COVID-19 Best Operational and IT Practices

On 1/19 President Elect Joe Biden and everyone across the nation honored over 400,000 Americans we’ve lost to COVID-19. 2020 was an unexpected and unimaginable year. However, through these “tough times” we stuck together and united as a nation to fight against COVID-19. The battle is far from over, and as COVID-19 cases start to spike again for the second time around, MASC Medical wants to support healthcare organizations by highlighting a few COVID-19 best operational and IT practices pulled from government and top healthcare organizations.

Here are the COVID-19 best operational and IT practices broken down into 8 sections:

Clinical Screening –

• Incorporate COVID-19 updates to daily team meetings
• Include links to the latest CDC guidelines on website and patient portals
• Improve online clinical triage protocol by adding chatbots and a nurse triage hotline for patients experiencing symptoms
• Leverage chatbots and online questionnaires for screening patients booking appointments and seeking visit medical facility
• Educate medical staff by making learning tools and videos accessible
• Run analytical reports and algorithms to identify at-risk patients based on risk factors

Telemedicine and Other Virtual Tools –

• Coordinate virtual patient consultations with remote physicians within network or partner provider networks
• Utilize telehealth for ambulatory care consultations, admissions triaging, and “hospital care at home,” including:
  • Video, phone and text-based e-visits for patient triaging
  • Structured, clinical, protocol-driven screening capabilities
  • Remote monitoring capabilities (weight, blood pressure, temperature) for high-risk patients
• Utilize telehospitalist services for virtual patient rounding to minimize caregiver exposure to infected patients
• Utilize teleICU services for remote monitoring of the most critical patients to help reduce the threat to on-site ICU care providers
• Provide easy-to-navigate, user friendly online scheduling options for virtual/telehealth visits (internal and external) and provide instructions on what patients should do prior to visit
• Configure (including wireless access, network bandwidth, security and EHR access) adjacent/remote care sites and/or drive-through locations – separate from ED – for triage screening of patients with suspected symptoms

Capacity Management, Patient Flow and Infection Control –

• Identify a “Rapid Response Team” with physical or virtual co-located departments utilizing shared dashboards to identify bottlenecks and control patient flow
• Develop mandatory procedures to speed discharge of patients early in the day and on weekends, coupled with tracking/reporting of timely discharge orders
• Identify and flag EHR and on room-tracking/ED dashboards with diagnosed or at-risk/suspected patients
• Actively manage ICU and negative pressure rooms
• Create in EHR designated overflow/surge areas
• Leverage iPads, videoconferencing, hands-free technologies in inpatient setting for nurse-patient communication to minimize exposure to infected patients
• Implement a hand hygiene monitoring system to track caregiver compliance with handwashing
• Follow CDC guidelines when disinfecting COVID-19 rooms
• Update capacity management system with COVID-19 disinfecting protocols
• Convert unused rooms to hold ICU beds with requisite IT equipment etc.
• Limit the number of entrances to medical facility – screen everyone coming into the building – conduct drive through testing at hospital for staff every 15 days (if possible)

Network Infrastructure, Security and Other IT Support for Command Center/Response Management, Collaboration and Remote Work –

• Provide real-time emergency response communication tools (email distribution lists, asynchronous text-based provider messaging etc.) for targeted/segmented communication to managers/caregivers/stakeholders
• Configure Command Center with application access, projection equipment, service desk support, access to clinical triage, telecommunications tools, incident tracking and knowledge database/portal
• Automate Command Center/emergency response dashboard with stats for:
  • COVID-19 patients
  • Appointment volumes
  • Ambulatory visits
  • Telemedicine visits
  • ED visits/turnaround
  • Admissions/discharges/transfers
  • Laboratory test volumes – including positive/negative COVID-19 results
  • Portal visits/queries
  • Phone calls – including hold times, abandoned, time to resolution, resolved on first attempt, requiring nurse triage
  • Appointment cancellations/no-shows
  • Critical inventory supplies
• Increase network bandwidth and remote access licenses to accommodate employees working remotely
• Reconsider employee usage of cellphones, including data limits
• Reconfigure at-home workstations for employees including a dual-screen setup (if possible)
• Configure IP addresses to allow remote employee access to secure websites of vendor partners
• Configure laptops to support remote work, including access to shared drives, secure intranet and instant messenger
• Provide online tools to support team collaboration, group presentations and team chats – including training and tip sheets for employees not well-versed in these tools
• Increase security monitoring for fraud, network penetration
• Create updates/alerts for employees regarding security penetration risks

Workforce Communication –

• Keep your communications clear, concise and fact based (information overload is a real risk)
• Establish a communications cadence and centralized distribution plan so information-sharing occurs on a regular, predictable schedule
• Identify what you are intending/needing to communicate in a given moment, state that up-front and then stick to that message to avoid confusion
• Include a few key points with links to more detailed materials/information
• Consider alternative ways of sharing information with frontline healthcare workers – recognize that they are exhausted and providing direct patient care so lengthy communications might not be the best option
• Consider creating a daily newsletter, email, internal portal communication or WebEx/teleconference
• Implement text communications/alerts
• Develop policies and procedures for the use of tools while working remotely
• Create an employee hotline for questions

HIM/Coding, Patient Billing and Payment –

• Configure a temporary “bill hold” for COVID-19 cases (pending federal mandates/legislation)
• Provide remote access to payer systems for eligibility, authorizations and referral management
• Provide remote access to coding tools
• Implement a process to rapidly assess financial risk – use model scenarios with variations based on:
  • Inpatient and outpatient volume
  • Changes in payment patterns relative to patient balances
  • Increase in premium staffing when/if surge comes
  • Changes in elective vs. nonelective procedural volume
  • Potential expense related to new labor laws
  • Likely implications to cash balances (e.g., access to cash)
• Provide real-time, remote work-queue assignments, management/reporting of backlogs, and resource supervision of HIM/claims edits and follow-ups
• Create a redefined workflow and scanning/imaging tools for lockbox/check payments

Supply Chain and Staffing –

• Be flexible with labor resources and provide access to on-demand resources to support necessary functions during surge
• Free up clinical resources from nonessential tasks to provide direct patient care
• Review and reset of trigger points for automated supply reordering – including increases in on-hand inventories
• Setup temporary, secondary inventory locations
• Reconfigure distribution channels to accommodate changes at GPO/distributor, secondary inventory locations, and intra-system movement of supplies
• Provide remote access to time-and-attendance system for workforce scheduling and timesheet submission
• Tightly manage PPE
• Develop strict protocols requiring PPE at all entrance points

Appointment Access, Management –

• Update website, portal and phone triage messaging regarding when not to come into the medical facility
• Configure phone system to “forward to” more than one number for remote coverage
• Update scripts for Access/Call Center, reception desks, and access/appointment personnel regarding appointment cancellations, clinical screening, and hospital/clinic visits
• Automate outreach to scheduled patients to postpone nonurgent appointments, virtual/online alternatives for care (if available) and provide instructions for arrival to medical facility
• Utilize chatbots for automated patient assistance with questions and appointments
• Utilize remote third-party resources to support triage online appointment requests
• Provide real-time, remote work-queue assignments, management/reporting of backlogs and resource supervision of online access queues

We hope that during these uncertain times, these best practices provide your medical organization with more guidance as we continue to battle the COVID-19 pandemic.

Visit our COVID-19 page for some of the latest information regarding the virus. And, don’t forget to check out other MASC Medical infographics, guides and resources for healthcare organizations.