5 ways COVID-19 has changed healthcare IT

Two years of COVID-19 has changed how many organizations and their IT departments function. The shift in priorities, particularly when it comes to issues like supporting remote and hybrid work models, has cut across industries. But one sector — healthcare — has had a much different experience and different needs.

As someone who used to manage IT for a healthcare provider and has worked on a number of healthcare IT projects since then, I was curious to see what changes IT departments for hospitals and other medical facilities have had to invest in, and whether these changes will persist in a post-pandemic world.

All in this together

The biggest change I heard from both hospital IT staff and the doctors, nurses, and administrators they support is that the two groups are collaborating more than before COVID. This wasn’t something I expected at all. While many IT departments have bumpy relationships with their end users, the strain on the relationship in healthcare organizations is particularly acute and volatile.

A big factor in that relationship comes down to the rollout of electronic health record systems (EHRs). Most healthcare organizations were spurred to adopt EHRs in the late 2000s and early 2010s as the federal government began urging their use through the HITECH Act of 2009 and as provisions of the Affordable Care Act in 2010. Most clinical staff initially saw EHRs as problematic because using the systems inserted extra work into their daily routines and required adjusting their workflows.

And because the federal government tied hospital funding to mandates to implement EHRs, it also required healthcare organizations to demonstrate (or attest) that the systems were being used in a meaningful way. On top of delivering the product, IT had to ensure that it was being used in specific ways. That led to even more frustration, because not only did IT deliver something most doctors and nurses didn’t really want, IT staff then had to hang around to make sure that it was being used as intended.

The pandemic — and burned-out healthcare staff — gave many IT departments an opportunity to show that they could help. As one hospital IT director in Florida (who asked that his name and hospital not be mentioned here for confidentiality reasons) told me, “For the first time, we really had the ability to go, ‘What can we do to help?’ It gave us the chance to do something that we don’t usually get to do. It allowed us to interact without government requirements behind it. The docs and nurses loved that we were able and willing to pitch in at every point we could.”

Here are five trends in healthcare IT that have blossomed during the COVID era.

1. Digital command centers

One of the most common tools that IT departments have been able to deliver for hospitals and hospital groups during the pandemic is a real-time interactive dashboard so that staff knew which departments could take which patients. One hospital group created a complete digital command center that allowed all hospitals within the system to share information about capacity and needs across an entire region, rather than each hospital being an information silo.

These tools didn’t stem the tide of patients, but they did make it much more manageable. And the dashboards weren’t particularly difficult to create, despite having a significant impact.

2. Patient data exchanges

One frustration about EHR systems is that they have traditionally not been good at exchanging records among multiple hospitals, clinics, or providers. In fact, healthcare providers often still rely on fax machines to shuttle patient data back and forth. Aside from being frustrating, this lack of interactivity can delay diagnoses and treatment. It also detracts from the biggest benefit of EHRs — the ability for a physician or provider to see a patient’s entire record at a glance.

There has, however, been a shift by state and regional actors to create systems that are capable of doing this. New York state’s exchange, dubbed Hixny, has become a staple part of patient visits to a new provider or hospital. In addition to providing their health history, patients are asked to opt in to the system.

In his book Care After Covid: What the Pandemic Revealed Is Broken in Healthcare and How to Reinvent It, Dr. Shantanu Nundy relates how useful the regional exchange for the Baltimore/D.C. area, known as CRISP, was when he saw patients with complex medical histories. Combined with a shift to telehealth, the exchange let him “see” a patient and her history from his office without having to track down her records manually and without the patient having to come into the clinic. He was better able to reach a diagnosis and plan of treatment in a matter of a few minutes, saving time for both doctor and patient.

One problem with CRISP, though, is that many doctors in the region aren’t aware of it. A tool isn’t of use if almost no one chooses to access it — or even knows that it exists. New York’s Hixny exchange has had better uptake with healthcare providers.

3. Telehealth

The transition to telehealth visits (either via videoconferencing tools or even just phone calls) started quite a while before COVID, but COVID gave it a major push. One reason for its slow uptake has been the patchwork of medical licenses and restrictions against practicing across state borders, some of which have been rolled back a bit during the pandemic. It remains to be seen whether this more open environment will change once COVID isn’t a major factor.

Dr. Nundy also notes in his book that telehealth solutions don’t have to be particularly technical. The story above was done via simple phone call. He also shares his experience in helping to craft a diabetes clinic’s coaching system to help ensure that patients take their medications and follow healthy eating guidelines. That system relied on simple SMS texts to ensure it was accessible to anyone with a cell phone. What truly made it successful, however, was that it wasn’t just automated messages. A nurse was available to track how people were doing and to deliver coaching and conversation. Knowing there was a human being there to help them made participants more likely to successfully follow the program’s guidelines.

4. “Hospitalization at home”

One of the more intriguing trends that IT departments have taken on during the pandemic is the concept of hospital-level care delivered in a patient’s home. The practice involves having a technician or nurse deliver anything required for basic hospital treatment (hospital bed, IV poles, various medical IoT devices for monitoring); walk the patient and their family through setting everything up; and talk about the patient’s needs, conditions being treated, and warning signs. Video visits with a doctor are enabled, and in some cases, a technician or nurse is assigned to monitor the patient, either in person or remotely. Should something unexpected happen, the patient can be brought into the hospital.

The concept has some serious advantages, chief among them that the patient is not exposed to COVID (or other infection) at the hospital. It also allows the patient a more restful experience than if they were in the hospital. Perhaps most importantly, it frees up bed space in overburdened hospitals.

The heavy lifting here is with monitoring the patient. It’s up to the IT department to source appropriate monitors that can transmit data remotely and to ensure that the technology works reliably and that the patient or a caregiver understands how the devices work. In some instances, IT staff might have to support patients, not just their doctors (and possibly to go onsite if there’s a problem that can’t be solved remotely), enlarging the need for help desk staff.

5. Automated patient rooms

The use of medical IoT isn’t just finding a place in patients’ homes; it’s also gaining traction in hospital rooms. While this trend has been growing since long before COVID, it has really taken off as hospital staff — predominantly nurses — have been tasked with monitoring larger caseloads with fewer co-workers to help.

One midwestern hospitalist I spoke with noted that some units have a completely automated workflow with a dedicated monitoring workstation within the nurses’ station. The result is that each nurse can quickly check vitals and other information without visiting every patient room. She said that this setup allowed each nurse to effectively handle four additional patients per shift during the delta and omicron waves of COVID — without quality of care dropping.

As with hospitalization at home, IT staff planning for automated patient rooms in hospitals need to source reliable devices that can feed that information to the nurse’s station, and to source or build a dashboard for that data. In the case of the midwestern hospital, the IT department created a dashboard from scratch with direct input from the nurses to make it as effective and efficient as possible.

The big question

While all these initiatives point to a new future for healthcare IT, the biggest question (as in other industries) is whether they will persist in a post-pandemic world. Although trends like telehealth and regional EHR sharing across providers are likely to remain to some degree, others are less certain. Will hospital groups see continued value in multi-hospital dashboards, and will the idea of hospitalization at home persist? Those trends are much less certain in the long run. Ultimately only time will tell.

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