For hospitals dealing with a surge in COVID-19 cases, the challenge of effectively treating each patient while managing resources and reducing exposure risks to staff and other patients can be overwhelming. The ability to treat some COVID-19 patients from afar might prove critical to relieving pressure on emergency rooms, ICUs, and other critical services.
In a new interview, John Vozenilek, MD, Chief Medical Officer, Innovation & Digital Health at OSF HealthCare in Peoria, Illinois, explores the system’s innovative at-home COVID-19 initiative, from deploying community health workers and home nursing staff to providing digital monitoring and durable medical equipment to help manage each patient’s condition. Dr. Vozenilek serves in OSF’s Saint Gabriel Digital Health, and describes the intersection of innovation and digital health for his system.
In all Kaufman Hall interviews, the expert opinions expressed are those of the interviewees and should not be considered opinions of Kaufman Hall. This interview was conducted on April 13, 2020.
Q: How did the pandemic health worker initiative at OSF Healthcare come about?
A: OSF Healthcare has an innovation center—supported by a large innovation fund—that houses the work of health analysts and staff from our research and development departments.
Before the COVID-19 pandemic started, the center was focused on a number of community health initiatives, including efforts that involved community health workers. These are lay people who are trained to help patients navigate and find support inside a complex health system, and, in some cases, to mitigate unnecessary emergency department utilization and other related services, when there are more affordable measures to be had.
When COVID-19 struck, we were particularly well-positioned by the work we had developed around community health workers. We looked at the pandemic as a particular need for vulnerable populations, within the framework of the social determinants of health. That context includes serving elderly populations and rural communities, as well as populations with issues around access to navigating information or health literacy, which all relates to COVID-19 in a unique way.
We did not want to expose lay people to a disease. As we anticipated that COVID-19 would become a pandemic, that meant there was going to be a lot of folks who were going to be affected that may not even know that they had COVID-19. We had to figure out a digital means to connect with them. We had already begun the process of connecting with patients through mechanisms like apps, chatbots, and other types of purely digital or automated solutions.
Q: How does the program work?
A: The first level is the pandemic health workers, who are not physically present in front of the patient. These are field agents who actually deliver equipment to people at their homes in the same way you would use a food or grocery delivery service. This service is the entry portal for integration into more advanced care from nursing, physicians, or advanced practice providers in the event a patient’s conditions worsen.
As we realized that our emergency departments were going to be inundated, we created an acute COVID-19 at-home solution. If a patient has an acceptably low level of illness but still requires hospital services, we will deploy durable medical equipment and home health nurses to limit the amount of exposure and the amount of personal protective equipment usage. It’s a really layered approach.
Our data science teams also have the ability to connect with these patients more uniquely than we have in the past. There’s an application that we've developed, Patient Sense, that helps us remain connected to patients. The application also gives us a heads-up about more global resource utilization, or the need for resources to be deployed to a particular region through a machine learning algorithm.
Q: How do the at-home COVID-19 hospital services operate?
A: There are many products that were designed for congestive heart failure, emphysema, or chronic obstructive pulmonary disease. These include digitally accessible devices that collect vital sign data or advanced monitoring. We're leveraging the existing programs we had and taking on more equipment, to help treat a person who is at home and not desperately ill, but may need additional monitoring. Perhaps they need a bit of oxygen. Perhaps they need some intravenous fluids. We can continuously monitor them remotely and have them backstopped through layered provider support.
Q: What's the reaction been so far from users of the program?
A: Although we’re early in the program, we've had a ramp up in adoption because Illinois Gov. J.B. Pritzker recently shared the program’s phone number. We’ve had a massive number of physicians reach out to me to ask how they can admit their patients into our program for continuous monitoring.
Q: Is this program intended specifically for OSF patients, or are you offering it outside your network?
A: We’re definitely going to serve a broader community. In our primary catchment, we have about 2.2 million patients. This program was designed for 4.7 million patients in its initial phase. And we're in touch with our partners in Chicago and Springfield to ramp it up to serve a greater population.
Q: How do you see a service like this transitioning through the post COVID-19 recovery and beyond?
A: The presence of the “internet of medical things” in a person's home, and the connecting of sensors, objects, and personal health information has been long anticipated. In the future, I think people will be generally more amenable to those arrangements. In addition, health administrators will have realized the potential benefit of that connectivity. The human element is still absolutely essential, so you can drive some of the human connection through digital means in unique ways and you can do that at a certain scale.
The proof of the program's benefit would result in both healthcare administrators and patients gaining a general understanding how digital health can improve long-term wellness.
The positive benefit of connecting with patients in this way could have a remarkable effect on programs that the state and federal government support. I think the data that is currently available at the patient level to know whether a particular therapy is helpful or not helpful is often difficult to glean. Right now, that data is used for our billing records, instead of this more sensitive instrument, which theoretically in the future could be in the patient's home.
Q: Do you envision this particular set of tools could be used for treating chronic conditions?
A: Absolutely. We’ve been developing programs for people with chronic conditions and ambulatory-sensitive conditions, which were in place when we went down this path. We were uniquely poised to be able to pivot quickly, because of the presence of the innovation center, to turn that in this new direction.
It’s important to also think about how the role of medical education. We have all these residency programs across the country, and very limited access to digital health and virtual visits. The post COVID-19 world will have a demand that will be met by residents and others in training to receive instruction and understand the particular benefits of a digitally connected world. There will be a significant rise in digital clinics, I imagine.
Q: What has the clinician reaction been so far? And how you do you envision physician acceptance of telehealth and telemedicine moving forward?
A: It’s a fascinating moment in time. Folks who had looked with askance in the past at the digital means to connect with patients are now rapidly adopting these measures, because there's not too much choice. I think the pendulum will swing in the opposite direction, and we will see appropriate use at all the different levels where we interact patient care.
It won't be where we are today during the pandemic, but it will certainly be further towards these digital means to connect with patients. I have had only the most positive experience from our physicians and providers. They see it as a great benefit, and are currently demanding more access to this service. There aren’t too many providers who have said this is not desirable.