Transcription:
Digital Health Advancements During COVID-19

This UAMS Health Talk COVID-19 podcast was recorded on August 4, 2020.

Prakash Chandran (Host):  In the ongoing standstill of the pandemic, many of our questions about case tracing and health management remain unanswered. Fortunately, medical professionals are using advanced digital health technologies to improve the health and safety of you and your loved ones. We’re going to talk about it today with Dr. Joseph Sanford, Chief Clinical Informatics Officer and the Interim Director for the Institute of Digital Health and Innovation and Dr. Kevin Sexton, Associate Chief Clinical Informatics Officer, both at the University of Arkansas for Medical Sciences.

This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. I’m Prakash Chandran. So, Dr. Sanford, we’ll start with you. How exactly are digital health advancements enhancing our abilities during this COVID-19 pandemic?

Joseph Sanford, MD (Guest):  The spectrum by which the digital health enhancements are improving lives of patients is really quite remarkable in response to the COVID-19 pandemic. There’s nothing quite like drastic change to beget more changes. So, it steps down from how you access the healthcare system. We’ve been doing more Telehealth visits and digital health visits at UAMS since the pandemic started for us really in mid-March than all of our previous probably existence combined. We’ve done several dozen thousands digital health visits at this point across all of our specialties and subspecialties. Everything from primary care all the way into neurology, neurosurgery and things like that.

We are focused on the quality of patient experience, the ease of access which for a rural state like Arkansas really helps for patients that have been driving from the corners of the state and eliminates sometimes as much as a six hour round trip drive if you are coming from the far northwest or southeast part of the state.

Other aspects of digital health and really focusing on the patient care experience are approving and building out communication pathways for patients in the hospital with their families. Because we have slightly more restrictive visitor policies to protect patients and their families from the nature of the COVID disease process. We’re additionally focused on data communication pathways, not just with the UAMS system itself but with the state and with the federal government to get as much data about the pandemic and medical information for future research projects as we can.

Kevin Sexton, MD (Guest):  I would add that it’s amazing to see that overnight, the primary modality with which we deliver healthcare changed and that could only be possible with technology. As Joe was talking about, we now have a visitation policy that’s highly restrictive so we’re dependent upon technology to do the care that we were normally doing in-person. And we had to design data systems for integrating large quantities of data and allowing it to flow to the appropriate person in real time, while we’re building some of these systems on the fly because we’ve never dealt with these challenges at this scale before.

Host:  Yeah, it truly is incredible just around how you were mentioning that primary modality has changed because you have to limit the patients and the visitors. So, first I’d love to just talk a little bit about ease of access. So, you mentioned that cutting down the commute time has obviously really changed the way that people get care. So, you have this balance between people who might have been apprehensive about getting care during COVID but now having it be more accessible because of all of the measures that you’ve set up. Dr. Sexton, can you talk a little bit about that dichotomy and how you’ve seen patients adopt this new technological process that you put in place?

Dr. Sexton:  Well I think patients have adjusted well to receiving care in a virtual platform. Whether that be the traditional telephone call or a new video integrated visit. I think what we don’t know and understand is which platform is best for what the patient would need. And sometimes our clinical systems are built upon delivering in-person care and serial laboratory testing, other serial examinations that are impossible virtually and so, do you have to bring someone to the hospital for just those isolated values and follow up? Or are there things that you can do in a new way to reinvent the system and to come up with the same sort of monitoring. So, I think patients have adapted quickly as well as their family members who are now feel I think more comfortable communicating with the healthcare system. I think we still have a lot to sort out though. Folks still are primarily communicating synchronously, and we don’t have great systems for asynchronous communications with patients and their families.

But that’s what we’re working to develop and learning more about every day.

