How Northwell is planning for a COVID-19 resurgence and utilizing IT in the next 18 months for recovery

When the COVID-19 pandemic hit, health systems across the U.S. canceled elective procedures and transitioned many team members to remote work.

New York experienced the peak of COVID-19 cases in April and now New Hyde Park, N.Y.-based Northwell Health is focused on getting back to business as usual. One of the biggest challenges is convincing patients that it's safe to return to the hospitals and physician practices, and then ramping up to fulfill the backlog of surgeries that weren't done during the crisis, said CIO John Bosco.

"Getting back to business is really important to us," he said. "That is what will keep our patients healthy and get us back to financial health. But we are also planning for a resurgence of COVID-19; that's where we are spending an extraordinary amount of time. We expect a resurgence to occur in the fall. We don't know exactly when it will start or how bad it will be, but as the largest health system in New York we have a special responsibility to be ready and do the best we can to care for our patients."

During the initial wave of COVID-19 cases, the health system was able to make the quick transition to telehealth and boost the number of ICU beds available to accommodate for patients who needed critical care. The health system stood up additional ICU beds at all of its hospitals. During the crisis, every problem was new and the health system innovated on a daily basis to get through it; now the top executives are planning for the next surge and making sure they're better able to respond.

"I needed my team to be more highly coordinated on a real-time basis than ever before," said Mr. Bosco. "I also needed to reassure them that we were going to get through it and that Northwell was doing a phenomenal job. I'd tell them one day we are going to get to the peak, we'll survive and then it will get better. I did a lot of calls, memos and emails to all of my 2,000 employees to reassure them, and I ended every call with telling them I needed them to stay safe and well because I need every one of them to help. Now, I tell them not to get complacent because the virus is still around."

Mr. Bosco said the system has a resurgence work group focused on what it will need for the next surge of COVID-19 cases and all members of each department are looking at how they can improve the response in the fall based on knowledge gained this past spring. Northwell is bracing for what it will need to care for patients, but also making sure it mitigates any further financial loss as much as possible.

"The pandemic has been a big financial hit to us and others like us around the country," said Mr. Bosco. "We have to understand how to make up for what was a really significant revenue challenge. We are dedicated to figuring out how to do that to make us better, stronger and more efficient than before. We aren't going to cut our way to making up for the revenue shortfall. The way we are going to make up for it is taking the lessons learned before and during the crisis and executing them now. If we become a better, more efficient, streamlined organization, then that will get us back to making up for the shortfall."

For example, the health system is planning the best way to mobilize its own clinicians and staff to respond to another surge of COVID-19 patients. During the initial surge, the health system brought in around 2,000 nurses and physicians from an outside agency to assist. "Now we can do things in a better and more organized way," said Mr. Bosco. "We had to build a lot of beds inside our hospitals. Now we have the time to pre-define surge plans based on when the hospital reaches a certain trigger point of patients coming in. We understand how to open up additional units in the hospitals, tents and other venues. Once that is pre-defined and we have a plan, our departments can build around that."

Another key issue during the initial pandemic surge that Northwell hopes to avoid in the future is PPE shortages. Rather than just-in-time scouring across the U.S. for PPE, now we have the ability to acquire it ahead of time," Mr. Bosco said. The same is true for IT equipment. We know now how much equipment we need and we can plan for it."

Northwell's initiatives to become more efficient and effective will be driven by automation and technology, said Mr. Bosco. "We will, even in the face of significant financial loss from this, continue to automate and make investments in technology in recognition of the things that we need to have but don't, and the things that we knew we needed before but didn't pull the trigger. There is a strong appetite for more automation, integration and standardization across hospitals," he said. "We are fairly standardized, but not completely, and there are a lot of things we want to do around that."

Notably, Mr. Bosco sees opportunity for more robotic process automation for administrative tasks. Intelligent RPA can make decisions and orchestrate actions, including manual and repetitive tasks that people are doing today. For example, the health system will use bots for call centers to more intelligently and efficiently handle calls and direct patients with COVID-19 symptoms to the right level of care.

Patient wearables will also make remote vital sign monitoring more accessible during the next COVID-19 surge and beyond. The remote patient monitoring limits the number of people who go in and out of rooms during the pandemic, as does two-way audio/video communication. They can also take remote vital signs and have the information integrated right into the EHR, eliminating manual work that is typically done.

Northwell also uses Microsoft Teams to make collaboration more efficient. Clinicians can use a chatbot within Teams to verbally ask for information about a patient and then the platform brings up the information from the patient's medical record on the screen.

"The physician doesn’t need to go find a computer, login to the EHR and then get the info. They can just grab an iPhone and ask the chatbot and get the information immediately," said Mr. Bosco. "We can deliver lab results for tests done on the COVID-19 patients and notify physicians when a priority result comes in. It's a matter of streamlining the tools physicians need and use, while making their jobs just a little easier."


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