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When Covid-19 hit, Mayo Clinic had to rethink its technology

One example: The healthcare provider had to make close to 3,000 changes in its electronic health-records system

Mayo Clinic, like many health providers, has been pushed to its limits by the Covid-19 pandemic. Its intensive-care units were often filled to or near capacity in 2020. And while doctors throughout the health system rushed to find ways to care for the wave of sick patients infected by the new virus, many of the medical and support staff were being sent home to work remotely.

The information-technology team led by Mayo Clinic Chief Information Officer Cris Ross faced immense challenges. Practically overnight, remote, secure and fast access to multiple systems had to be provided to thousands of workers, including doctors. The influx of Covid patients, meanwhile, needed to be able to communicate with the outside world while being kept in isolation. And it all had to be done on the fly. Adapting the healthcare system’s networks and building new tools to meet these demands required planning, decisions and execution at speeds undreamed of a short time before.

Mr. Ross spoke to The Wall Street Journal about his IT department’s efforts to support Mayo’s staff and how the pandemic is changing the way his team provides IT to the organization. Here are edited excerpts of the discussion.

WSJ: What was the biggest lesson you learned?

MR. ROSS: Sometimes we have an expectation that if we’re going to make a change, it’s going to take months and months—that we have to step slowly and carefully. But with the pandemic, we were forced to make decisions in weeks or days. We’ve discovered that when necessity requires rapid decisions and fast action, we can do it.

WSJ: Can you give me an example?

MR. ROSS: We had to make close to 3,000 changes in our electronic health-records system to recognize rapidly evolving hospital-facility changes and protocols. Clinical guidelines for Covid treatment were developed and made available from within the records system. So, for example, if someone arrives at the emergency department who may have Covid, what are the steps? If that patient is admitted, what’s the next step? And if they’re sent to an ICU, what’s the next step?

We also have an internal system called AskMayoExpert that lays out clinical pathways and decision support for clinicians on how to treat a particular disease set. We quickly decided in the early days of the pandemic to make the Covid guidelines in AskMayoExpert available to the general healthcare-provider community.

WSJ: What was another huge challenge?

MR. ROSS: We had to get 30,000 people working from home quickly, of which 20,000 had not been regularly working from home.

We made a decision in an afternoon that we were going to take existing desktop computers and ask people to drive into the office and take them home. In a perfect world, you might do a better job of inventorying those computers and making sure you didn’t lose any equipment. Those are all prudent things to do. But we needed to get people home and doctors taking care of patients. We didn’t have the luxury to put traditional controls in place.

WSJ: And that included doctors?

MR. ROSS: Yes, they were doing virtual care from home.

We had been building technology to do virtual care over a long period. But at the time of the outbreak it was only a fraction of patient visits. We went from about 4% of our visits being virtual to about 85% in a matter of weeks.

But we discovered that people figured out how to use it, that it’s an acceptable way of visiting with a doctor. And it seems like it has real permanence, whereas before, it was kind of an experiment.

And, today, between 15% and 20% of our visits are virtual at any given time.

WSJ: What were some of the challenges you faced in having to move so quickly with virtual visits?

MR. ROSS: Initially, if a doctor was at home doing a video visit, the connection would come into Mayo and from there go out to the public internet and then to the patient at home.

When we were routing it through the clinic, we were taking maybe a couple thousand simultaneous video connections through an infrastructure that was not constructed to support that kind of volume.

Some great engineers on our team and our telehealth vendor, Zoom, figured out a way to route that traffic so that it never came to Mayo. They used something called “split-tunneling" to connect the patient and physician securely over the general internet without going through a telecommunications chokepoint on one of our campuses. We put administrative controls in place to make sure all the connections were secured. And it took this huge load off our infrastructure.

WSJ: What’s an example of the new way of thinking at Mayo?

MR. ROSS: To explore new ideas, we used to have a step that was basically an “approval to think about an idea." We had a pretty controlled process for that because, honestly, you can use up a lot of hours chasing ideas that don’t ever come to fruition.

So, we might have had a proponent document an idea in enough detail to justify the resources to explore it.

However, some really good ideas don’t necessarily present very well on first look. Or a proponent might not be able to articulate the case well because the ideas are not yet well formed.

By eliminating that extra step, we made the planning reasonably lightweight and decision making more streamlined. We’re basically removing a layer of required documentation before people can begin to look at an idea, allowing them to move ahead, after discussions with management about their ideas. The ideas will still need to pass muster. But hopefully we’ll get those ideas workshopped more quickly.

WSJ: How do you keep up with everything?

MR. ROSS: We had a pre-existing group of about 25 or 30 CIOs from other healthcare organizations and we just started emailing each other furiously about what we were seeing.

Everybody started adopting some really cool things. They were accelerating telehealth and virtual care and looking at setting up communications inside isolation rooms using things like iPads on poles—which Mayo also did.

It’s no surprise that many people did the same things, because we were all talking to each other and seeing what worked and what didn’t work. And one of the things that’s really lovely about healthcare is that, sure, we compete, but we don’t compete on taking care of people.

WSJ: What could healthcare do better?

MR. ROSS: Improve on data exchange. I’ve noted that healthcare went from paper to digital in about 12 or 15 years. Imagine if this pandemic had come about in 2008, when most of healthcare was still notes in manila folders. Trying to do public-health surveillance on paper records would have been absolutely disastrous.

We had digital records. And we could share them.

WSJ: How have patient expectations changed during the pandemic?

MR. ROSS: We believe that patients are going to expect a digital experience in healthcare like they have in other domains. Why can’t they all go online, get an appointment, manage their care, communicate with their caregivers? Even shop around for healthcare services?

A big challenge is scheduling. To come in for a well-baby check, a sore-throat check—some sort of primary-care visit—is reasonably straightforward. I look up my doctor, see available slots and choose one.

But when someone is looking at complex care that requires coordination across multiple teams, scheduling that visit in a digital way is more challenging. At Mayo, we’ve enabled that kind of scheduling in a couple of disease areas and we expect to expand that.

This story has been published from a wire agency feed without modifications to the text.

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