CIO on reopening healthcare systems for nonemergency care

As healthcare systems plan to reopen for routine, nonemergency care, CIOs will help lead the transition of bringing a largely remote workforce back into a traditional care setting.

The Centers for Medicare and Medicaid Services (CMS) released the first phase of guidance on reopening healthcare systems for nonemergency care. The guidance includes facility considerations, workforce and personal protective equipment availability, and sanitation protocols. Before reopening a facility to non-COVID-19 care, healthcare systems will also have to align with state guidelines that have passed federal criteria.

In this Q&A conducted in April, UT Health Austin and Dell Medical School CIO Aaron Miri talked about a healthcare CIO's role when it comes to reopening healthcare systems and why he's focused on making the right data available in the EHR for in-person care and ensuring systemwide testing as a monitoring method for COVID-19.

How are you making the case for reopening healthcare systems to nonemergency care?

Aaron Miri: Is it on my radar? Absolutely. Right now, there is a phenomenon occurring across the country where you actually have fewer people presenting to the emergency room with chest pain, respiratory duress or whatever. It's to the point that people are wondering what has happened here? … It wasn't because there were fewer incidents, it was because people were so scared to go into the emergency room, they didn't want to leave their houses.

Aaron Miri

Unfortunately, now, instead of coming in early with pain, people are having heart attacks at their houses and it's a worse situation. … So, is it the right thing to do to open things back up in terms of elective procedures? Yes. Most of the time, some of these elective procedures are pre-indicators for something else going on. … Is it the right thing to do, though, in a very pragmatic way -- testing, asking the right questions before admission? Yes. All those kinds of things have to be assessed.

What are you doing as a CIO to help UT Health Austin reopen to nonemergency care?

Miri: First, we're doing a great job of healthcare-worker screening, meaning healthcare workers are getting tested. We're doing it in batches of about 100. That is giving us indicators of a potential internal cluster that could inadvertently expose somebody to COVID. Our infectious disease team is doing an amazing job of both internal testing as well as external population testing so that we can have early warning radar.

The three things we are doing now:

No. 1: You need to know the pulse of your workforce, how are they doing? Do they have the tools necessary to do their jobs? Are we equipped from a personnel perspective -- making data available, actionable and in a dashboard format? That's one dimension.

No. 2: The electronic medical record. Obviously, we had to quickly shift with changing various service lines to be virtual, which required adjustments to the medical record. Charting, all sorts of things like that, making sure those service lines are transitioned back. There's a close partnership not only with the chief clinical officer, but with the physicians on staff to make sure the medical record aligns to what they want to see and the data is in a format that's actionable.

No. 3: Assume [someone] is COVID positive and they've been in a process of being monitored. How do we make sure that information is actionable to the physicians so that they can say [this person] was enrolled in contact tracing and home monitoring, here's the data from that, we need to take action?

Do you think the coronavirus will change healthcare delivery as we know it?

Miri: The glass is half full here. I think we have proven telemedicine is here to stay in some capacity or another. I think there's going to be a balancing effect. Is it the right thing to fully reimburse a straight telemedicine fee-for-service kind of encounter? No. There has to be a value-based component to it at some point. … I think CMS is talking about that. … They are looking at elements and dimensions to keep around, but we need to curb the utilization of medicine in a way that is truly preventive medicine in a value-based way. Those metrics and those dynamics still need to be invented and created, thought through and pushed forward. … I think all of that together will be the new future.

Editor's note: Responses have been edited for brevity and clarity.