Deborah Heart and Lung Center

Rich Temple

The current COVID-19 public health emergency is impactinghospitals in unimaginable ways. One big lesson we have learned so far from this adversity is that if there can be anything positive that comes out of such a dreadful pandemicthat even hospitals whichhistorically struggled to react to and respond to rapid changes,found the capability to pull it together and change on a dime when a global health emergency necessitated it.

One cannot underestimate the strain that hospitals have been under during the pandemic. Hospitals have had to take care of potentially super-contagious patients and surges of gravely ill patients. They have also had to ensure their frontline healthcare workers have access to all the personal protective equipment (PPE) that they need to protect themselves and the patients they are caring for. Hospitals have also had to quickly deploy an extraordinary number of critical care beds and alter nursing units’layout to accommodate the surge of very sick COVID patients. This involves many things, not the least of which is altering the airflow in hospital rooms, enhancing patient monitoring tools, and also involves a lot of restructuring of electronic health record systems, revenue cycle systems, and many other computer systems within the hospital.

Those are some of the major changes impacting the “frontlines” at hospitals. Behind the scenes, a whole new world sprung up almost overnight. A “virtual world”. Hospitals thatnever really had large-scale “work from home” (WFH) programs had to implement them in very short order, since regulatory agencies were strongly recommending to allow employees to work from home to the extent possible to minimize social contact and the possible spread of the COVID virus. While most hospitals have had “remote access” capabilities, those capabilities often were not meant to fully replace the “office desktop” experience. Additionally, hospitals may not have had the level of system capacity needed to support so many remote users simultaneously. Hospitals have had to scale up their remote-user offerings almost instantly, with an eye on a whole new set of cybersecurity risks inherent with remote access from personal computers over external connections. This was a major undertaking that many hospitals (ours included) did an amazingly good job. Workflows for remote employees had to change to ensure compliance with all aspects of HIPAA, going well beyond cybersecurity. Picture an employee office or a cubicle. There will be a computer and – no doubt – different piles of paper and filing cabinets. That may be fine from a patient confidentiality standpoint, as offices are likely to secure areas. Many cubicles are in areas where the potential to see confidential information on paper documents can be easily controlled. Alas, not so much in home office environments. Extra care must be taken to keep paper out of the home office environment, so family members or other unauthorized eyes do not inadvertently see protected health information. Policies about printing have to be re-examined. So it is a huge deal and one that hospitals have had foisted upon them rather abruptly earlier this year.

“Workflows for remote employees had to change to ensure compliance with all aspects of HIPAA, going well beyond cybersecurity”

Another thing that changed almost overnight was having physicians embrace telehealthvirtual visits through smartphones, tablets or computers. Since patients were very reluctant to come to hospitals for care in many cases, CMS relaxed many of the limitations previously in place for reimbursement for telehealth visits, which catalyzed virtual visits almost immediately. From an IT perspective, the right telehealth vendor had to be selected, configured, and workflows had to be established to allow providers and patients to get the most out of the virtual face time by making sure the connectivity worked by setting up reminders of the upcoming visit for the patient, and other things. The advent of telehealth also meant having to purchase webcams for computers that previously lacked them. We have said in jest that webcams were the “toilet paper” of the early stages of the pandemic— flying off distributors’ shelves and thus IT departments had to be creative about how they procured these badly-needed webcams.

Along with the surge in COVID patients came requirements for reporting to different governmental agencies, each of whom had their own methodology for reporting that had to be adhered to precisely. Those requirements also changed with some regularity, further exacerbating the pressure being borne by already stressed-out caregivers.There were mandates from different sources to report on a number of tests, number of positive patients in-house, in the ICU, on ventilators, and also to report on inventories of PPE on-hand. There were separate mandates to complete applications for different Federal funding programs (and, yes, we are all grateful for having access to those programs during these extremely difficult times!). And that only spoke to the external reporting requirements. Internally, hospitals had to have easy-to-digest dashboards to help drive their ongoing care processes in near-real-time and the wherewithal to communicate and act upon any situations shown in those dashboards that would merit attention.

Possibly the biggest COVID-related challenge with the potential for the most long-term adverse consequences is the immense financial impact felt by hospitals. It was because of the mandates to suspend elective surgeries to allow for medical resources to be optimally deployed to the wave of COVID patients arriving at hospitals. Elective surgeries are the “bread and butter” to most hospitals’ bottom lines, and having those cease or be sharply curtailed meant, in essence, pulling the financial rug out from under hospitals just as they are being hit with overwhelming overhead in taking care of patients in a pandemic. While hospitals did get assistance from some of the COVID-related Federal programs, for most, it did not come close to covering the out-of-pocket hit hospitals took and many hospitals, especially rural hospitals in underserved areas, are in tough situations as far as continuing to be able to take care of patients as they historically had.

We are not out of the woods yet as far as this pandemic goes, and many of us are still right in the peak of things. We learn more every day about the damage the COVID virus does across so many different dimensions, and we are hopefully learning to react and respond in ever-improving ways to continue to serve our communities during these challenging times.