At Franciscan Health, Innovating Around the Pandemic Has Improved Efficiency
As a result of the COVID-19 pandemic, health systems all across the U.S. have been put in unstable situations in which their leaders have had to find new ways to keep patients and staff safe, while also still delivering quality care. Telehealth has been one obvious approach, and its use has massively surged since the onset of the pandemic. But clinical and IT decision makers have innovated in other ways, too.
For example, one specific case study at Franciscan Health, a 14-hospital health system which includes clinics, home health services and doctors serving Indiana and Illinois, involved isolating patients and multi-disciplinary rounding with several physicians consulting at the same time, resulting in a reduced length-of-stay and improving care plans for several patients at the same time. The health system’s vice president, digital innovation, Sri Bharadwaj, who recently came to the organization from UCI Health in Orange, Calif., recently discussed this case study, lessons learned, and other ways Franciscan has innovated around the pandemic. Below are excerpts of that interview with Managing Editor Rajiv Leventhal.
Can you further detail this case study that involved isolating patients, enabling several physicians to do more consults in shorter amounts of time?
We have had lots going on. The need for us to double up a digital portfolio of activity has been paramount. How do we engage and stay engaged with patients? Also, how do we stay engaged with physicians, who are not traditionally used to virtual [processes]? At Franciscan, we have [deployed] several physicians in a conference room, using Microsoft Teams to work with one physician who is in an isolated environment—kind of like an ICU. We have a cardiologist, pulmonologist, hospitalist, and intensivist, as well as a possible physician consultant from the outside who can provide some specific guidance around the diagnosis for patients. This is all remotely done while the patient is in the hospital room. We have been able to pull together a simple solution with an iPad in the room with speakers, so folks can listen and see.
We took the plastic that you get from dry cleaners, an IV pole—the kind that hangs in hospital rooms—fixed an iPad stand to it, fixed the speaker to the iPad, and then put the plastic on top of the IV pole, and every time you moved the pole from room to room, all you had to do was remove the plastic, put in a new one, and you were done. So you are disinfecting the apparatus you are using for having the conversation, and doing so extremely quickly. You can change masks and gloves quickly, you can quickly replace the plastic sheets, and you’re good to go. The speed at which you can see several patients over a short period of time has been the biggest benefit. Normally you have to walk in and out of a patient’s isolation room, get new PPE, disinfect all the devices, roll the devices in and out of the room, then have the conversation with patient. There is a lot of time wasted in that process. This model completely eliminates those components.
In one case study, we saw six patients within a matter of 30 minutes, and we were able to change care plans, diagnoses and reduce the length-of-stay by at least a day or two. That phenomenal impact from a physician perspective is something I have not read or seen anywhere else. It’s important, not just for the patient, but for the physician community—how you can use a circumstance like COVID to transform patient care. You are now doing several consults for several patients over a very short period of time, leading to improved physician productivity, patient engagement and improved care. And you are now collaborating with other doctors to deliver that care.
What have been other lessons learned from this new healthcare environment?
We are able to do this across multiple hospitals in one health system, as long as I have a concentration of physicians in one location. For example, if I have 30 pulmonologists across our system—and pulmonologists and cardiologists are scarce during COVID—we can utilize those physicians effectively by putting them into one location and doing Microsoft Teams vide-based meetings across the entire team, which we call the e-ICU in a very focused care delivery environment. So we had several consults happen across several hospitals from one single location. Also, we were able to have physicians meet with other physicians at the same time, meaning all we had to was coordinate their schedules. We really just need someone in the room. Typically, there is one hospitalist, or a nurse, or physician’s assistant, or someone in a clinical role, visiting the patient. This process transforms the patient visit to a complete consult and leverages short-staffed physicians.
In which other ways has technology helped during the crisis, as digital health has clearly been seen as a natural fit when you need to limit in-person visits.
We did about 80,000 patient interactions through digital means across the board and across the system. Over 50 percent of our visits are virtual [at the time of this interview in early June]. We have transformed all of our 290 clinics into virtual visit centers so physicians can come in and do virtual visits for all their patients without losing any of their pre-scheduled patient visits. We have also been able to do palliative care video visits; we’ve done several interactions with patients’ families using video capabilities, especially if they’re in isolation.
We even had one situation in which a patient was not willing to walk into a clinic, but didn’t have an Internet connection at his home, which was rurally located, so he drove an hour to do the visit, but didn’t feel comfortable walking in. So we actually did a drive-in clinic visit where the patient was seen in the parking lot of the clinic by a physician. We deployed an iPad to the patient, he consented in the iPad, the physician logged onto the iPad, and had a video visit with the patient. The patient was very satisfied and went home.
Telehealth visit volume will clearly decline from the peak of the pandemic, but it should still be higher than pre-COVID levels. How do you see the future playing out?
We are proposing that on our normal schedule, physicians take an hour or more out of the day to see patients through virtual visits as a [new] norm. We believe that will become a [regularity]; we know that several patients still don’t want to come into the hospital, and would like to stay home while still being taken care of by their doctors. We’re looking at how blocking schedules for virtual visits as a way to help physicians manage how they see patients going forward.
What have been some of the biggest digital health challenges for physicians and others during this time?
Change management has been a big challenge that we didn’t anticipate. The absorption of technology was initially rather slow; people are more attuned to [being discomforted] with not seeing that patient face-to-face. That caused a lot of initial discomfort among physicians. After the first four or five patient video visits, they realized this was becoming the norm, but it did take some time. Also, [virtual] is a completely different workflow than [in-person]. They were trying to replicate the face-to-face workflow digitally, but it’s actually much different because you don’t have patients waiting in the room, seeing a medical assistant who takes their vitals, and then seeing the physician. All of that is shrunken to a minute of interface between someone upfront before that person is handed off. So the actual visit time is shrinking compared to face-to-face, meaning you’re able to see twice the amount of patients in the same amount of time.
People need to think of the bigger picture access to care problems; if I can see twice the amount of patients virtually compared to having them come in, the same resources are utilized in a much better form. We call it RUM—resource utilization maximization—so you’re not only taking just the physician resource, but also the medical assistant, the front desk receptionist, and [those] related to facilities, such as the cleaning staff. You don’t need [as much] of that. Physicians are also more focused now; rather than having one eye on the computer and one on the patient, there is more eye-to-eye contact with virtual visits. It’s a more compact visit, so the patient has the physician’s undivided attention the entire time.
