Recapping the CHIME Digital Recharge Conference

By Shana Tachikawa

Highlighting Three Standout Sessions for COVID-19 Era Digital Transformation

This year, the CHIME Fall Forum transitioned into CHIME Digital Recharge in a virtual conference format to accommodate COVID-19 restrictions and concerns. Considering the many current competing pandemic priorities and projects vying for health IT leadership's attention, we are recapping three standout sessions for those who could not join, starting with advancing technology adoption.

1. Advancing alternative patient care technology
   Within Robin Farmanfarmaian's keynote and follow-up Q&A session, she shared her personal health journey as a chronically-ill patient and how that led to her distinct focus on advancing technology options, patient empowerment, and the future of healthcare delivery. She discussed consumer-driven patient care and engagement advancements seen in the marketplace, like the more visible drive-thru COVID-19 testing, but also direct-to-consumer blood lab services with mail-in results, as well as phone applications that allow on-demand flu shot orders where a physician is then sent to a patient's home for vaccination delivery. For chronic care patients, leading technology advancements have centered on making the home a true alterative care delivery site. Farmanfarmaian discussed advancements including fully self-contained portable dialysis units for at-home dialysis treatment, as well as alternative site infusions for at-home care, like direct-to-consumer IV hydration. Biometric technology has gone mainstream to aid with remote patient monitoring, as demand continues to surge during COVID-19's strain on care delivery. Patient inhalers now have sensor technology to track time, location/atmosphere, and frequency of medication utilization, so patients can better understand their triggers and log and share their data with care providers. Even for diabetic patients, sensor technology transitions to at-home clinical care via sock sensor subscriptions, which track foot temperature, inflammation, and potential injury real time to send information to care providers. We're also now seeing skin-friendly wearable epidermal electronics worn by patients at home after hospital care visits to help monitor and predict the need for readmission.
   
   One major takeaway from Farmanfarmaian's keynote was the ongoing fear from chronic pain or end-stage disease patients that if they go the hospital ED, they will not be believed or will face incorrect assumptions. She challenged healthcare leaders to create a patient-care version of the TSA pre check for chronic care patients that would provide quick access and validation to their medications, diagnosis, and pertinent information, so they can be believed and approved for treatment in the ED, if needed. She said that while the EHR has come a long way, it's still not the solve-all solution here.
   
   
2. Telehealth expansion
   During the CHIME Digital Recharge day-two telehealth roundtable, participants first discussed the evolution of how to define telehealth and telemedicine. Previously, telemedicine was more transactional as direct virtual care interactions, especially useful in remote or rural areas. Now, there has been a fast telehealth evolution through digital transformation beyond individualized care transactions for holistic patient care virtually. It's not just episodic interactions. COVID-19 has been a catalyst for much of this drastic change, especially for propelling reimbursement. There is significant need for patient portal support alignment with telehealth's push, coordinating portal access and patient navigation education, patient-generated data for clinical notes, and use for clinical colleague interactions, like bringing an infectious disease specialist into the care picture. Additionally, as health systems look at the internet of things (IoT) and connected devices, IT leaders need to sort through that flood of data to make meaning, so it's not just a million more data points to swim through. How do you organize that data so it's easy to manage the patient's care for the provider, patient, and family in a meaningful way to review data in a timely fashion? As another layer, the industry is seeing heavy use of telehealth support for hospital care at home to manage acutely ill patients remotely. This helps to get patients out of the hospital sooner through processes like gathering remotely monitored patient data to send to a nursing hub for assessment and triage. The session closed by stating that virtual care is here to stay even beyond the pandemic and that telehealth provides a new sense and literal view into a patient's life to better understand and appreciate what their challenges are at home.
   
   
3. COVID-19 response tactics
   Finally, a helpful session on real-time deployment of COVID-19 IT response was BayCare Health's track session. For the pre-visit phase of COVID-19 care, the health system hosts a self-triage tool on its website with chatbot functionality, as well as a nurse triage call line to help answer patients' questions. There have been significant EHR workflow and infrastructure changes. EHR order sets have evolved with the changing evidence-based care protocol. In a major push, the health system has transitioned and trained its ambulatory providers to conduct telehealth care. The workforce has realigned, adjusting ambulatory facilities from their regular office hours to operating one week in person and then two weeks remotely via telemedicine to drive down COVID-19 virus spread rates. For COVID-19 positive patients who do not require hospitalization or are released, the health system uses a remote patient monitoring process to see any health deterioration. The health system's COVID-19 system tracker tool also aids post-visit care, enabling patients to enter and score their symptoms into the chatbot to see if their health is getting worse. BayCare also created a long-term COVID-19 positive patient clinic for focused, more chronic care.
   
   In closing, the pandemic has taught health IT leaders these four realities:
   
   • The shift to work from home is likely permanent for many health system workforces, requiring reliable IT infrastructure for telehealth support, but also remote access for operational continuity.
     • In the remote work shift, many organizations may struggle with maintaining a sense of connection and cohesive work culture. Techniques like daily morning team briefings requiring everyone to be on camera for at least 15 minutes can help.
     • True telehealth support has moved beyond individual virtual care appointments to the cohesive care journey virtually, including the need for patient portal support.
   • COVID-19 has shed light on most health systems’ revenue insecurity — that revenue is extremely dependent on elective surgeries and procedures.
   • Population health initiatives have been highly focused on chronic disease and long-term care. There needs to be a pivot to better strategize and handle acute care emergencies.
   • Data analytics programs have shifted overnight in many organizations from initial implementation and tiptoeing around data insights to pandemic-era demand for analytics to understand risk for exposure, capacity management, cost reduction, and revenue recovery trends.
   
   

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