On June 23, HC3 (Health Care Council of Chicago) hosted a virtual discussion addressing Chicago’s disaster preparedness. In this conversation our panel of experts discussed actions local health systems took to address the COVID-19 pandemic, as well how they are planning to brace for additional waves of the COVID-19 pandemic.
Paul Casey, MD, MBA, FACEP, Acting Chief Medical Officer, Associate Professor, Vice-Chairman, Operations, Department of Emergency Medicine at Rush University Medical Center
Suzet McKinney, CEO & Executive Director, Illinois Medical District
Heather Nelson, SVP & CIO, UChicago Medicine
David Smith, CEO & Founder, Third Horizon Strategies and Co-Founder, HC3
CHICAGO HEALTHCARE EXECUTIVES DISCUSS EARLY LESSONS FROM COVID-19
Health News Illinois, June 23, 2020 | Link to Article
Watch the Recap | Link to YouTube
The June 23 event marked HC3’s first virtual convening since the start of the COVID-19 pandemic. Amidst the crisis, HC3 proactively took a step back to intently listen to and support members and partners.
Throughout history, one element common to any pandemic is that it changes everything, ranging from culture to politics to the economy. The health system has adapted and filled gaps in a swift manner that was unimaginable before. And, HC3 firmly believes now more than ever, that our system is capable of changing the way we deliver care, especially as it relates to some of the data that has showcased the disproportional impact of COVID-19 on communities of color.
Prior to her current role as the CEO and Executive Director of IMD, Suzet served as the Deputy Commissioner for the Chicago Department of Public Health (CDPH) in late 2008. In 2009, she was leading the efforts to combat the H1N1 pandemic. Chicago has been taking measures to prepare for pandemics since 2006.
Suzet began the process of a comprehensive warehousing strategy to acquire and maintain important equipment and resources (including PPE) that the city could be deploy with anticipation of a potential outbreak or pandemic. The goal was to build up the supply of necessary equipment to be deployed to hospitals to assist with potential shortages until they received their own supply chains.
She began assisting the state of Illinois with its COVID-19 response in the first week of April serving as a non-clinical operations lead for the state’s alternate care facilities. The development of alternative care facilities to decompress hospital capacities included converting McCormick Place to offer treatment areas with capacity of 3,000 beds, as well as reopening four shuttered hospital facilities (including Metro South and Westlake) adding an additional 2,500 bed capacity state-wide Over the past few weeks, she has transitioned to support the state with addressing its congregate care settings - nursing homes, jails, homeless shelters.
Based on research and experience of other pandemics, Suzet stated that we should expect to see a second wave. Suzet described ways in which Chicago is prepared – including robust epidemiology and surveillance for tracking purposes, great relationship with health care providers, significant outreach efforts to reach vulnerable populations, the recently-released RFP for an entity to lead contact tracing – and noted that Chicago’s elected officials have remained adamant to using science and data to influence activities. However, she cautioned that there is still an ongoing challenge to address how to alleviate pressures and coordinating in the prison system.
Dr. Casey provided an overview of activities that Rush initiated to prepare to meet potential needs related to COVID-19. Dr. Casey noted that Rush leadership’s philosophy early on was hoping for the best while preparing for the worst met. They met in late February to start their preparations, opened their Command Center February 29, and began meeting twice daily every day in advance of the potential surge of cases. Their team studied the early hot spots on the coasts, including Seattle and New York and proactively worked with community hospitals and providers on the south and west sides to help balance resources as the area’s academic institution. Dr. Casey stated that bringing together partner institutions to coordinate and better treat members of the entire community was key.
Rush recognized the importance of PPE during the Ebola outbreak, and were fortunate that the city had already taken some measures to prepare. At times, there were some discussions about shortage of PPE, either for themselves or for other institutions, so they continued to oversee the amount of PPE available and burn rates to predict PPE needs and identified backup plan and a trigger for going into that plan for every type of equipment. Dr. Casey underscored the importance of ensuring all staff needs were met, especially with the sensationalizing of news surrounding extreme shortages. Daily communications for the entire staff included exact amount of days that they had equipment for.
Dr. Casey said that CDPH did well in coordinating communications for providers and hospitals, hosting frequent calls, and ensuring all voices were heard from the health care community. To address challenges in getting reliable data, CDPH brought together a number of institutions to work on the universal data hub that would both improve capacity for reporting, but also try to capture better lab reporting (on race, ethnicity, etc.) to look at impacts on these communities.
Dr. Casey concluded his remarks by stating that some of the long-term impact of COVID-19 has accelerated opportunities for better care through innovative solutions like drive-thru access and telehealth. He noted that there is still a great need for a better cadence around on-demand services that allow the provider to be more proficient.
Heather noted that before the pandemic, providers and hospitals were progressively slow in the adoption of virtual care models and telemedicine solutions. While UChicago Medicine had already been exploring working on digital health strategy for some time and had all of the technology, the pandemic truly accelerated their digital health roadmap as the technology became a necessity.
Heather said that UChicago’s IT team had to be responsive and nimble during this critical time in order to respond to clinical needs and also coordinate their work force. Some examples of specific situations included providing proper resources and equipment for people to work from home; developing creative solutions for patient needs by transitioning rooms and beds from surgery to the ICU; ensuring monitors, ventilators and so on were working as they should; switching beds back to make room for non-COVID patients; and, offering innovative care delivery options like drive-up lab work. “There will not be as much capital to do certain things,” Heather said. “However, there is no putting the genie back in the bottle.”
Heather described two key next steps in moving forward. First, optimization of what has been implemented – especially because of speed of implementation and lack of capital due to COVID-19 – and the resources they have via measuring utilization and getting staff more comfortable with the new technology. Second, establishing true interoperability to shrink information gaps. Vendors, especially EMR systems have to become nimbler and “allow these systems to talk.” Being able to share data is easier than it was prior to the pandemic but there is still improvement to be made (while still making sure privacy is in place).
Open Discussion/Questions from Participants
How is the city thinking about distribution and scaling of vaccinations in a way that is safe?
McKinney: The city has a number of mechanisms for distribution, including distribution to hospitals and physician’s office, as well as a number of public vaccination centers. All will be focused on setting up mass vaccination, while ensuring safety and complying by social distancing measures.
What is the enduring impact on clinical practice itself?
Casey: The COVID-19 pandemic is the accelerant that was needed. Advancements like drive-through testing sparked discussions on what other clinical practices can be done in drive through settings. Telehealth has come far in a short time and understanding what is necessary will be key for developing better cadence of office visits in the future. The on-demand model for cuing patients to come in has also improved.
Where has there been pushback from? Are there any challenges in certain parts of Chicago that did not have the right level of infrastructure for connectivity?
Nelson: Providers want this to be easy, so we need to continue to develop this as another level of providing care with ease. Vendors have done a lot to make video conferencing more secure; however, everyone has experienced issues with connectivity on a zoom call. We need to continue to increase bandwidth and have the technology to support this change.
What are we doing across the state in jails?
McKinney: The jails are testing residents and have separate areas for isolation for those who have tested positive. For hospitalizations, there is coordination with the state health department and other departments.
This time next year, how optimistic are you about our city’s system and ability to respond if this were to happen again?
Nelson: 5 or 6
McKinney: Optimistic, 8