Lynn Gibson, Chief Technology Officer & VP, CHRISTUS Health
There will no doubt be a tremendous number of articles regarding the impact of COVD-19 on our world, our country, our community, on our technology. Those of us in the healthcare world can certainly attest to a whole new series of demands that have suddenly been placed on our infrastructure and new types of demands to provide access and services to personal health information so providers in remote or isolated situations can access their application sets.While the demands for greater access and more options for access grows, so has the external threats. Some organizations were prepared better than others to meet this challenge. When the dust settles, what should we expect will be in the future of healthcare and, more so, healthcare information technology?
The discussion for the past several years was getting more mobile-oriented, but the focus was more on delivering results and services to a consumer model. Although many organizations did a tremendous job of creating a consumer Telehealth model, the reality of providing services normally inside the hospital setting in remote conditions has fallen behind. With what is known now, the challenges can be in three broad areas:
At-home Services, Access, and Security. At-home services have multiple variables. The concept of work from home has new challenges for healthcare workers. Simple access to email and some files, now brings requests for video conference, virtual patient monitoring from remote locations, and clinical quality imaging delivery to the clinician in a remote setting. Basic things must be in place to provide such services such as virtual desktops designed to provide the services, the security behind its operation which will be discussed later, and most importantly, the endpoint equipment as this will create the most stress on the end-users to obtain and the organization to deliver. Carts, cameras, open conference sessions in the patient’s room with peripherals to monitor the heart, blood pressure, and check the throat, eyes, and ears, so the clinician does not have to be in the room to see the live results is all part of the Tele-health remote monitoring package. This would need to be situated in the patient room and on a device that could be remotely activated, which now generally means a laptop versus a tablet.
"As we go forward, it will be time to move away from the shiny new objects and take the time to strengthen your basic processes and ensure they will meet the next demand. Take advantage while the memory is still warm, as it won’t last long"
The available supply of equipment becomes another critical issue that is a challenge when a disastrous situation starts. What devices will support the work functions? Who can deliver if you don’t have a supply on hand? A plan for prioritizing the distribution as a balance between functions will need to be established.The employee working from home must have a strong enough internet provider to have adequate bandwidth that they will be competing to utilize. In this day and age, a number of employees may not have internet services at home. Will your company pay, do you have special relationships setup to provide discounts, will you reduce expected workflows and deal with wait times or delays in transfer times processing? Many healthcare applications have a latency demand that cannot be supported by cellular speeds that are currently available. Of course, then they need a dedicated location to work so they can access whenever they need. They also need to be savvy on how to connect all of this equipment at home. Will a clinical or employee portal be enough, or will it be necessary to have a virtual desktop? A virtual private network may be the last option, but will the overhead it brings impact the overall performance? Setting expectations to match the need will become an information tech new expected skill.
Access is more than just granting a person the use of an application. Multiple processes may come to play, and it could require your vendors to have agile processes as well. In a rapidly changing environment, granting access to areas of the organization will be expected to be handled quickly. The normal request process will go out the door, and the demand for infrastructure will suddenly grow geometrically. In an agile organization, you would expect the answer to be not an issue. However, if you are reliant on a vendor whose processes are bound by an automated system that may take up to 48 hours to provide new licenses, certificates, or access, you could quickly find yourself at the unfortunate position of being the corporate roadblock. What if your organization suddenly decides to focus on its key processes on an infrastructure that is already at 70-75% capacity? Can you build an alternative and position it to grant access in 24-48 hours? Again, another ugly moment in being sure granting access does not bring the whole organization to a grinding halt.
In challenging times, people will start demanding quick, simple, and broad access. Just what the bad actors in the dark world love to have made available to them. It took about 12 hours for the scams to start when news broke about the COVID-19 virus. The ugly activities went way beyond the hoarding. It was the phishing attacks hoping to place ransomware. It was attempted to shift payments to dummy organizations as a “quicker” method to get deliveries. The stress on the organization is to drop security, stop patching, support quick and ever-changing needs. Yet, this the time that exploitation of the system weakness will be a constant target. It is truly the time to ensure you have higher security protocols in place to protect your patient’s information and your organization’s business performance.
In trying times, it could be a time to stop and observe those around you. The types who are frozen in making decisions, those who are making decisions without facts but want to look in charge, and those who are quietly working behind the scenes to keep a level head and direction for the team for the benefit of the organization. As we go forward, it will be a time to take a lesson learned and realize that no facility is immune, every infrastructure will be pushed, and every individual will be stressed. It will be time to move away from the shiny new objects and take the time to strengthen your basic processes and ensure they will meet the next demand. Take advantage while the memory is still warm, as it won’t last long.