At NYC Health + Hospitals in New York City, which is the epicenter of the COVID-19 pandemic, leaders have optimized the system’s EHR and telehealth services to treat COVID-19 patients.
Michael Bouton, MD, chief medical information officer and emergency medicine physician, has worked to ensure clinicians have access to the appropriate COVID-19 information and tools in the EHR. Additionally, Ted Long, MD, vice president of ambulatory care, has spearheaded the use of virtual tools to treat patients.
Below, Dr. Bouton and Dr. Long describe how technology is being used to treat COVID-19 patients as well as how to keep staff motivated during the pandemic.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What virtual tools are you using to treat patients? How are patients and physicians responding?
Dr. Ted Long: Our priority is to keep our patients safe, and give them the right care in the right place at the right time. This means giving them access to care from their homes. When the COVID-19 crisis began, we stood up a clinician hotline for people with exposure to COVID or COVID symptoms. To date, we have had more than 750 clinicians take calls, and we have spoken with more than 50,000 New Yorkers with symptoms of or concerns about COVID. In addition, we have converted the majority of our scheduled revisits to televisits, and in the past week scheduled more than 29,000 televisits. Patients have responded well to these changes, appreciating the opportunity to receive clinical care while being able to stay at home. Physicians also appreciate these changes as they understand that the way to stop COVID spread is to have people stay home.
Q: How have you altered your EHR or used other technology systemwide during your COVID response?
Dr. Michael Bouton: Using our EMR we are able to coordinate action as a system and have a better view into our patients’ medical stories. We match capacity to bed demand on an enterprise, rather than hospital level. On a daily basis, we transfer patients out of our hardest hit hospitals to our other facilities without missing a step — the labs, notes, vitals are all easily accessible from the systemwide EMR. We also share lessons learned and successes across all of our sites. We implemented COVID note templates that quickly capture the necessary clinical information while reducing the burden of documentation, we standardize order sets in line with national best practices and update them at the speed necessary to match this rapidly changing crisis and as our critical care population swelled we aggressively pushed out monitors that are fully integrated into Epic so that staff are free to care for their patients and not transcribe their vital signs. Our analytics, telemedicine and numerous other teams have also leveraged our information systems to fight this virus.
Most importantly though, our EHR has improved care. Emergency physicians are used to making critical decisions based on limited information, but when these decisions are around end-of-life care the stakes are particularly high. Perhaps a patient had never been seen within NYC Health + Hospitals before, but using Care Everywhere we are able to access their records from multiple other NYC health systems, including a long list of comorbidities.
Question: How are you keeping your staff motivated during this time?
TL: In crises like COVID-19, communication is everything. We have weekly virtual town hall meetings, and we send daily updates about the changes we are making to support our staff. We transitioned scheduled revisits into televisits early on to ensure our staff would be minimally exposed to COVID-19. In addition, we have implemented a new policy to support COVID-19 testing of staff members. We understand that this is a stressful time for both patients and staff, and we want to ensure that our staff feel safe and comfortable at all times.
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