How the pandemic has reshaped CIOs’ views on adaptability, agility, security and hiring


Technology leaders at U.S. health systems have learned a lot this past year-plus. They’ve gotten better with adaptability and rapid implementation of new workflows. Some have learned that 24- to 72-hour downtime processes are inadequate to prepare for a 23-day outage. And they’ve discovered that teams that don’t usually spend time together can co-create innovative fixes for urgent challenges.

Among some other lessons learned by IT execs during the past year and a half: the importance of IT teams partnering with clinical, financial and operational teams at a moment’s notice, and the difficulty of hiring key staff during a crisis that needed all hands on deck.

In this 11th installment in Healthcare IT News‘ Health IT Lessons Learned in the COVID-19 Era feature series, we speak with three health IT leaders from points across the map, including:

  • Dr. Andrew W. Burchett, chief medical information officer at Avera Health, based in Sioux Falls, South Dakota.
  • John Gaede, director of information services at Sky Lakes Medical Center in Klamath Falls, Oregon.
  • Beth Lindsay-Wood, CIO at Moffitt Cancer Center in Tampa, Florida.

(Click here to access the portal to see all the features in this series of articles.)

Working with new workflows

Burchett of Avera Health said one of the lessons he learned during the pandemic concerned the adaptability and rapid implementation of new workflows.

“Typically, we move at glacial pace as we look to begin using new technologies and solutions,” he observed. “With the pandemic, we were able to rapidly virtualize our care environments, continue to provide excellent care to our patients and keep our staff working.

“Virtual care has continued to be part of our new normal,” he continued. “We are performing about 400 virtual visits per day, where at peak last year we were seeing about 1,500 per day. Both patients and providers prefer virtual for certain types of visits. Interim follow-ups, medication management, quick visits to name a few.”

“We are performing about 400 virtual visits per day, where at peak last year we were seeing about 1,500 per day.”

Dr. Andrew W. Burchett, Avera Health

The convenience of attending these visits from home, work or even in a parking lot has been satisfying, he noted.

“In our rural environment, this also saves patients a tremendous amount of time on the road and keeps them in the workforce,” he added. “The behavioral health service line continues to utilize virtual care in high numbers. They have seen better patient engagement, lower no-show rates and higher provider and patient satisfaction.”

Hospital at home

Another lesson Burchett learned was big: Hospital-level care can indeed be provided in the home.

“We were able to serve more than 5,000 patients in our hospital-at-home service,” he reported. “Daily census was nearly 500 at peak with more than 100 of those on oxygen. We were able to use remote patient monitoring software with peripherals to care for patients in a more robust way in their homes, protecting our emergency departments, hospitals, urgent cares and clinics.

“This also helped preserve personal protective equipment and preserve precious capacity in our already full hospitals,” he continued. “For those patients who had increasing care needs, a controlled admission to the hospital was achieved through our transfer center and EMS, avoiding the emergency department visit and exposure.”

Avera Health has closed down the COVID-19 hospital-at-home program in the last month because of exceedingly low numbers in the region.

“With this experience, we can confidently transition these efforts and participate in the new CMS Acute Hospital Care at Home Program,” he said. “Another area of growth is our remote gestational diabetes management program, or e-GDM. Remote monitoring allows more continuous engagement rather than episodic care.

“With significantly improved glycemic control, these patients have better perinatal outcomes, with lower preterm birth rates, lower Cesarean section rate, lower rate of large for gestational age babies and fewer as well as shorter neonatal intensive care unit stays,” he added.

Staff members are able to centralize the care in the tertiary care center and one regional facility. As they have seen with other virtual services, these patients are saving thousands of miles in travel and hundreds of hours of time, thereby keeping them in the workforce and lowering child care costs. Ultimately, the organization has healthier moms and babies, he said.

Dealing with a ransomware attack

One health IT lesson learned at Sky Lakes Medical Center in the past year – one that surpassed the unusual setting that COVID-19 brought to the organization – was the realization at the height of the pandemic that the organization’s 24- to 72-hour downtime processes were inadequate to prepare for a 23-day outage.

“Our vice president for patient care and chief nursing officer said, ‘We have worked downtime out of our processes.’ This statement captures a stunning learning: IT is so often seen as an unrecoverable expense to the bottom line.”

John Gaede, Sky Lakes Medical Center

“In October of 2020, the Sky Lakes organization, which includes the medical center, a cancer treatment facility, and primary care and specialty clinics, experienced a tip-of-a-spear Ryuk ransomware attack that hit the healthcare industry with blunt force trauma,” said Gaede of Sky Lakes Medical Center. 

“Our vice president for patient care and chief nursing officer said, ‘We have worked downtime out of our processes.’ This statement captures a stunning learning: IT is so often seen as an unrecoverable expense to the bottom line.

“What we learned is that the investments done over time in IT do in fact yield organizationally dependent efficiencies that we quickly forget about,” he continued. “When Ryuk took all systems offline, all the many employees required to process orders and results, prescribe medications, and transport everything related to these items were ‘worked…out of our process’ and instead replaced by various technologies.”

The organization no longer had runners in the emergency department to transport specimens to lab services. It no longer had unit secretaries on the various medical, surgical and intensive care units to process orders and results. It no longer had runners in pharmacy to transport medications.

“All these employees were ‘worked … out of our processes,'” he said. “We no longer had these resources for the day-after-arduous-day of operations held hostage by a 100% paper downtime after decades of electronic medical record use. IT does make us more efficient and that is why we make these investments.”

The way the organization plans on applying this lesson today and beyond is by capturing, documenting and implementing the salient learnings from each clinical, financial and other operations workflow.

“After six months of recovery from the 23-day outage, each department solidified the deficiencies and the inadequacies of our 24- to 72-hour policies and procedures,” Gaede said. “We lacked the real-world understanding of a longtime outage of IT. When every system in your healthcare system is offline, your organization must be able to operate differently.

“We have just officially recovered from the ransomware attack and we are now meeting with each department’s leadership and frontline staff to capture, document and then categorize the information in a playbook, should something like this ever happen again,” he explained. 

“This will allow us to put into play these key learnings at the front-end of an IT downtime disaster, rather than learning about our inefficiencies and deficiencies, and building our solutions, on the fly.”

Exhilarating agility

A big lesson for Lindsay-Wood of Moffitt Cancer Center centered on agility.

“There is nothing like a good disaster to bring people together in a different way,” she said. “It was exhilarating to see teams that don’t usually spend time…



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