"We’ve seen a 500% increase in telehealth visits"

John M. Kravitz, Chief Information Officer of Geisinger Health Systemin conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “We’ve seen a 500% increase in telehealth visits”

PP: We are starting a new series – coronavirus conversations – where we will feature healthcare leaders, especially those who are leading IT in large health systems and healthcare organizations on how they’re responding to the crisis. Today is March 20th and it’s my honor and privilege to introduce my first guest for these series, John Kravitz, CIO of Geisinger Health Plan and Health System. 

John can you tell us what is the situation at Geisinger? How many Covid-19 cases have come in and how are they being screened and tested? 

JK: At Geisinger Health System the number keeps changing by the hour. We’ve had several Covid-19 confirmed cases, some have come into our acute care system and others are being treated in ambulatory settings. The numbers have continued to increase in the state of Pennsylvania. My last count was 158 patients had tested positive for Covid-19. Most are in ambulatory, some very sick are in the acute setting, and some have expired. Unfortunately, happening all over the country. We, like others, have set up screening tents and treatment tents. Trying to keep those patients outside of our ED settings to avoid infection to other people. We’ve used a lot of technologies to support that, like iPads or FaceTime so that people can do work at their existing workstations. For example, registration people can get into communication with patients. Not everybody has to be in the tent and exposed to things. This minimizes for us the PPE because they are becoming in short supply, especially masks, even level 1 and level 3 masks, not include in the N-95 masks. We have 11 campuses and 13 hospitals in our system. We’ve set up these screening and treatment tents in every one of them with all the technology. They have got workstations on wheels, printers for lab labels, patient wristbands, everything you can imagine. It’s like a MASH unit and is well established. 

PP: Do you develop your own test too?

JK: Yes, we were one of the two in the state of Pennsylvania to do our own testing. We got validation from the state and were cleared to begin our testing process. The challenge is the test kits. There aren’t enough test kits for all the requests coming through. We’ve been using a triage process. We use a bot that helps us considerably on our website and direct patients to that. Communication goes out through our patient portal as well to let people know what the process is. They can access that bot there. But it goes to a nurse triage hotline where they go through several questions with the patients and then set up appointments to be screened. 

PP: ChatBots have been introduced to respond to the crisis. Anything else for launching a new tool or reconfiguring any existing tool or technology in order to respond to the crisis? 

JK: We have a particular tool at the bot that is called Syllable. We have some in concept testing but haven’t had more fully deployed yet. Our main concern in responding to this crisis is getting people to have access to work from home so that we can do social distancing, so the disease doesn’t spread across our employee platform. Anyone who is a non-clinician can work from home in our environment. Clinicians can as well, when they don’t have to have direct patient care. Part of our process has been establishing remote connectivity for home workers. We use VMware’s VDI when people are in contact centers and need to make phone calls. We provide the Meraki type device; it’s an IP address mobile device that allows them to work at home effectively. We do not allow printers at home because of PHI or credit card processing machines at home because of PCI. But we take measures and provide access so that our employees can be separated. For example, in a contact center or a call center where we make appointment calls for our patients, if we have 300 people in a contact center we will move 100 those people to the home setting provided they have proper internet connectivity and speed and everything else to support that. We’ve created our own speed test and can run that for any of our potential people moving at home which has worked effectively. This allows us to spread people out more than 6-foot distance easily between contact center agents because we’ve taken people out of that mix. So those are some of the things that we’ve done. At this point time, we have 13000 remote workers at home on our systems and working well.  

PP: So, when your work is going from a campus-based workforce to a remote workforce, what have been some of the challenges you faced both from clinician standpoint as well as from a technology standpoint? 

JK: We have a lot of radiologists that do work from home with high-speed connectivity at their homes with high-resolution monitors. We call them broadband monitors,standard in the industry. We have a number of those people and we are doubling the size of the folks working from home. This adds new challenges to make sure they have adequate bandwidth, adequate facilities, and proper security at the devices at home. With our employees working from home, we still are cautious of PHI and making sure that the data is protected. And folks using Zen desktop or VDI, the work goes on back in your data center or in the cloud, where you’re connecting to, adding a layer of protection. That information isn’t sitting on someone’s home equipment. It’s easy to install that connectivity and in most cases, in a matter of minutes, people are functioning as long as they have adequate bandwidth. 

PP: Are you seeing any increased threats from cyber-attacks in this current situation and are you being extra vigilant about any of that? 

JK: We do have surveillance systems that are in place. I have not received any through our Chief Information Security Officer about any new attack vectors that I’m aware of.Although I’ve been reading that there are increased attacks that are occurring. When there is a potential for vulnerability, the bad guys always want to look at new ways to attack and leverage their cause, unfortunately.We have not seen an uptick on that. We do have endpoint security, which is very strong to minimize or mitigate the spread of malware. I think it is the network surveillance that goes on all the time through MSSP. That’s a cloud-basedsolution and it’s worked well for us. Fortunately, we have not seen those increased attacksor are just not allowed to occur. So thankfully, that is the case for us so far. 

