our regional group. And this is impacting the whole country. We had the opportunity to learn from what happened in hospitals in smaller cities in Lombardy and the north. So we understood that the ability to promptly to redefine the care settings of the hospitals would be vital. Each region decides on hospital management and on which hospital facilities should be converted to COVID-19-exclusive care delivery. Three hospitals in Lombardy already have been converted. This will be an ongoing process; we are literally working around the clock. And five hospitals in our group have made room for patients from public hospitals, because they can no longer cope with the volume of COVID-19 patients. We’ve had a close cooperation between private and public hospitals,” she said. “And because we realized this was an opportunity to learn, last week, at the HIMSS Italian community, we produced a webinar on best practices, and the colleagues in Bergamo, Brescia, Pavia, Emilia, and the national association of religious hospitals, shared their learnings so far.

Further, Sini noted, “Everybody is facing the same challenges. And the idea was to have colleagues plan as much as possible in advance. In the South [of Italy], we were able to see this coming. The most important thing is to be able to develop an incident command structure. We understood that this won’t end soon, so you have to ensure that you have all the experts in IT areas, to meet the wave of demand. And it’s sad, but also, people on the IT staffs of hospitals are becoming sick, so you have to rely on smaller cadres as needed. And this requires adapting by the hour. As a consequence of the lockdown first in three regions of the north and then in other regions of the country, you realize you have to deploy a massive number of employees who weren’t ready. You have to allow all non-essential staff to work from home. And you have to apply changes to the HC system in terms of records and communication. And you have to do it very quickly, because it’s obviously very relevant. And you have to make sure that your network can support all the communications. We all experience gaps. As a consequence of the lockdown, we’ve had a huge problem with the supply chain. And this is even more relevant because some hospitals have had to develop new broadband and Wi-Fi connections, and more equipment (hardware) than they had had. There are more than 700 pre-triage tents outside hospitals now in Italy. And you’re going to need… the government has decided to employ retired doctors and nurses, also medical students, who are really being fast-tracked into urgent situation. And you have to get these healthcare workers quickly up to speed.”

Meanwhile, Sini noted, “In terms of security, there have been significant DDOS and other cyber attacks. Remote workers are particularly vulnerable, so you need a strong information security team.”

Very significantly, Sini went on, with regard to telehealth, “That has been an issue for us; hospitals in Italy did not have full telehealth capabilities until the crisis. We obviously have to keep everybody connected. There’s a strong collaboration between clinical and technical departments. We’ve had to set up new ICUs sometimes in a matter of hours, so collaboration is incredibly important.”

And what have been the biggest lessons so far?

“We’ve found that the heaviest toll has been falling on the clinicians,” Sini said. “But burnout has also been an issue for the IT staff, who have to be there in order to support the doctors and nurses on the wards. So my colleagues need psychological support, which could be very, very useful. So you need to prepare for a significant surge in patients.”

“Thank you, Elena,” Alessi said. “Henning, what is your perspective on this situation? Germany has the fifth-highest number of infections globally. But it appears that Germany might be on the verge of ‘flattening the curve’?”

“Yes, we’re hoping for a lower curve of new infections,” Schneider said. “I’m not sure whether that’s a trend, though. At the moment, we’re a hospital group with 60 hospitals and in 14 of the 16 German states. And on Friday, we had 20 patients in our ICU or in normal wards. And it soared to 100 patients as of this morning.”

Meanwhile, Schneider said, “Hopefully at the moment, the situation is OK: we have enough beds and ventilators. And over the last week, one of our major IT projects was building a lot of reports across all of our different IT systems, to make sure we had a single, unified dashboard, indicating the number of ventilators used and free, including those able to be moved to the normal wards. That’s one of the major projects where we can prove what IT can do. Over the past week, we were able to create this unified dashboard, very quickly.”

Schneider went on to say, “Elena has mentioned a lot of things we’ve been working on in the past week. We’re just one week behind the situation in Italy, and my fear is that we’re running into the situation in Italy, and that’s why we’re not stopping to prepare for this. So my first learning from three weeks ago is that every IT professional is a human being as well, and so leadership and communication are the first and most major thing that CIOs have to do at the moment.” So one of the keys, he said, is “a lot of communication with your own people, and then good communication across the organization. We’ve identified workplaces that could be used as home offices,” he added. “We identified 600 different virtual desks we could use to send people home. And we’ve rebuilt our complete telephone system.”

As a result, Schneider continued, “Almost  everybody in the IT department is able to work at home. Only the support people in the hospital have to be there. There, you have to be close to your users. We’ve stopped all of our projects in our organization” not related to the virus, “and everybody who has some free time is focusing on how to support nurses and doctors on the wards. For example, they’re reorganizing all the hospitals to separate infected and non-infected patients. We’re trying to do that separation in our dashboard as well. And all our Internet providers have been really supportive, and have expanded our Internet bandwidth by 100 percent, to support all of our now-remote workers in their homes.”

In fact, Schneider said, in the current situation, “You have to stop all your regular IT projects in order to focus on reports and user support for COVID-19. And we’re looking at our data and dashboards, and we’ve moved our first reports, are trying to really prove now what our IT organization is able to prove. We’re working with Charité, the big university medical center here, to see if they’ve built a care path with video consulting. And the really important thing is the cooperation with the IT department, to really explain to others, communicate good ideas, to combine your successes. I think this is really important to do.”

