Find out how Firelands Regional Health System in Sandusky, OH have been using their COVID-19 dashboards to track patients, as well as monitor vaccinations and assess their effectiveness.
Title: How Data Brought ‘New Life and New Hope’ to Providers during COVID-19
Guest: Denao Ruttino, VP of Operations and CIO, Firelands Regional Health System
Host: Christine Parent, Associate Vice President, MEDITECH
Denao: If you can picture this command center, big screens on the sides, keeping everybody informed, everybody coming in the room multiple times a day or initially staying there to really drive change and decisions throughout the organization and to external entities.
Christine: Welcome to another episode of MEDITECH Podcast; the leader in healthcare technology empowering you to be a more informed healthcare consumer and provider. Hear the latest from our friends and colleagues on topics we think you should know about.
Today, I'm joined by Denao Ruttino, VP of Operations and CIO at Firelands Regional Health System in Sandusky, Ohio; the only full-service medical center in Erie County. A former Tactical Management Information Systems leader for the U.S Army, Denao has over 20 years of experience leading teams and meeting challenges across multiple industries and revenue models. Denao will share how his team leverages analytics in a centralized command center to lead his organization through the COVID-19 pandemic and how he is now employing this same strategy with vaccine administration.
Denao, when the pandemic hit I know analytics played a big role in your decision making. Can you explain how?
Denao: What we ended up doing was leveraging these BCA dashboards; it gave us this near real-time information that we could see. How many tests, once testing came out how many tests were we putting out? Which format was it happening? Was it happening in our drive-in clinics? Was it happening here in-house? Where were our COVID positive patients and how fast were they growing both here in our units in the hospital but also in the community and surrounding communities where we're seeing these pockets of COVID positive patients pop up. So we really did that as much as possible and then also referred to analytics of external firms; John Hopkins, other people who are looking at things on a global scale to really see where we were different than them or where it was the same so just trying to leverage those dashboards to drive our visibility into what was going on initially.
We even kind of moved that forward as things became a little bit more progressive if you will and we understood things better— it was clear to everybody we had a PPE shortage, so another good example we ended up saying okay good, we know what we have in house. We can put that up on a dashboard so everybody understands but what does that translate to days on hand when we're expecting another surge. So we worked with MEDITECH Professional Services, as an example, to deliver some really basic predictive dashboards that said okay, if we have a surge and we increase our census by 50% 60% of this type of patient population, now how many days of on hand do we have of gloves and face shields and masks at a time when, if we all remember back we were working with other entities to use 3D printers to get some of this equipment in-house, so really leveraging analytics to make good decisions as quickly as we possibly could with the information we had.
Christine: No, that's great and what you're using is data to really make tactical and informed decisions so that is probably using some of your military background in there a little bit I'm thinking. So, I understand that you maintained a command center to coordinate efforts around your pandemic response. Can you walk us through this command center?
Denao: We can. You know Firelands is blessed in many ways and one I guess I really want to give credit where it's due is we hired, a number of years ago, a new director of safety and security and she brought with her this real mastery of incident command and that whole structure which is used by a number of other government entities and FEMA which helps us integrate well with police departments, fire departments. We're all speaking kind of the same language, so when this started it felt really like a conflict, right, like you're going into a war zone because you don't have all the right equipment that you wish you had. You don't know exactly what the situation is but you know you're going and you know that we're going to tackle this and help, if you will, defend the community against this virus so we did end up propping up an incident command.
Most of our senior leadership was part of that. Interestingly, it's this was a little bit unique in that normally when we had rehearsed this it was kind of the same people based on the type of incidents we could predict. We never really predicted a global pandemic, right, and so what we found is a number of leaders from all over the organization stepped up, you know, not necessarily because it was their position but it was really because of their skill set and that's why they could play a really good part in this specific command structure which is a little bit different than our normal organizational structure.
So initially that was very beneficial and to be honest we're still using that here a year later, although in a much step down way. So we were able to flex up those resources and flex down those resources in command as we needed to, and I think a big key there was making sure the right people were involved but we could drive all communication to the organization and the external entities from that command structure. So we had marketing involved from a public relations perspective right from the beginning. We were communicating effectively with our staff on PPE shortages and had infection control driving science-based decisions and how we were going to use it allowing our new CMO, who was incredible through this process, to have a direct line of communication to the staff, so that's what we did.
Again, if you can picture this command center with big screens on the sides, keeping everybody informed, everybody coming in the room multiple times a day or initially staying there to really drive change and decisions throughout the organization and to external entities.
Christine: Now, that is great and I know that health systems have a special staffing that work in and work together very well and have come together I think through this in efforts in ways that I don't anticipate that some of these organizations expected, so it's been humbling to hear some of the stories that have been coming out. So, we all know how important community outreach was during the pandemic. You alluded to some of the marketing components. Take us through your efforts to connect with the community.
