The strategic vision for long-term remote work at 12 health systems

One of the CIO's major responsibilities when the pandemic hit was to safely transition thousands of individuals to remote work.

Now health systems and organizations are grappling with whether to keep their teams remote and what their plan will be for returning to the office. Here, 12 CIOs and healthcare executives outline their organizational philosophies on remote work and what they're plans are for the future.

Eric Neil. Interim CIO of UW Medicine (Seattle): Like everyone else, we were glued to the coronavirus news and on Feb. 26 we had a meeting to ensure our IT infrastructure was prepared to support a vastly expanded remote workforce at UW Medicine. Only three days later, the United States had its first coronavirus related death, just miles from here. Within a few days we were encouraging staff in our department to work from home and within two weeks, we were requiring it.

Since that time, our staff has worked extremely hard to support the COVID-19 response and has been more nimble and responsive than ever before, all in the midst of an Epic implementation. Because the team has been performing at such a high level, we have made the decision that our IT department will permanent become a mostly work-from-home department. We say 'mostly' because once we are on the other side of the pandemic and it is safe to do so, we will require that individual teams work in the office together no less than once, every two weeks. Restoring some limited in-office time is important since we need the face-to-face interactions, the brainstorming and creativity that comes from working physically together, as a team. Our managers and directors also need in-person 1:1 time in order to connect with and invest in their staff.

Since this decision, we have terminated two real estate leases, saving our health system $150,000 per month. We are converting our remaining IT office space into hotel spaces where teams can make online reservations for the cubicles, offices and conference rooms they need during the days they will be in the office. Other departments are looking at similar approaches as they reduce their need for physical space. One challenge is how to best support our team members as they deal with COVID related childcare issues, home schooling needs and staff taking care of elderly parents. In the interim, we are giving everyone as much flexibility in their daily schedule as possible and encouraging everyone to show grace and patience as we all come together to make this work.

Jonathan Shoemaker. CIO of Allina Health (Minneapolis): We've pretty much come to the conclusion that it wouldn't make sense to ask people to start driving back into an office, given what we've been able to accomplish by having staff working remotely. We're seeing that our ability to support them as well as employee engagement is high, and we believe that productivity of folks is also high, so I think we have a permanent change.

Deanna Wise. CIO of Banner Health (Phoenix): Throughout my career, I have been a believer in the ability to deliver outstanding outcomes with a work-from-home core team. It has allowed us to select from the best-of-the-best talent pool, and allows team members to live just about anywhere, as long as they are able to travel as necessary. It is about focusing on outcomes and exceeding customer expectations, versus managing time in an office. This requires clear expectations and strong leadership, with a recognition of work-life blend when delivering across time zones, but it can be done successfully.

Geoff Brown. CIO of Piedmont Healthcare (Atlanta): A number of system office teams went remote when the pandemic hit; this included a good portion of staff that were non-patient care facing who moved to remote work overnight and we had to stand up that process. With the new distributed working environment, we want to make sure things flow easier and there is a secure way for us to expand and grow. Behind the scenes we have to protect the system against bad actors that are trying to gain access to our data and systems. In the first version of the systems we stood up, it was all about keeping staff productive and operational. In version two, we are figuring out how to build a business case around new initiatives, build productivity measures and effective remote management.

Keith Perry. Senior Vice President and CIO of Carilion Clinic (Roanoke, Va.): Carilion Clinic had already embraced remote work prior to the onset of COVID-19. Like most organizations, we have certainly seen the remote workforce grow as a result of the pandemic. We continue to be supportive of a remote approach where appropriate and foresee this becoming a more permanent, hybrid workforce with a mix of remote as well as onsite employees.

David Chou. CIO of Harris Health System (Houston): I am glad that I work for an organization that is forward-thinking in our remote work approach permanently. Our philosophy is that we trust our employees and measure them based on their work output versus the need to see them physically. If leaders feel the need to see the employee in person to manage the work effort, then, in my opinion, the leader should not have hired the employee.

Post-pandemic, we will have full time and hybrid telecommuters, so nothing changes for us. I am glad that we will not revert as we embrace the digital world for patient care and the workforce.

