Part 2 of a Series on Lessons Learned from Covid-19
This blog was originally published as a podcast on Forbes Books
Physician leader Dr. Michael Meyer from MultiCare’s Pulse Heart Institute in Tacoma, Washington spent 20 years performing heart and lung surgery in the military, learning important leadership skills that have become invaluable during times of a pandemic. He shared lessons learned from his time in the service and applied them to today’s unique healthcare environment, in part two of our deep dive on lessons learned from COVID-19.
MultiCare had adopted the use of LeanTaas iQueue for OR about three years ago and already was a leader in the use of healthcare analytics. COVID brought the need for this strength to the forefront. Dr. Meyer added, “It’s been three years where we’ve been using the IQ product to help manage our block time in the operating room. We were early adopters in this and we’ve benefited so greatly from the LeanTaas team.”
As health systems navigate volatile market conditions such as unexpected “demand and supply shocks” from COVID-19, the need to abruptly open or close rooms and/or to change block and/or staffing needs becomes increasingly important. Building agility and resilience requires the adoption of scalable tools for flexing resources, viewing and managing backlogs, and prioritizing cases.
With MultiCare’s forward-thinking adoption of iQueue for OR, Pulse Heart Institute was able to get at data in a way that would have been impossible just relying on an EHR.
The EHR Is Limited
One of the repeated refrains that we’ve heard from working with institutions like MultiCare and others is that COVID really highlighted the inadequacy in some ways of the tools and techniques that exist within most health systems. An oft-heard lament was the inability to identify and measure the elective surgery backlog.
One of the major impacts to healthcare systems during COVID was the loss of elective surgeries. So getting that backlog back on the schedule was critical. While EHRs might have patient lists, there was no way to quantify it in an actionable manner.
Dr. Meyer described a process to extract information from their EHR, EPIC. “We did have some access into EPIC, but it’s not very robust. So we didn’t get a ton of information, but what we did have were lists from different clinics, and how many patients we expected would need things done. I had an EPIC patient list, but really it was just a recapitulation of patients who needed lung cancer surgery that I couldn’t get on the schedule. And these are the patients that have needed elective heart surgery, couldn’t get on the schedule, or didn’t want to come in. We took that information from as many sources as we could to try to build up what we thought we needed. What we wished we had was a way to look at our trending data.”
The inability to make a system decision based on backlog really hurt MultiCare because they couldn’t plan properly for their time. They couldn’t give financial predictions. They couldn’t calculate how long it would take to catch up. Using LeanTaas iQueue for OR was extremely helpful, but it wasn’t a tool in use for the entire MultiCare system.
There is a large investment that goes into existing toolsets like the EHR and all the individual dashboards that hospitals have invested in. The electronic medical record is important as the source of truth of a patient encounter and for capturing how a patient moves through the system. But in many ways, healthcare is the way technology was when IBM and Microsoft were the only two companies offering anything in technology. And a lot of the innovation hasn’t happened around those tools. When you think about the medical record as being central to the technology infrastructure, why is it that, especially in the time of COVID, the EHR serves a very important purpose but leaves much to be desired around optimization?
Dr. Meyer described the EHR as something that imperfectly tracks the patient journey: “It doesn’t really describe adequately what a patient goes through. The reason why we can’t get to the place where the EHR serves the purpose that you’re implying is because we use it more like a cash register. And we don’t get the opportunity in an easy way to analyze our data.”
Appreciating the importance of understanding the EHR and the data, Dr. Meyer joined MultiCare’s medical informatics committee soon after leaving the military and joining the system. His experience in the military gave him insights into logistics and operational considerations not typical of physician leaders. “It was the first committee I joined by my own request. Physicians have the power of the pen. In other words, the cost for a particular encounter, whether it be surgery, a hospital admission, or a clinic visit, is really based on what I ordered.”
“I joined medical informatics to learn more about this. I went to EPIC Headquarters to do what’s called the physician builder course. EPIC works very much like an analyst where you will look at order sets and try to figure out the best way to manage sepsis based on what we order and how to build a report out so that I understand what the ramifications of lab tests are, and other things on this patient’s journey. The building is extremely difficult and extremely complex for technical reasons. And the fact that it’s not straightforward, that you actually have to go to a course to understand the impact of the EHR, to how you provide care in and of itself, tells you what the problem is.”
“I think that they try really hard to satisfy the needs that we have as physicians and as systems that they serve, but they are not user-friendly. So you take a product like IQueue for OR, and suddenly we’ve taken this incredibly complex block time thing that isn’t an EHR, and now we’ve made it so that a physician who is scared of technology can get into it and understand their utilization and how to book a case.”
Dr. Meyer strongly believes in using data and medical informatics for planning now and into the future.
“Our medical informatics guys are incredible data geeks. They love data. Every day we’ll take what’s been happening in our region by county. They will take it by the hospital and they’ll compare it to national data to see exactly what our census is today. What will our admissions be in the next 14 days? What will our census be in the next 14 days? And they were doing this all through COVID. Actually, they were building on some models that already existed, but then they refined them and changed them a little bit to reflect the local data. And that’s been a big part of our planning. Everyone’s familiar with what Johns Hopkins had put out and the website to track the cases, but with a high level of specificity where you can drill down into a particular MultiCare hospital. Watching those trends has been really critical and then adjusting our hospital configurations based on that. It’s been a huge part of our planning.”
Dr. Meyer sees that in the future, many of the changes they’ve implemented for COVID will outlast the pandemic: the adoption of more negative pressure rooms, reconfigurations of wards, upgrades to systems and more robust and resilient ORs, and the use of data and predictive analytics.
Read Part 1 Lessons Learned from COVID-19