By Fred Lizza
COVID-19 has disrupted normal life in America, hobbled the economy and strained the nation’s healthcare system in multiple ways.
For provider organizations, the extreme preparations made to accommodate the influx of a very large number of coronavirus patients have hamstrung normal operations and strained the exchange of patient data, exacerbating challenges to communications that are difficult to maintain even during normal times.
As census levels rose in recent months at organizations treating severely ill patients, hospitals scrambled to treat patients, forcing them to manage multiple disruptions to standard workflows and long-ingrained workflows.
While the COVID-19 crisis represents an extreme example of communications disruption, any provider organization facing a stressful disaster scenario can face unanticipated information exchange challenges that are difficult to anticipate.
Many problems arose in New York City as provider organizations faced persistent high censuses of coronavirus patients. Facilities had to revamp normal operations quickly to manage high patient loads. Many cancelled elective procedures to free up capacity for COVID-19 patients.
As patient caseloads shifted, hospital systems reallocated clinician assignments. For example, Northwell Health reassigned clinicians to areas of need in April, according to an article in the New York Times. Other hospital systems in the metropolitan area followed the same playbook, desperate to manage shifting caseloads.
As a result, a wide range of clinicians – including neurosurgeons, cardiologists and other specialties – were pulled into emergency departments and intensive care units to care for patients. The Times article notes that work role disruptions were necessary in order to treat patients. In addition, the article notes that COVID-19 cases also led to conversions of conference rooms, lobbies and some cafeteria spaces to ICUs.
The reassignment of personnel is a logistical challenge, according to Robert Foronjy, MD, chief of pulmonology and critical care medicine at University Hospital Brooklyn. “Logistically, to keep this going is such a challenge,” he was quoted in an article published in mid-April.
Normal patient flow also was disrupted in New York. For example, Samaritan’s Purse deployed an emergency field hospital to Central Park in New York for five weeks in partnership with the Mount Sinai Health System, treating more than 300 coronavirus patients. More than 240 relief specialists served at various times on the disaster assistance response team there, the organization reported.
The fluidity of the situation also posed problems for clinicians who experienced high-volume needs for patient information, particularly as intake grew exponentially and patients had to be treated in isolation, without family members to advocate for them or even to provide critical patient history or demographic information.
The nature of handling information capacity while treating COVID 19 patients reveals weaknesses in patient identification and matching them consistently to their records, notes Dan Cidon, chief technology officer of NextGate, in an opinion piece published in the Journal of the American Health Information Management Association. Gaps in data generation and health information exchange can also affect treatment plans for vulnerable individuals – access to a patient’s medical history can make a huge difference in care given to a COVID-19 patient with pre-existing conditions.
Prior to the COVID-19 pandemic, hospital communications systems were already highly fragmented and inefficient. Caregivers are forced to constantly toggle between different systems and means of communication, creating inefficiency and multiplying the chances for errors by stressed clinicians working long shifts.
The current COVID-19 crisis highlights the fact that healthcare organizations urgently need to improve core communication and patient data workflows during chaotic disaster scenarios, whether they occur within a single day or over extended periods of time. Care team coordination is challenging even under normal operations, but care delivery can become disjointed when stress is added to the system.
Organizations need to stress-test systems to ensure that they can handle the load. Procurement decisions also should look at the ability to manage communications across a wide variety of settings, when clinicians are within the walls of an organization, offsite or at home.
Also, more attention needs to be paid to how patients’ medical records are distributed, how they are associated with patients and ensuring accuracy in patient matching during high-volume crises. Care coordination is even more challenging when communications and EHR “channels” are kept in siloes and not coordinated or harmonized.
It’s clear that ongoing COVID census loads (and overloads) are opportunities to refine current workflows and fix issues that stand in the way of care coordination and staff efficiency. This review should incorporate review of new technological tools that hold the promise of improving communication and patient record availability – once past the current crisis, these capabilities can offer dividends to improve efficiency in delivering care in the post-COVID era.
About the Author
Fred Lizza is CEO of Statum Systems (https://www.statumsystems.com/), a startup developer of advanced mobile collaboration platforms geared to caregivers. He was previously CEO of StrategicClaim, an insurance claims platform, and Freestyle Solutions, an e-commerce leader. Fred earned his MBA from Harvard University. Contact him at [email protected].