How Northwell Health's CIO updated its EHR to manage surge of patients, additional beds

In the epicenter of the COVID-19 pandemic in the U.S., New York City-based Northwell Health has built various tools into its EHR to manage the surge of patients flooding its 23 affiliated hospitals. 

John Bosco, CIO of Northwell Health, has spearheaded all tech initiatives. Working with leadership as well as Gov. Andrew Cuomo and Mayor Bill de Blasio, Mr. Bosco has put Northwell Health in a position to manage the flood of COVID-19 patients. 

"Assuming that our hospitals were going to become overwhelmed at some point, we pre-built an additional 50 percent of beds into each hospital EHR," Mr. Bosco told Becker's Hospital Review.  "So, if a hospital was 400 beds to begin with, we pre-built in 200 surge beds in the EHR and registration systems so as we are moving things around in the hospitals and creating new ICUs, we don't have a tremendous amount of work to do to add beds and units into the EHR."

"This has been a godsend to us because normally adding beds to the EHR and patient registration system takes 24 to 48 hours," he continued. "By pre-building these beds into the systems, we have been able to cut down that time to two hours." 

Mr. Bosco and his team have also been leveraging Microsoft Teams to stay in contact with each other. In return, Northwell Health has not had to resort to paper documentation, like other hospitals have. 

Below, Mr. Bosco discusses how Northwell Health staff and leadership are staying connected as well as the piece of information he wished he could get his hands on. 

Editor's note: Responses have been lightly edited for clarity and length. 

Question: How do you communicate with your team and other executive leadership daily? 

John Bosco: Our primary platform has been Microsoft Teams. Through Microsoft Teams, we have a very wide deployment that we started about a year ago. We have around 25,000 active employees that are on Microsoft Teams, and it has been a godsend to us during this crisis. We are using it for clinical collaboration as well as emergency operations center collaboration. Northwell has multiple emergency operations centers active, clinical advisory groups, clinical operations groups and more that all have established both chat and audio/video calls within Microsoft Teams. 

For example, every day we have an emergency operations center call with about 75 leaders on it every morning. This is done on Microsoft Teams, and we are able to share documents, see each other, talk to each other and chat with each other while the call is going on. We are almost sitting here saying "how would we have done this and continue managing if it was all phone calls?" 

All of our emergency operations, preparedness efforts and response efforts have been done through Microsoft Teams. The solution is also an extensible platform, so we can develop apps that run under Microsoft Teams. During this crisis, we have been to do things like get laboratory results to a physician in Teams. So, if they are already communicating with Teams and carrying their phone around, they will get a notification that they had a positive lab result that they need to call up. This has made communication even easier. 

Additionally, our intranet, public website and email continue to be ways we are updating employees.

Q: Have you had to resort to paper documentation for anything? 

JB: Not really. There are some spreadsheets that are being maintained. We've also worked hard to automate a lot of documentation so that when the leadership team needs to see the census at a hospital at any given moment or how many COVID-19-positive patients are in our hospitals at any given moment, it is delivered immediately. These reports are also stored in a Microsoft Teams shared folder that allows everyone to call the data up and look at it when necessary.  

Q: Is there a piece of information or data set you wish you knew? What data do you wish you had your hands on? 

JB: We started doing predictive analytics. We are doing a lot of what we call load balancing. So, we have 23 hospitals, 21 that we own, and we are shifting patients amongst these hospitals as some of them go through various phases of being overwhelmed. There were a few hospitals in Queens that closed because they were at capacity and that started flooding some of our hospitals that are close by. We started pulling patients out of those hospitals and sending them to ones that were less full. Now, we are developing predictive analytics to estimate how long patients might be in the hospitals, how many might be coming to us and other things to help us with load balancing. 

A couple days ago our governor and the mayor of New York City basically put all the health systems together and said everyone is one health system. In return, we are all going to share equipment and patients. It would be great to have a data set that combines all of the data from each hospital together, and then automates the information so we can have a better way to understand the best way to manage patients and supplies. Right now, it's being done with a lot of phone calls and manual spreadsheets. 

Q: What other updates have you made to your EHR?

JB: We have certainly needed to develop clinical order sets so we could standardize the care. So, we have certainly needed to develop clinical order sets for COVID-19-positive patients so we can standardize the care they are getting. These order sets are in the EHR so that physicians can easily order what we deem to be the appropriate tests and medications for each patient. 

Additionally, we have really opened up telehealth in a big way. The use of telehealth has exploded during this crisis. We are fortunate that we had our EHR set up and our patient scheduling system set up so that a telehealth visit can be scheduled and registered and billed using the same workflows that we use for inpatient visits. 

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