Reflecting on COVID-19 and tech transformations becoming reality

Recently, we diagnosed an 88-year-old gentleman with COVID-19. He was clinically stable and chose to convalesce at home with telehealth monitoring. Using a digital thermometer and pulse oximeter he self-reported his data to nurses remotely watching over individuals in their homes. A couple days in, the patient's son called his nurse and said, "My dad seems short of breath." The nurse pulled up the patient's stats, noting his oxygen saturation was excellent, 98%. She reassured the son, "He is okay right now, how about if you keep checking in on him?" Dad took a nap and woke up feeling fine, and his O2 sat stayed completely normal. Having data in hand kept him safe and comfortable at home where he completely recovered, never needing a hospital bed.

From Seattle, front lines of the COVID-19 pandemic, our hypothesis is planning is the antidote to panic. We believe by using 21st century technology, it's possible to stay a step or two ahead of the curve, using science and data as the weapons to defeat a global foe.

Treating a patient with novel coronavirus back in January was a wakeup call for our system—this pathogen was a credible threat. We knew we had no surveillance testing, so while COVID-19 still hovered off-shore, our data analytics team began tracking patients with influenza-like illness (ILI: cough, fever, shortness of breath) to see if our communities were caring for patients at unexpected levels compared to prior years. This evolved into the Coronavirus Epidemic Registry and Emergency Data (CoVERED) platform, a suite of predictive analytics to estimate the future impact of COVID-19 on our communities. Providence has a system-wide data warehouse including EMR, financial, community and social determinant of health data, providing the platform needed for a comprehensive view. Using this predictive data we can now plan ahead, guiding decisions on how best to triage, test, and treat patients in the next few weeks. We can plan for where to deploy people, in what places and with what products they'll need, helping to optimize outcomes for our patients and our caregivers.

Our CoVERED tool tracks a variety of critical data points including COVID-19 patient census and resources they are utilizing in each facility (ICU beds, ventilators, PPE). The tool also helps us understand community penetration of the virus by zip code with data that informs challenging resource decisions, such as when to initiate universal masking and how to shift supplies between regions to accommodate an anticipated patient surge.

In February, as cases in the Pacific Northwest started to pop up, we realized we needed a path to caring for patients while minimizing risk to caregivers. When the clinical team approached our digital innovation group and Microsoft partners with the possibility that demand could outstrip supply of people asking "Could I have COVID?", they developed an online chat bot, a self-service tool helping individuals with concerns decide if they needed care. Triage is done without a call or visit and has now been used over 150,000 times. If people do need care, they can connect directly to a nurse triage line or begin a virtual visit. Our urgent care virtual visits jumped from 50/day to over 1000 in the span of two weeks. People needing testing were able to get an appointment at our drive through testing centers (as more testing becomes available, we'll do this on demand). People that are COVID positive, who have risk factors but are stable, are sent home with a pulse ox and digital thermometer to remotely oversee their health. W've done this for over 700 patients to date, with 13 going on to admission for decompensation. This has helped patients recover more comfortably while sparing the PPE demand on our overburdened facilities.

Working at scale over 7 states, we've enabled and trained around 10,000 Providence physicians to use Telehealth tools for their routine visits. We're helping under-resourced geographic areas by using TeleHospitalist and TeleICU systems to monitor patients and support onsite nurses, supplementing where local physician staffing cannot cover the surge in care. We're also leveraging technology to share the clinical experience of physicians across our system, conducting virtual grand rounds to rapidly learn what works in caring for this novel infection, attended by hundreds of physicians (and downloaded later by many more).

Operationally, Providence built a virtual emergency operations command center (vEOC) that reports out daily to the system and our executive teams. This structure has been invaluable in providing nimble support as rapid changes are made due to the evolving reality on the ground with rapidly shifting regulations and/or community needs. The vEOC handles crisis planning and communication, risk and issue remediation, escalation of critical decisions, and consistency in cross system communications. These are all essential functions that allow teams to quickly resolve issues and escalate decision requirements throughout the organization.

Taking a lesson from aviation, or where manuals reduce panic in a crisis by helping pilots work through checklists of critical needs, Providence developed a "Pandemic Playbook" with an intuitive framework, consistent taxonomy, and accessible tools/resources. It is a guide to help local facilities as the surge hits their locale, focusing on how to adjust care delivery to continue serving our communities under duress.

The overarching framework, which is the foundation of the resource, is based on contingency planning and demand management of three resource "pillars"—people, places, and products. During times of crisis, these resources tend to be under extreme pressure to meet the surges and fluctuations in demand, which are made more manageable by systematically using a defined approach.

Our framework depends upon three levels of triage:

1. Level 1 is the normal operations while planning for the pandemic to arrive.
2. Level 2 is triggered when the current resources approach 95% utilization and is focused on extending the internal capacity while adjusting for surge.
3. Level 3 triage gets activated when the internal stretch capacity exceeds 95% and involves regional, community, and governmental outreach for capacity expansion.

Our Pandemic Playbook is helping Providence get ahead of the curve and be ready as COVID-19 migrates across our communities. We knew supply chain disruption coupled with increased demand would create a PPE shortage and we fought back by starting the 100 Million Mask Challenge. We secured significant support from individuals, community organizations, and local manufacturers. As the movement expanded beyond our capacity, the AHA has taken over to make this a national endeavor. The outpouring of support from across the country has reaffirmed our faith in the helpful, hopeful, can-do nature of Americans.

We also know while social distancing buys us time, only science will defeat COVID-19. Our researchers are working across facilities, states, and organizations to share data and discoveries to help develop a vaccine, anti-viral medications, and immune modulators. We currently have multiple trials underway in all three areas, along with health sciences research using real-world evidence to understand questions about medication use, effective care attributes, and risk models for disease severity.

The Providence mission is to create Health for a Better World. With this pandemic, we are putting our resourcefulness, innovative thinking, willingness to be led by people with expertise rather than titles, and capacity to demonstrate through actions rather than words that our caregivers and patients are job one. We will stop COVID—it will not stop us.

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