Randy Davis. CIO of CGH Medical Center (Sterling, Ill.): The short story is, we allow it. We did prior to COVID-19, so it wasn't a change for us. Admittedly more take advantage of it today. We clearly spell out our ground rules and requirements/qualifications in our policy on working from home, and it's been pretty easy for everyone to live with. I believe it was a proper option to offer prior to COVID-19, and is a necessary reality post-COVID-19.

Chris Harper. Vice President of IT at University of Kansas Hospital (Kansas City): We have actually been working toward leveraging remote work for the past three years. The philosophy with the modern connected world is to attract, retain and really bring on the best technology for your organization to be able to have remote work capabilities in place, so we have been piloting with other departments including revenue cycle who are better situated to remote work alongside IT.

Prior to COVID-19, we had roughly around 300 staff between IT and revenue cycle who were working remotely; we have since been able to set up infrastructure and put everything in place to send about 2,300 to 2,500 employees to work from home pretty much full time during the pandemic. It's been a valuable capability for us, so we really didn't miss a beat in our performance supporting our providers and patients when we had to transition to remote. Now we're looking more ahead to see how we can become a more virtual and remote [in a way] that adds value system wide.

Healthcare is always slow to adopt and utilize technology compared to other industries, whether financial or retail. I feel like this pandemic really gave healthcare organizations the opportunity to kind of up their game when it comes to remote work and telehealth. It's been a hard pandemic for everyone, but IT and the tech we have in place has really been showcased in this time of need.

Raymond Lowe. Senior Vice President and CIO of AltaMed (Los Angeles): Before the COVID-19 pandemic, large-scale deployment of remote work was not a consideration. We have been diligent to ensure that our people can work remotely without compromising productively or cybersecurity. If this is to be the new normal, we must be up to the challenge.

For example, in March 2020, over 1,000 employees worked remotely from the care provider, call center, medical management, and administration/shared services (HR, IT, compliance, etc.). Even today, we continue to enhance our plans that include additional remote work enabling physicians and nurses to work from anywhere. This work is part of our digital transformation and strategy of having 'flexible walls' for our patients, improving patient satisfaction, providing quality outcomes while lowering cost, and addressing provider burnout.

Terry Wilk. CIO of Effingham (Ill.) Health System: Unless an employee's work responsibilities require them to be on-site to provide direct or indirect patient care, I believe that there are times when it is appropriate for a trusted employee to work remotely either on a short-term (one or two days) or long-term (three-plus days) basis. Short-term examples include when the employee's child is ill and the employee needs to stay home to look after the child, and when the employee needs to oversee a major repair to be done at their home. Long-term examples may include when the employee is too ill to be around people at work but they are willing and able to participate in virtual meetings, complete work assignments, etc., while recovering at home.

However, enabling an employee to work remotely is a privilege for and not an entitlement to the employee. I consider my employees professionals and treat them that way unless they give me a reason to do otherwise. At a minimum, an employee authorized to work remotely must have a cell phone and a PC or laptop with a stable internet connection to access email, work on documents, participate in virtual meetings, etc., throughout the workday. Of course, the employee must be trusted to work independently away from the office, stay engaged and productive, and be accountable for his/her time working remotely on behalf of the organization (e.g. time/activity log).

If we continue to see positive results from our remote work experiences, I see my organization continuing to offer this alternative with appropriate oversight and accountability post-COVID-19 to benefit both the employee and the organization.

Chris Paravate. CIO of Northeast Georgia Health System (Gainesville): IT strategic and operational alignment with the health system has never been more important but the pandemic has made us redefine how to accomplish this. From IT orientation to the board room, I have set the expectation that we will understand the technology needs through the eyes of our customers. This means getting out the of the IT department and out in the field. In our organization, our projects encompass operational performance improvement and change management.

The positive impacts of COVID-19 include:

• Users are leveraging video to facilitate support resolution, enhancements and education; meetings are less structured and more ad hoc, shorter, leveraging more frequent check-ins.

• Internal IT management meetings that use to be scheduled for an hour in most cases are done in 30 minutes.