Denao: Wow, that was extensive and I want to be clear here this is not my efforts, Denao efforts, but on behalf of Fireland Regional Medical Center because there's so many people who were involved. Our CEO is a great communicator, our CMO, our marketing team. It really started out with making sure we were talking internally well but immediately you know had a strong partnership with our local health department in addition to that local health department the Ohio Veterans Home is in Sandusky here which has a very large population you know of older and in some cases sick veterans so we reached out to them as well and formed those partnerships right off the bat.
They inevitably did have a little outbreak there that again they managed in an incredible fashion at a time when you heard a lot of horror stories across the the country as things were very easy to get out of hand—but not just them we also reached out quickly and in many cases to be honest not even us reaching out we had the local vocational schools reaching out to us to say hey, we can print things to help you make shields, we can help you acquire these other resources so those partnerships really just you know were very great for the organization and I think for the community.
You know the local media partnered with everybody, made sure they were getting the message out. We didn't have a lot of the political banter in the local media it was really about let's get out the science-based facts, let's let people know where they can get tested, let's let people know what outbreaks were really experiencing and that even translated later on when we wanted people to come back to get health care because they were neglecting certain things. You know, when you have people having heart problems and other things just because they didn't want to come in to risk it and COVID, all of those organizations kind of helped get that message out as well. So, that's really where we spent a lot of time and effort you know keeping those partnerships through our incident command.
The other big thing was making sure that the community had a way to honor the caregivers because that was a big need and we saw that come out in spades and in our environment. You know, everything from trying to donate equipment and donate food to make sure that you know as simple as you can have iPads in place to communicate end of life conversations with patients when they were in isolated units all the way to making sure that the community was putting out signs and they all gathered in the parking lot one time and they're flashing lights and honking horns at a specific time in order to show the nurses and people who couldn't get away from their bedside appreciation was just incredible, I think.
Christine: Thank you. So, it's also been clear that this pandemic has really heightened the importance of patient engagement, so what are some of the ways you communicated with your patients directly?
Denao: We had our marketing team leverage social media quite a bit. So, we've got the the local media talking more of a broad scale but those that increasingly followed us on social media via Facebook, LinkedIn, things like this spent a lot of time making sure that they had appropriate messages. Believe it or not, even though we talked to the people internally via email and conference calls and all of that some of them tended to you know working a night shift, didn't get into email that time so they would look at some of those social media outlets as well, so I think the shorter answer to your question is everything we had available to us at the time was really what we wanted to do because different people consume those messages in different ways. So, a lot and again our employees, I refer to that because they were a big part of our patient population right. We had employees and staff members, caregivers getting sick, caregivers who were scared because they're in the face of this virus all the time so when I talk about direct engagement with patients I'm really focusing on those caregivers as well.
The other thing that we did is really leverage our patient portal— helped us quite a bit as we were starting to get testing. Because what we found is that quickly people were calling in and overwhelming our phone lines just with follow-up calls like is my test available yet so being able to ensure that our process said “hey, you're going to go to the portal, you're going to get results there faster than we will see them you know before somebody can look it up they're going to go directly to you”. That helped a ton— it drove people to that forum freeing up the phone lines to be able to answer questions at a time where there was a lot of fear, uncertainty and doubt in the community. So from my perspective, that's really the methods that we were focused on.
Christine: Yes, and we're hearing that the portal numbers have really increased during this time frame and as you said a lot of it was to get your results and get it quickly and kind of see and do some communication. Let's pivot a little bit. So, now that the vaccine has arrived how are you ensuring that your patients are getting vaccinated?
Denao: Well that's been an interesting run as well. So, we started out with very little vaccine and really focused on those that were most at risk, right. So keep the caregivers healthy so they can care for others, so we spent our, I don't know, initial few weeks or month really focused on those frontline caregivers that were most exposed in our emergency department, on our floors, and our ICU's, and a lot of that was kind of into very individualized, right? We want everybody who is willing and wants to get the vaccine to come down at certain times.
After that, we started getting more vaccines and a wider group to communicate to so we ended up having people do self scheduling. Hey, you know, if you qualify under one of these criteria go to our patient portal go ahead and sign up you know get an appointment and that was a very smooth process which was good. People wanted to come in, they wanted to get the vaccine. The biggest delay, if you will, was having to wait 15 minutes to make sure that they could safely leave and not have some really big reaction to the vaccine. After that, we really made an effort to identify the patients that needed it, as well to develop a separate list. So as we started hitting an old elderly population as an example, let's say we had five doses left still short supply we don't want to waste any so you wanted a list of other people who qualified under the criteria in the state of Ohio that we could call quickly and say, Hey, can you be here in 30 minutes we need to be able to get this vaccine done before it expires and passes the time that we can keep it.