Dr. Sanford:  Yeah, I think that’s a really good point Kevin, and I would add to it that one of the interesting assumptions that we had rapidly challenged in our pandemic response and Telehealth, digital health expansion is would the patient population respond to the requirements of the text. So, to use kind of a common example would Zoom be an appropriate modality and would our elderly patients be comfortable using something like Zoom or Facetime if they had never used it before. Yes, there is some of that, but it’s not along a lot of the generational or educational assumptions that you might come into as a scientific hypothesis. We’ve really found that adoption has been pretty quick, and we have patients that we would have assumed would need a lot of handholding are already using Zoom to communicate with their families or Facetime to play card games remotely and they’ve got – I’ll use an example from my parents. They have one iPad set up for the Zoom call and then they have all of their iPhones and they play Hearts with my cousins and other relatives. So, the assumptions about how people will respond to change and whether or not they are going to fear change I think had not been completely mis-founded but I’m very heartened by the populous response to we’re going to do something totally new and different and we’re going to figure it out on the fly together and as long as we focus on our priorities of keeping people healthy and safe, and really focus on the patient experience that relies upon really, trust, then the rest of the technical pieces we can take the time to figure out on the fly.

Dr. Sexton:  And so we noticed a lot of resilience in clinicians and in patients and in those in the healthcare system when it comes to technology. Folks find ways to make up for any gaps in the technology itself. We’ve had clinicians calling patients at the same time as they are trying to log on to a video based platform to help them troubleshoot. And so folks really find a way to make up for inadequate systems or poor system design.

Host:  Yeah, I think it’s amazing that one of the things that has come out of this pandemic is everyone has really banded together to adopt these technologies and especially like an environment like a hospital or in medicine, families want to provide support to their loved ones and so, doing so by whatever means necessary, even if it’s adopting Zoom or Facetime as you were saying, they just want to get it right and I’m sure that the staff has really come together to say you know whatever it’s going to take to make that happen for our patient population. One of the things that I wanted to move on to, is the metrics side of things, especially as it comes down to case tracing and tracking. Dr. Sanford, can you talk a little bit about the efforts that are going on there?

Dr. Sanford:  So, we use a, and I don’t know if this will be interesting to your listeners but, we use a tool called REDCap, it’s a free research tool originally that was the foundation of our initial response to the COVID pandemic. And that allows us to build a relational database from which then our College of Public Health colleagues and then data that we sent to the Arkansas Department of Health at the state level to do follow up contact tracing and communicate about patient symptoms, where they are at, who they might have been in contact with and allows us to do and participate in the statewide contact tracing for patient follow up especially on the multiday contact tracing piece where you can have a new patient encounter everyday to get types of symptoms, when they resolve, on what day they’ve resolved versus what their starting symptoms were. So, a cough that persists for four weeks, a GI disturbance that only lasted for four days. Or how high the fever was and when it finally went away. And all of those other little things that as medial professionals, we are learning more and more about and trying to define this disease more precisely.

Additionally, at UAMS, we take our employee and patient screening very seriously, so we do everyday it is screening for employees when we come into work, we take a questionnaire and symptoms and travel. We get our temperatures taken at the door and that gives us essentially a permission that is literally a sticker that allows us to come into the building today.

For patients, around perioperative testing your listeners might be aware that the ordinance from the Department of Health has relaxed some of the perioperative testing requirements at the state level. However, given the nature of what UAMS does, in terms of the complexity or the surgery and the medical complexity of the patients themselves; we persist in doing perioperative screening for COVID including a test before we do any elective procedure.

Dr. Sexton:  Contact tracing is an interesting area to discuss. I am fortunate to sit on the technology advisory board for Governor Hutchinson and we reviewed a lot of different applications for software programs for contact tracing. At UAMS, our College of Public Health practically overnight stood up a contact tracing call center with support from Information Technology which was impressive. It’s still a pretty human resource dependent activity and requires a lot of skill and communication and we’re learning that contact tracing honestly, is a lot like customer relationship management in how you interact with folks. And when we talk to our customers, epidemiologically, we mention the term surveillance and that’s not what people want to hear. You’ll read about contact tracing applications that are based on someone’s location, Apple and Google have a synergistic product that they are working on for contact tracing. But I think there’s a lot of apprehension on invasion of privacy from patients and from the community with these applications.

Dr. Sanford:  Not just invasion of privacy but we kind of got some humorous examples where previous exploratory technologies in the telecommunications space have really hampered us because everyone is so sick and tired of spam, now no one picks up the phone when the hospital calls because we don’t have the trust in the populous to pick up our phone when it rings. And so we’ve had to develop a whole new set of practices around scripting language to leave a voicemail that is informative yet not alarming. Because no one wants to get a call from UAMS and hear hi, you may have been exposed to COVID. Call us back. You have to be very sensitive as Kevin was saying about the customer relationship piece, it’s odd to think of patients or potential patients as customers but these are people who have wants, needs, fear and hopes and anxiety around COVID is high and only seeming to get higher. So, we are very conscientious of our responsibility to inform and educate and investigate without hopefully contributing to any uncertainty or fear.