• More visibility to outcomes; our organization is in a COVID-19 hotspot and we have an incident command center and IT system enhancements are communicated daily.

• Space – we have lots of it; not sure how to reallocate yet.

The negative impacts of COVID-19 include:

• It is easy for meetings to turn into transactions, losing the creativity and interactions that lead to better solutions.

• Internal IT leadership rounding and customer rounding is nearly impossible. Often the best troubleshooting and problem solving come for impromptu conversation. It's 'virtually' impossible to accomplish this type of interaction.

• Communication to direct reports and staff require additional discipline to ensure everyone is up to date and informed of decisions and direction.

• On the job training and leadership development – the ability to coach, develop and mentor teams seems impossible when everyone is remote. You can coach to the outcome but it is very hard to deliberately mentor leadership skills.

So now on to your question: what is the long-term implication of COVID-19 on remote work?

We are all learning how to balance work that can be completed remote and what activities require us to come together. It has been striking to me how much efficiency we have gained by moving to a remote workforce. The efficiencies tend to be in the completion of tasks and support related changes. I believe this efficiency is a bit short-lived and may be attributed to more routine activities.

My long-term focus is related to how the IT division continues to learn and grow together with the health system to improve our patient care, reduce our costs and improve our value. This work leverages human interactions and innovation that has been best demonstrated when we come together to leverage the skills and talents of a team. In my opinion this is best achieved when we are physically present.

For example, there is no substitute for dressing out in the operating room to see how anesthesia documentation flows during a short surgical case. You can literally see the entire workflow from the anesthesiologist's eyes, you can ask questions and understand what is trying to be accomplished. Only when you understand the work can you develop solutions that leverage technology.

What do I think the ideal balance is? Generally three days remote for most staff, two days in the office.

Shawn Slack, MD. Board President of The Everett (Wash.) Clinic, part of Optum: The Everett Clinic, part of Optum, has been a leader in telehealth innovation, and we believe the COVID-19 pandemic will accelerate the long-term trend towards increased use of remote care. In February 2019 we began offering video visits to our behavioral health patients. When the pandemic began this year, we were able to leverage the resources of both Optum and The Everett Clinic to quickly ramp up the use of video visits to all of our patients. Currently, about 20 percent of our primary care patients are seen through our video platform.

Our goal is to provide a safe, seamless care delivery experience to meet the varied needs of our community. We have found that for some people the convenience of remote care is driving its adoption. For others that are unable or unwilling to come into the clinic for an in-person visit, or don't have the right devices or web-access, we have developed two options. The first is a drive-up service where patients come to one of our clinic parking lots and use a The Everett Clinic iPad to conduct their virtual visit over our guest Wi-Fi network. The other option, for our transportation disadvantaged patients, is for us to courier an iPad to and from their home so they can connect with their doctor over video.

For patients that have multiple visits with providers or the need for routine, frequent follow-ups, they are able to retain the iPad for a period of time to ensure they can get the care they need. There is also a concierge service number on the iPad for patients to call to walk them through any challenges they may have preparing for the visit. Our next move towards the telehealth future involves remote monitoring of health diagnostics and we are currently piloting that technology.

By building our remote health infrastructure, removing barriers to adoptions, and increasing our providers, teammates, and patients' comfort level with telehealth, we believe this will permanently become a significant part of our care delivery model. This will allow us to better care for more people across a broader geographic footprint. While we don’t yet know exactly what the breakdown will be for in-person versus remote care, we anticipate growth beyond the current 20 percent of our volume being video visits.

While the shift to telehealth may also increase opportunities to work from home for our providers and team members, there likely will always be the need for in-office teams caring for patients in our clinics. We believe direct human-to-human interaction is key to effective patient care. That includes building trust and having a strong sense of team among all our clinical staff. One example is our commitment to in-person clinician on-boarding. We view this as a best practice as it really helps us kick off our commitment to be a collaborative, best place to work and deliver care – whether in-person or remotely.

It also allows us to potentially recruit staff from a broader geographic area. While much of our telehealth is conducted from our clinics and offices, we have implemented ways for our providers to conduct patient visits over video and access our electronic medical records system from their homes in some circumstances.

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