One of the many early COVID-19 pandemic challenges for patient care organizations has been gaining transparency into critical resource shortages—such as bed capacity—that nearby hospitals and health systems are dealing with in real time. As the crisis unfolded in the U.S., the early epicenter areas—mainly New York City, New Orleans, and Washington State—were the first regions to see their hospitals get bombarded with COVID-19 patients, thus making it difficult for those state leaders to prepare for what was coming.
But for states that have not been impacted as hard, and have been paying close attention to health systems’ early struggles with load balancing of critical resources, opportunity has arisen to avoid having one area of a state be overwhelmed by COVID-19 patients while another region’s hospitals remain empty.
To this end, in late April, the Arizona Department of Health Services (ADHS) announced the launch of the Arizona Surge Line, a new service for hospitals, aiming to ensure COVID-19 patients receive appropriate inpatient placement. The Surge Line is a centralized statewide system designed to keep hospitals and regions of Arizona from being overwhelmed by facilitating COVID-19 patient admission, transfer, and discharge to appropriate levels of care. “The establishment of the Arizona Surge Line is a proactive step to provide flexibility in our healthcare system in the event additional capacity is needed,” officials noted in the announcement, while contending that it is a first-in-the-nation initiative.
The technology powering the Surge Line is a Microsoft Azure-based platform by Utah-based Central Logic that integrates data from electronic health records (EHRs) and numerous other information systems used by all of Arizona's healthcare organizations to enable real-time, statewide visibility into facility bed capacity, provider availability, and inventories of critical medical equipment such as ventilators. Based on that information, those running the Surge Line can make decisions about where patients should be transferred, for load balancing and faster access to much-needed care, officials stated.
One of the leaders tapped to help run the Surge Line is Charley Larsen, R.N., program director for the state’s COVID-19 Response Team. Larsen, who also works as a senior director at Banner Health, the largest health system in Arizona, was called on by state health officials to oversee the daily operations of the transfer center that spans across various organizations. Larsen recently spoke to Managing Editor Rajiv Leventhal about the project and how this type of public-private collaboration could be a model to build upon for the future. Below are excerpts of that discussion.
Can you describe your role for the state’s COVID-19 Response Team?
My role is to help facilitate and stand up a transfer center that spans across [different state] organizations. It’s something that we have never done in Arizona—or across the U.S., I would imagine; an [initiative] in which we’re all competitors and all vying for the same thing. But we have put that aside to do what’s needed for the patient.
The Arizona Department of Health had spoken with the health departments in Washington State, Louisiana, and New York, trying to learn what was going well and what they wish they had done differently [in regard to the surge of COVID-19 patients]. One thing they mentioned was that there were pockets of COVID-19 surges surfacing, and depending on where they were [located] and what hospitals were in that area, some organizations were getting wildly overwhelmed while other hospitals just got ‘lucky’ by not [being near] a nursing home or an area where so many people got infected. So these [health department leaders] said they wished they had an infrastructure in place to help load balance. And that’s where I came in. We [already] run a large transfer center for Banner Health, and had the opportunity to scale that up and work with other systems.
How does the Surge Line specifically work?
It’s built to load level and monitor, but not impede on the transfer systems already in place, as some health systems in the state already do have a transfer center facilitating patient movement for their organization. We didn’t want to incumber those processes at all, so the Surge Line was built to sit on top of all the other transfer centers for all COVID patients. The benefit it provides the rural community is that they can call the 1-877 Surge Line phone number, and with that they are essentially calling every single [health] system at once.
With Central Logic, we have built the bed visibility for every organization. The prior [method] involved using a program in which hospital executives are mandated by the governor to [log-in] every day and update how many beds, ventilators, and other [resources] they have available, But anyone who works in hospitals knows how quickly things change. So in Central Logic we built real-time bed visibility, using our HIE, Health Current, who reached out with interest in working with us since they have ADT interfaces with 95 percent of hospitals in the state.
Health Current partnered with Central Logic to get those interfaces into a language that the Central Logic app could give us real-time bed visibility on across different organizations. It takes time to build all that; we don’t have bed visibility for every hospital in the state, but we prioritize it for the major hospital systems. So we started to chip away at those major systems so we could see rollouts; for example, hospital X has this many ICU and non-ICU beds, and this many ventilators. This way, when agents at the transfer center get a call from rural Arizona health systems, saying they have a COVID patient who needs ICU care and needs to be transferred, they can look at this bed visibility platform, look across the state, and quickly see where everyone is at in their “whelm” status.
Could something like this have been deployed at a national level?
It could. Banner Health was a customer partner of Central Logic’s before the state of Arizona, and that’s where I started all this work. We had built bed visibility at Banner, and that was quite the project, but we didn’t leverage the HIE because it just wasn’t needed. Each state has their own HIE, but the model is the same, and uses the ADT feeds, as long as the information you need is in those ADT feeds. So then it’s just a matter of translating that language into a common one, and presenting it.
It was months of work when we did this at Banner, and if you asked me then if we could do it for the whole state, I’d have said yes, but give me three years. At the same time, there are different resources out there you can leverage. So I think it could be done at the national level, but there are [also] HIEs and other ways to gather that information that would probably be quicker than doing this [on a national level].
Has Arizona experienced a COVID surge yet?
It certainly hasn’t been what we planned for when we built the Surge Line, but there is a strong belief that we don’t know what we are dealing with. Depending on what model you look at, you’ll have a different opinion on when the surge is coming. Some models estimated May 1, some May 22, some in mid-June. We just don’t know; that’s the reality. Arizona has started to open the economy back up, so there is an expectation that there will be a surge, to some degree, and it’s just a matter of when that will come. But when we built the Surge Line, we built it and named it as the Surge Line, not the COVID line. So while it is for COVID today, it’s meant to be stood up or activated for anything that might arise. The beauty of it is we’re building something for both today and the future.
Looking toward the future, how might you plan to evolve the Surge Line?
One of the things we experienced here—and I imagine some other states have, too—is that we have an influx of residents come every fall. This coincides with flu season every year. So the value will remain with the Surge Line, and the ability for state health systems to come together annually and continue this collaboration and support one another so that we can support the citizens of the state.
As we were getting the Surge Line off the ground, [a few] people reached out to me to say that when this is all done, let’s not let it die since we have the technology and business intelligence in place that we have never had before, as well as other forward momentum. I do see the technology evolving, and once we have the year-over-year visibility and insight, you will start to be able to [examine] the data you procured last year and the one before to create more predictive analytics.
