'People see the value of technology and trust it': Yale New Haven CIO on the pace of change and what 2021 will bring

Connecticut was among the early states hit by the COVID-19 pandemic and Yale New Haven (Conn.) Health mobilized quickly to develop an "all hands on deck" strategy to meet the needs of patients, community members and employees.

The health system reacted quickly to move employees to remote work and in a matter of days deployed the hardware and equipment needed to keep employees connected while working from home. Lisa Stump, senior vice president and CIO of Yale New Haven Health, was responsible for the technology to keep operations working smoothly.

"It became clear early on that we would have to work remotely, but the teleconferencing platform we had was not robust enough or user friendly enough to support that, so we moved to Zoom," she said. "There were also cultural changes we needed to make. We still needed to engage with our employees, executives, trustees and stakeholders remotely. This isn't rocket science in terms of technology, but we were a group of people who weren't used to routinely interacting in that virtual way."

To keep patients, staff, and visitors safe, visitors were restricted from the hospital. And with personal protective equipment in short supply, the hospital wanted to limit the number of times caretakers entered the room with a COVID-19 patient. Ms. Stump and her team deployed technology so a centralized nursing station could constantly monitor patients remotely and stay connected frequently without entering the patients' rooms. They also installed tools for patients to video chat with family members and loved ones throughout the day.

The health system also accelerated its telemedicine deployment. Prior to the pandemic, the system didn't have significant buy-in for telehealth and only conducted about five virtual visits per day. However, when the pandemic hit they had to scale up to accommodate for thousands of visits per day, which required training providers and patients in that capability. "We created a telemedicine conversion center to do that work," said Ms. Stump. "We trained the staff to do the work and connect people to telehealth. We also created new patient units and ICUs and set up tents in parking lots so that patients could have drive-thru tests.

Behind it all was the data and analytics of understanding the spread of the disease and ability to cohort patients safely. All of the new patient care locations, testing sites, bed designations, testing results needed to be connected electronically and get reported in our dashboards."

The health system had a fairly robust enterprise data warehouse before the pandemic to support and ingest information, as well as a robust team to support data initiatives. Ms. Stump said the system is continuing to build out its prescriptive and predictive analytics capabilities.

"We have a small group of data scientists. I think we will see the need to grow that or partner with others in the future," she said. "We already had additional plans around genomics and leveraging genomics as part of the data warehouse before the pandemic, and that's at the leading edge of where we will continue to grow."

The pandemic created a need for quick innovation to care for patients, but it also put a financial strain on the health system long term, which will put further tech investments under more scrutiny than ever. "We deployed in three months what would have taken three to five years," said Ms. Stump. "All of the careful planning, business case and return-on-investment analysis took a back seat. We typically would have planned, developed a plan B, and a back-out strategy if the technology didn't work, but we didn't have time for that. We had to operate on our instinct and make quick decisions. Now that the dust is settling, we'll revert back to a happy medium, still moving with agility and flexibility and we will need a solid business case now more than ever. But people now see the value of technology in a new way and trust it."

Part of that rapid change was also postponing or removing priorities that did not immediately affect patient care.

"What were priorities in November are not necessarily on our list of top priorities anymore in some cases," she said. "It doesn't mean that those things weren't a great idea at the time, but we needed to shift to meet the needs of our organization. We are now working across traditional boundaries of our teams and we may need to utilize their skills differently. We had nurses that were analysts on the IT side get pulled back to the bedside and as we ramped up testing, there were 40 to 50 IT team members that were sent to COVID-19 testing sites to help. The flexibility and agility were really important for the IT team."

In the future, Ms. Stump said the health system's technology investments will focus on key business strategies such as returning patients safely to the brick-and-mortar hospital and offices. Telemedicine, virtual care and remote work technologies will also be key investment areas over the next year.

"Our fiscal year 2021 will be a 'keep the lights on' year for a lot of the core infrastructure that we support so that we can make those smart investments and get patients back safely," said Ms. Stump. "Telemedicine, which I think is here to stay, is now the way we practice. It will be a balance between new patient engagement strategies and less of the more back-end solutions where we'll invest in the near term."

Inside of the hospital, Yale New Haven Health is making upgrades as well. The health system deployed ambient listening devices more broadly during the pandemic to change the way clinicians interact with technology, facilitate communication and reduce burnout. These technologies are some of the very promising advances that will enable clinicians to use voice to make clinical notes and place prescriptions or orders at the point of service. Patients can also use the ambient listening devices to control their environment, such as the lighting and room temperature.

Connecticut is now bending the curve when it comes to COVID-19 cases and has become a leader in social distancing and mask use. The health system is now focused on bringing patients back to the office safely when necessary but continuing remote work as part of how it operates.

"We are shrinking our physical footprint in the office space, and we will continue supporting teleworking some or all of the time for employees," said Ms. Stump. "That is a positive takeaway. Clinicians say that telehealth is more personal and intimate; patients are more relaxed at home. That's how we know we've made the right changes."



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