Dr. Sexton:  And contact tracing is only as effective as adoption. The applications become more effective the more folks are adopting and using the technology on a daily basis. And I’ve not seen great examples of a high percentage of the population using any of the technologies.

Host:  But in terms of the screening that you do at your hospital itself, all of that information whether it be employees, visitors or the patients; all of that data is being run through the system that you’re talking about, right, around did you call it REDCap?

Dr. Sanford:  Yes, so REDCap is the data capture tool and then we run that either through our student employee health service or if it’s medical data, we run it through the EMR which we use called Epic. And then at the end of the day, once all of our clinical activities have occurred, much of that information is stored in the Arkansas Clinical Data Repository which is also managed through UAMS. Access to the various buckets of data is pretty closely scrutinized because some of it’s employer employee data, some of it’s clinical data, some of it’s state level contact tracing data and so, anyone that want to eventually do research on this stuff will have to go through all the appropriate IRB processes to make sure all of the critical rights are respected by accessing it. But generally speaking, for an overall surveillance package, we do metricize and track along the same lines that the Arkansas Department of Health reports it at the Governor’s press conference every day.

We’re looking at largely the same metrics and we do that not just on the individual patient level, but there are also tools in the state that allow hospitals to share information about bed statuses, ICU capacity, ventilator capacity and other logistical necessities.

Host:  Well I know I could speak to both of you all day about this because I just find that technology is in some ways, the unsung hero in all of this just how it helps advance so many things during COVID. We talked about a number of different topics here. We talked about how it improves ease of access, it improves those communication pathways for patients to stay connected with their loved ones. We talked about screening and contact tracing. Certainly done so in a way that follows the guidelines and standards of everything that you discussed. And just as we close here, Dr. Sexton, I just wanted you to have maybe some closing words around how technology, you feel can really help the patient experience so as a patient might be listening to this, just on the surface level, they may not necessarily understand all the complexities around what we’ve discussed here today but what’s one thing you’d like to share with them around how technology is helping keeping them safe during this pandemic.

Dr. Sexton:  What I’d like to share is that technology is just helping facilitate communication and technology is a broad term and means many, many different things. It doesn’t need to be intimidating and it can be very, very simple. At its foundation, technology helps people do more than they normally would be able to do. And it allows us to communicate faster, allows us to communicate with more folks and to share more complex information than we’ve ever been able to do before. So, my parting words for folks on technology would just be that it’s already what you’re using. We don’t have to introduce new things but whatever modality they are comfortable with, clinicians and the folks at UAMS are here to connect with them where they are at.

Host:  Dr. Sanford do you have any final words to add to that?

Dr. Sanford:  Yeah, I think I know it was very well said, I would just echo that technology is a force multiplied, by itself it does nothing. And so, it really relies upon the human connection and the trust and feedback of those that use it to affect change to be the most of what it can be. And so, what we’re – in addition to what Kevin said, what we’re very interested in here at UAMS is how we build tools and solutions that are very proactive and work in a very real setting, not any kind of a toy or a lab environment. And that are very sensitive to the vast diversity and necessity of healthcare needs across the state of Arkansas. From the delta and the agro business and the healthcare needs specific to that all the way to central Arkansas and the Fin Tech industry up to northwest Arkansas and trucking and retail. All of those different parts of the state have different needs and it is our ambition and goal to serve all of them equally well.

Host:  Well I think that is a perfect place to end Dr. Sanford and Dr. Sexton. This has been hugely informative, and I really appreciate your time today. That’s Dr. Joseph Sanford, Chief Clinical Informatics Officer and the Interim Director for the Institute for Digital Health and Innovation and Dr. Kevin Sexton, Associate Chief Clinical Informatics Officer at University of Arkansas for Medical Sciences. Thanks for checking out this episode of UAMS Health Talk. For more information on this topic and to access the resources mentioned, visit www.uamshealth.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.