COVID Crisis: How Children’s Hospital of the King’s Daughters responded

How are healthcare organizations dealing with the effects of COVID-19? I recently had the opportunity to moderate a panel on the topic with two members of the strategic IT leadership team at Children’s Hospital of the King’s Daughters (CHKD) in Norfolk, Virginia: Dr. Dean Cauley, CMIO, and Joseph Hooks, CTO and CISO. Together, they shared their IT strategies as measures for pandemic preparedness and identified areas where their experience responding to the COVID crisis can help other healthcare organizations prepare. The following summarizes the key highlights of the discussion.

Pandemic Preparedness

Like most hospitals, CHKD faced rapid changes due to the COVID crisis. On the information services (IS) side, Hooks anticipated a supply chain crunch, particularly for those supplies that enable remote work – laptops, PCs, and other workforce equipment. From the clinical side, Dr. Cauley compares the early days of the pandemic to the “Hunger Games” series – “there was fear like we haven’t ever seen” as patient volumes spiked for COVID-19 but others stayed away in fear. They had to quickly figure out how to meet new demands, such as admitting children for treatment while simultaneously protecting family members from infection.

As with IS, the clinicians faced supply chain shortages. For Cauley, that meant a shortage of personal protective equipment (PPE). He also had to make day-to-day resource decisions without any real sense of the scope of the crisis, in terms of its duration and rates of ongoing impact. This was truly uncharted territory for us all.

Doctors, meanwhile, had to adapt to the “moving target” of diagnostic criteria to identify COVID symptoms. Early on, for example, it wasn’t clear that a child who presents with gastro-intestinal symptoms might have COVID. As a result, doctors were triaging those patients with standard GI protocols, without realizing these patients might have COVID. The understanding of the disease progression, possible symptoms and epidemiology early on changed almost daily, forcing doctors to continuously stay abreast of new developments.

Moving to a Remote Workforce

Like many organizations right now, CHKD had to pivot very quickly to accommodate a remote workforce. Prior to the pandemic, the hospital had not broadly supported a “telework” model per se, and had only a few departments working remotely. When the impacts of COVID became clear, however, the IS team quickly moved into action.

Luckily, Hooks had a supply chain that could provide much of the required equipment. Before the pandemic, he estimates that CHKD had approximately 200 people configured to telecommute; it now has over 800 set up to effectively work from home – a significant ramp up achieved in less than one month. Routers, network, architecting, and bandwidth – all had to be upgraded. Hooks also had to acquire additional licensing, a task where “Imprivata was extremely helpful in helping us expand and surge our licensing – and my team now understands the licensing model better, which is hugely helpful.” Some members of his team wanted dual monitors at home, as they have at the office, so Hooks arranged for those to ensure maximum at-home efficiency.

Cauley quickly realized this his end-users needed immediate tele-work access. Because a vast majority of CHKD network end-users were already familiar with Imprivata’s dual-factor authentication solutions, he was able to issue more licenses and roll that out quickly and at large scale. “We were pulling rabbits out of the hat” at points, he says, but watching the successful ramp up in services his team provided was “one of those moments where it’s fun to be a provider.”

Balancing Security and Access

CHKD effectively rolled out a whole new dimension of information systems for remote work and changed to new workflows. They were extremely focused on making sure that the changes to their architecture and infrastructure did not extend to the end users. Above all else, they wanted to prevent serious disruptions for their clinicians. One of the biggest challenges was balancing usability with security. Hooks noted that the hardest part of his CISO job is balancing data protection/patient privacy with clinician access. The sudden increase of tools like WebEx for meetings raised security concerns, but he was able to maintain the highest security posture as they scaled. One intervention that helped significantly was requiring single sign-on for all users – that way he had confidence in exactly who was accessing their systems, from where and exactly when. It was an “education on security” for staffers, but it progressed with an emphasis on the true common goal: taking exemplary care of their patients.

Cauley’s approach mirrors this emphasis on patient care. Having clinicians use personal devices can be problematic from a security perspective if not managed properly, but maximizing productivity was critical. So his team makes sure both the devices and the platforms being used are as secure as possible, while providing workflows the clinicians feel are streamlined and usable. In the end, good security shouldn’t prevent clinicians from doing their work.

Tools for Telehealth

WebEx and other similar platforms (such as Zoom) are not formal “telehealth” platforms, but they are now being used increasingly in hospitals and providers’ offices around the nation – including in Dr. Cauley’s shift to virtual patient visits. When he saw the growing need, CHKD began identifying which patients are the best candidates for virtual visits and delivering a robust infrastructure to support the workflows. Keys to success include how CHKD communicates telehealth options to the patient and working within each platforms’ limits.

One very helpful element of telehealth is electronic prescribing of controlled substances (EPCS). “I can’t imagine not using EPCS in this crisis,” Cauley said, calling EPCS “incredibly valuable” and so widely expected that it’s “as much as an imperative as telehealth itself.” Both telehealth and EPCS allow for top notch care delivered virtually, without the need for face-to-face interaction. With the COVID-19 pandemic and infection control concerns, these technologies have been not only helpful, but probably life-saving as well.