PP: Switching to the front–end technologies, the ones that you use for engaging with your patients. Telehealth is now front and center as you want to try and avoid in-person contact in the current situation unless it’s absolutely necessary. Have you seen an uptick in telehealth visits and how your platforms coping with that? 

JK: We’ve seen a tremendous increase, probably a 500% increase in telehealth visits. And our platforms and our physicians are all being trained as we speak now. It’s been happening all week, but they’ve been trained in proper technique. We have a thousand new providers that are going to be doing telehealth visits. Whether in the office or in their home settings, they will be able to do telehealth consultation visits. We pulled roughly a thousand iPads which can be used to do the telehealth visits. This is a crisis situation where good opportunities will come. I am hopeful of the relaxation of payments by commercial insurance as Medicare, Medicaid. In our state, Medicaid has paid for telehealth visits for a number of years in Pennsylvania as an in-person visit. But I would hope that the changing tipping pointfor people to really utilize telemedicineis seen in crisis, how it works. We can see it works effectively in day–to–day settings. It’s a new opportunity. Out of every crisis, a new opportunity arises. I believe telemedicine is a new opportunity for us and I am excited about it. We have patients in our ICU that may be nearing end of life because of this disease, we will utilize telemedicine. We will utilize links into our eICU so that they can talk to their loved ones. I hope there will not be any end of life and people do recover from this. 

PP: How is the technology itself holding up against this surge in usage? 

JK: Actually, very well, we’re using VDI in our cases where people may be using Zen desktop. It is really sending a minimal amount of data back and forth. When I looked at our internet pipes just yesterday to see the trends, we have not spiked up. We do have three major internet providers coming into our organization and we have the ability to burst and grow considerably higher if necessary. But honestly, I am surprised with 13,000 people at home, radiologists moving at home, and contact center agents, we have not spiked considerably. We may have gone up about 25 percent on our usage, but we still have a lot of capability. I expected more to be honest with you but seeing very pleasant results here and our systems have been doing very well.

PP:What about the IT organization itself John? These are new times, has there been any impact to your day–to–day operations in the data center? What kind of adjustments you had to maketo respond to the crisis and to support that with your capability? 

JK: As every other health system, we have tried to minimize disruption in operations. Our service deskbeen doing very well. When we have information, we can communicate. Communication is the key for us and getting proper communication out to people. For example, when we started this telemedicine expansion, we’ve set up on our ACD, our automated call distribution. We have a menu item that says if you are calling about telehealth problem there is a special small group of technology people supportthat will address those calls. Our data center has been working very smooth. I think part of the challenge is because we’re looking at new and creative ways to tackle this problem. We have six enterprise implementation systems going simultaneously, including CRM and billing systems and everything else. We’ve not really stopped them, but we have reprioritized our work for this period and we’re going on two weeks now and I don’t see it stopping anytime soon. We have people working, unfortunately, in some cases 16–17 hours nowadays. And we are not the only ones. At some point we’ve got to give our staff rest time and we want to do that. Butthe patient and our providers are top of mind for us. I am the CIO for the health plan and the health system and have been pulling resources from my health plan in augmenting for our health system, which is beneficial. 

PP: How do you think healthcare is going to get reshaped as a consequence of this crisis? Do you think that telehealth is going to become more and more mainstream?

JK: We’re all looking in digital. How do we do digital technology? How do we provide the best service for our customers? I think this is the opportunity and telehealth is one area. But, reach outs, capabilities make the process smoother to enable and get good care, whether it’s in the setting or in an ambulatory setting or an acute setting. Using technology to leverage that is going to be important. Leaders from all over our organizations are blown away by the level of support they’ve received from information technology and information services throughout this entire process. They never expect that we could respond like this and they are so thankful. I am sure every organization is hearing the same thing because we’re all hardworking, good people. As Winston Churchill said – never miss the opportunity.’Do not miss the opportunity for innovation. That’s what we’re doing now, and I think it’s going to only continue. It’s an upward trajectory for us. Unfortunately, lives are at stake, but we’re doing what they can with technology to support that. 

PP: John, I really appreciate you taking the time and I want to extend my deepest gratitude to healthcare workers all across the country for all that they’re doing in responding to this crisis. I think we’re going to be forever indebted to all of them. 

JK: Paddy, if I could put in one plug for my fellow CIOs. I happen to be the chairman of CHIME. And I know there is a lot of work going on behind the scenes for policy and in communication to CHIME members. I think that the team works extremely hard to support our CHIME members. A lot of these initiatives, telehealth, national patient identifier, things that we’re going to need for the future. CHIME is really working hard to help support us to push that forward. I just wanted to give acknowledgment to them because the team, while it’s very small, is very agile and they’ve done fantastic work. I’m really honored to be the chairman of the board for that group. And I think this will help us as well for my fellow colleagues and members of IT. 

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.