How COVID-19 accelerated a hospital’s telemedicine plans

Many organizations have digital transformation plans. For those that were ready, the COVID-19 crisis enabled them to accelerate those plans.

A good example is North Carolina’s WakeMed Health and Hospitals, a four-campus not-for-profit institution with over 940 beds that serves the capital Raleigh and surrounding Wake County, and its rapid uptake of telemedicine.

“Over the course of a week, we changed everything,” Peter Marks, WakeMed’s vice-president and chief information officer, said on Tuesday during a virtual roundtable session at the virtual Cisco Live event.

Peter Marks, CIO WakeMed Hospitals

“We went from no telemedicine appointments to 2,500 a week. Now we’re back to a nice mix of in-person care and telemedicine where we’re seeing on our out-patient side (combined meetings) of 12,000 a week, and our normal average is about 13,000.”

Fortunately, Marks said, WakeMed was part of the way through a digital transformation and had good relations with all of its vendors, allowing the institution to scale up its telemedicine-related needs quickly.

Marks and CTO Traci Tyndall appeared on a panel for Cisco’s two-day online press and analyst days, two days of product announcements and webinars on customers’ use of their technology.

Tyndall said the primary telemedicine tool WakeMed leveraged was the existing electronic medical records system from Epic Systems Corp., which has a health module for patient monitoring and outpatient consulting. Before the crisis about half of the patient rooms were equipped with iPads medical staff could use for wireless charts.

Traci Tyndall, CTO WakeMed Hospitals

The crisis created a shortage of personal protective equipment (PPE) such as masks and gowns. But Tyndall said WakeMed realized that it could use video meetings with patients to cut down on the need for in-room visits and the necessity for staff to regularly done PPE.

More iPads were quickly ordered and configured with Cisco’s Jabber unified communications app. “What that allowed us was have a care team sitting back at a nurse station talk to the patient through video. That helped to reduce (use of) PPE. We also had situations where the administration of blood and medication required dual signatures. So instead of two people going into a (patient) room we used Jabber to video into the room and validate that administration.”

More importantly, she added, videoconferencing allowed confined patients to communicate with an expanded circle, including family.

Jabber-equipped devices were also used by medical staff inside emergency tents put up outside WakeMed facilities.

Meanwhile, Marks said, inside the facilities, medical staff used Cisco Webex for videoconferences with colleagues and patients. In contrast, senior management used it to communicate with the 9,500 doctors, nurses, technicians and other staff.

He also admitted at times for him the atmosphere was “crazy.” From going to meetings, “all of a sudden everything became tactical. It was take off your sport coat, roll up your sleeves and pull cable. Traci and everyone else were on the front lines.” On Easter weekend, when a hurricane was about to hit some 30 IT people had to be called in to pull the technology out of the outdoor tents — and then later re-install it.

Marks acknowledged that having a robust infrastructure before the pandemic, including a strong login system, helped make the institution quickly scale what it had. It also helped, he added, that governments quickly changed regulations so they now pay hospitals for videoconferences for new and outpatient consultations.

Now, he added, WakeMed wonders how far telemedicine can go. “You can do a lot of behavioural health through technology,” although some need in-person treatment. “The good news is the box is open, and now we have to follow each path and create processes around when it is most appropriate to use. We are fully expecting we’re going to be in this (pandemic) a while, we’re fully expecting some parts of the country that may not close but will have to create guardrails. We need to be in a position where we can react again … What else can we do in terms of patients taking care of themselves at home when possible?”

“When COVID hit we shut almost everything except emergency care. We couldn’t do that again, because people still need that [in-hospital] care. What we have to do [in the future] is old-fashioned infection disease management where we keep those patients separate and use technology to care for them, but we also care for other patients at the same time.

“Not everyone has to come to the hospital, though, so the opportunity to keep present limits on what we can do remotely with our patients will pay off for us in the end. And the patients are demanding it now because had a taste” of telemedicine. “They’re asking why do I have to come in just to take a blood pressure? Those are fantastic questions.”

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Howard Solomon
Howard Solomon
Currently a freelance writer. Former editor of and Computing Canada. An IT journalist since 1997, Howard has written for several of ITWC's sister publications, including Before arriving at ITWC he served as a staff reporter at the Calgary Herald and the Brampton (Ont.) Daily Times.

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