I'm proud to tell you that the team that was in charge of that so far we've wasted zero doses which is amazing from my perspective, and some of that was even key leaders in our environment literally walking the floors to find you know somebody from housekeeping or dietary who was willing to take it that maybe just didn't want it the week before so that's been really good. That's evolved quite a bit now so now when I look at how we're making sure patients are getting it. It's a lot of that community outreach again, right, we're working with the local health department as one example and cedar point has a sports center that's over 145,000 square feet in our community and so we've partnered with those organizations to have mass vaccination clinics. Older people can then apply. They can schedule a vaccine, come in and try to get the shots into as many arms as possible. So, it's really evolved quite a bit over time.
Christine: So, I understand that beyond administering the vaccine you are taking a unique approach at evaluating the vaccine's effectiveness. Can you take us through your analytics process?
Denao: There was a lot of apprehension, right, we've got a new vaccine. It's authorized for emergency use, you know it is working. Is it worth the risk, and we had a lot of people even internally, although I'm really proud to say that 80 % of our staff or more is now vaccinated, but we wanted to be able to put things out to say “Hey, is it really working? Are we seeing what we're hearing?” So what we ended up doing was tracking these types of things, tracking different demographics, and then when we saw somebody who had come up COVID positive, were they vaccinated, were they not vaccinated, and so we had all that stuff in our database.
It was nice to put it on our dashboard that our CMO could look at it. Hey, if somebody is post-vaccination and ended up coming up COVID positive is it a mild case, is it not a mild case, what does it look like in our community? It was really interesting because at first you know there were some people who thought, maybe we we don't care so much about that, we'll just kind of inherently know, but once we started producing that data and people started looking at it they really started diving in and frankly it drove a lot of confidence in the vaccine.
What we have found is after a couple of weeks of getting the second dose you know it's very rare that we've had anybody come up positive and when they have it's been very mild cases and again even after that first shot not many people who had been vaccinated got sick. We did have some initial cases where somebody got vaccinated after they already were positive and so we had to get through that and I think we were very fortunate and that none of our staff died from any of that type of complication but it was it was just a really neat thing to be able to provide that data, instill confidence and now I would say that the the wide majority of people in this community and especially in our health system are confident based on our local data.
Christine: How did you then communicate that back out to the community?
Denao: We've got a spectacular chief medical officer and when I say spectacular he's smart but he's also just very personable, great communicator. So we actually used him a lot to relay that message, hear the facts and doing that through op-ed pieces with our local media, doing it through interviews with the rotary and other local groups where he could get an audience. And they would bring him in and then also through our social media sites, local media and our marketing group but you know really what stands out for me is to be able to have somebody like him speak to these things in the community, be available for interviews, be available to talk just facts. No political insights, no personal insights, just here's what we're seeing and here's why we're seeing it. I think has proven very valuable in our community.
Christine: I do think people are looking for a trusted source for information so that's great that you have a leader like that within your health system. So, what is a poignant memory you will take away from this pandemic experience? Can you share something with us?
Denao: When we started vaccinating people you know we really started with the public, anyway when we started with the public it started with a an elderly population so the cutoff was 80 years old. So I volunteered to come in on a Saturday and help escort patients with a vaccination site. I you know again I had requested I don't want to be in charge of anything I literally just want to walk people to their seats, get them to the right place whatever I can do to help from that respect and I'd never seen that many of our greatest generation if you will kind of gathered in one spot and just excited you know to hear the stories of couples coming up that have been married for 50 years you know 40 years and they're they're getting this shot together and they're excited and thankful. Hey, I have the ability to get this and this is a big difference in my life. I haven't seen my grandkids in a year and I'm going to go visit them. I'm going to get this, I'm going to get my second dose and I'm gonna go thank you guys for what you're doing.
I just can't. I mean it gives me chills when I talk about how touching it was to see our community caring for our community and the real life impact. You know, most of us in healthcare are bogged down you know for so long on the on the sad side of these stories, right, where people are are not coming out so well, but to also be part of that giving new life and new hope to other people, that's not what a CIO gets to do very often right, like it was I don't know very touching and something I'll remember for the rest of my life.
Christine: Thank you for sharing that with us. So, we always end a podcast with a fun question. With the weather warming up in Ohio and more vaccinations being rolled out, it looks to be a good summer for many people spent outdoor with families what are you most looking forward to this summer? Any vacations, activities or projects that you're daydreaming about these days?
Denao: Some of my hobbies are just social distance by nature, right. I like diving, I like doing things that don't require crowds, but I also brew beer and I get together with quite a few people that are brewers and we have these contests and we haven't been able to do that. We haven't been able to get together, consume alcohol and lie to each other about our beer brewing capabilities and complement each other even when sometimes we just want to make each other feel good. So, if I'm looking forward to anything it's gathering back with that group to where you know we can we can let loose just a little bit and share in that type of camaraderie.
Christine: I think that's a nice way to end this podcast session. So, I thank you very much for joining us and sharing with us your experiences specifically over analytics in that command center.
Denao: Thanks, Christine, I appreciate the conversation.
Christine: Thanks for listening. Stay informed and subscribe to the MEDITECH podcast and be sure to check out our resource page for links from this episode. We'll talk to you next time.