“What advice might you give your colleagues in other countries?” Alessi asked Sini. “I would say,” Sini said, “plan for the long haul. We all know that this is not going to end soon. Nowadays, we are mostly focused on the South and central Italy, to set up new ICUs and intensive care beds; that’s the priority. And of course, we’re working to take care of the hundreds of thousands of staffers who are working remotely. My entire team is working from home. The people who are supporting the doctors and nurses in the hospital, we’re trying to help them as much as possible, remotely.”

Meanwhile, she said, not surprising, “It’s clear that we can always use data more efficiently. And analytics is focused on public surveillance and tracking now, as was done in South Korea. So that’s also an area where EHR [electronic health record] vendors could do more. CEOs are asking vendors to make changes, so that they can add new capabilities to the EHR; and this could be relevant.”

What’s more, the telecom needs during the crisis are turning out to be massive. “The demands have increased up to 90 percent on fixed lines and up to 40 percent more on mobile lines,” Sini said. “Suddenly in Italy,” with a nationwide quarantine, “everyone is online—schools, universities—so it’s complex to respond to the increase in demand. And was our IT system ready for COVID-19? We reacted as quickly as we could, but it’s challenging for everyone. The HIMSS-Italy community has responded as quickly as possible. This problem of HC professionals who are positive—we don’t have so much personnel in hospitals in Italy; and many hospitals have limited IT staff and capabilities. And there’s a lack of gowns, face masks, gloves; the government is addressing this. Everyone is working to minimize the risk to HC workers, but many HC workers have become positive, and that’s really a problem. It’s been like a tsunami that’s hit us.”

Meanwhile, Schneider said, “We were really, really lucky that in most of our hospitals, we were ready for the situation. We had just initiated a lot of projects focused on IT security, focused on virtual desktop security and offering home office opportunities to our employees, and working on… last year, mostly focusing on comparing costs for IT and treatment between hospitals, but we could use this data to build this dashboard around occupancy rates. So this is where we were very happy. This infrastructure project had just been finished in the past year. On the other hand, I have to say, where we really have a lack of infrastructure is in communications between hospitals in Germany. We don’t have any good way of communicating between hospitals. And the funding for hospital IT security infrastructure is not possible right now in Germany. We haven’t had funding in the past two years. So a lot of hospitals lack a secure infrastructure. And in Europe, we had the first two university medical centers suffering from new email viruses. Cyberattacks regarding the topic of Corona, for example. It’s really a frightening situation.” And, he added, the lack of IT infrastructure secure from cyberattack has proven to be an apparent weakness in Germany.

Meanwhile, Alessi asked, “What would you change, if you could start over” prior to the COVID-19 crisis? “That we would have central, organized reporting systems on a state or even national basis,” Schneider said. “At the moment, every state is trying to build their own IT system for reporting on the situation and covering it. And again, we’re faced in each case whether we could report on the actual status of ICU bed availability and supply. I would say we should have a nationwide reporting system.”

“Elena, what are you missing, in Italy?” Alessi asked. “We are missing the ability for patients to self-screen,” Sini said. That would make a difference in reducing the transmission across communities. Not having screening tools for patients at the beginning of triage, has been a problem. I think that telemedicine would really make a very positive difference for us, and could be used in a variety of ways. People who have contracted the virus and need to communicate with their doctors. People with mild symptoms. I had high fever and coughing for five days. And when COVID-19 came to our country… So my doctor said, just stay at home. And I’m still in isolation. So many are at home with mild symptoms. It would be so good to keep people at home and communicating through telemedicine. With mild symptoms but overall doing well. And these people spread the virus even more. In Italy, the GPs are among those most affected, because they make house calls, etc.”

Still, Sini said, “Looking on the bright side, there’s definitely an opportunity to accelerate care transformation here. In Italy, we have so many telehealth projects, but they were all isolated, and we were struggling with change management issues. So I think that after these challenges, we could see an opportunity to accelerate these two models in other regions. This is also something relevant for my organization. I joined this healthcare group nine months ago. And so we were already moving towards telehealth; I think we’ll move forward in this direction. And as Henning said, it’s very important to share real-time data and to do tracking. Improving those capabilities would be very useful for all the infections.”

Meanwhile, Alessi said, “The U.K. is made up of four different health systems. In theory, it should manage an epidemic of this nature better than everybody else. We did reasonably well in contact-tracing in the first few weeks. Now, we’re in a situation of partial lockdown, and I think we’ll get to a situation of total lockdown in a couple of hours or days. And in terms of our situation, we’re a couple of weeks away from Italy; of course, we’ve tested considerably less than they have in Germany, so our numbers could be lower simply because of having tested less.”

Further, Alessi said, “We’ve also got another big issue, which certainly causes concern, and that is the number of beds. We have some of the lowest numbers of beds per capita, even lower than in countries like Denmark, and also very low numbers of ventilated beds. So the ground we have to cover will be significantly greater. So it’s even more important that we leverage technology as well as we possibly can. In Asia, they certainly have used strategies like tracking, to contract-trace far more effectively. In retrospect, that’s something we could have done a little bit more of, a little bit earlier. But we’re all in this together. We’re also mobilizing medical students and retired doctors, and are speaking to the population about the importance of isolation. The last thing I want to mention is the digital transformation. One of the biggest problems with the coronavirus is the fact that it totally engulfs and consumes the medical system, to the extent that people with other issues can’t be seen or treated as fully—people with strokes and heart attacks. So we need to help patients manage their non-communicable diseases better.”

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