Serving UHealth’s comprehensive network, which includes three hospitals and more than 30 outpatient facilities across South Florida, a team of information technology professionals provides innovative technology solutions and services in support of the medical and research activities throughout the entire University of Miami Health System. Known as UHealth IT, this group of about 270 individuals—including physicians, nurses, and pharmacists—remain focused on innovations in health care IT and ensuring the health system is at the forefront of new technologies that deliver better patient care, education, and research.
“In the world of health care, and particularly health care IT, what’s next is always evolving,” said Dr. Maritza Suarez, chief medical informatics officer. As a practicing physician who heavily utilizes UChart, Dr. Suarez understands the need to bridge the gap between the technical build—or programming and related activities in a software development project—and clinical application.
Even before the pandemic, and during some of the most crucial moments the past few months, the team at UHealth IT has worked alongside health system colleagues to build workflows, develop systems, and implement technologies that equip caregivers to do their jobs better.
Harnessing the power of technology.
Among their contributions to facilitate a rapid response to COVID-19, the business intelligence team created a leadership dashboard using Microsoft Power BI—a data visualization and analysis tool—which includes patient data from UChart that is refreshed every 30 minutes, as well as data from Florida county statistics. “The dashboard helps ensure that real-time data points are easily accessible and can be used to drive decisions which focus on optimizing patient care,” said Michelle Hurtarte, assistant vice president of finance and operations, UHealth IT. If an issue or question comes up, IT is on call to troubleshoot and answer questions regarding the dashboard.
With each system, application, or workflow that is implemented, training is required to ensure the clinical staff is able to maximize its time on the job. The UHealth IT training team—which consists of 11 employees—plays a vital role in supporting more than 13,000 UHealth employees and 1,300 providers. Shifting to virtual classes in less than 24 hours, the team utilizes webinar technology to conduct all UChart training for every newly hired employee who requires access to patient documents. During the past few months, the team has conducted more than 325 virtual classes for physicians, nurses, clinical staff, ancillary support staff, and non-clinical staff who handle patient registration, billing, and health information management, including cross-training. Additionally, the team has provided enhanced COVID-19 training for clinicians on new workflows created for the emergency department, inpatient units, call centers, and drive-thru tents.
Supporting telehealth.
“With the increased pace and pressure placed on everyone because of COVID-19, the training team has created, developed, and maintained instructional material for UHealth’s massive telemedicine initiative,” said Gloria Sanjur, director of training. The team created detailed, user-friendly instructional materials and videos to explain the process of connecting patients with providers during virtual visits, which has enhanced the new experience of telemedicine and increased satisfaction.
Since Jan. 1, UHealth has logged more than 70,000 virtual visits, providing patients with a safe way to receive medical care during the COVID-19 pandemic. “Telehealth is here to stay,” said Ravi Akkiraju, executive director of UHealth IT. “We are just scratching the surface and a lot still has to be done to completely utilize various technologies to provide a seamless service to the patients.”
In addition to virtual visits, the IT team made information more easily accessible to patients though the MyChart app, a mobile platform that allows patients to access health records and care information from anywhere. Utilized by more than 370,000 UHealth patients, the app allows patients to request or cancel appointments, share health information, connect to and learn about telehealth visits, pay bills, and communicate with providers, to name a few things.
Enabling safe, efficient patient care.
Through medical device integration in the hospital setting, critical information flows from the device into the patient’s electronic health record, UChart. “The goal is to have an automated, timely, and accurate patient data documentation flow, which saves valuable time on manual data documentation and increases the visibility of trending data through retrospective analysis of data event snapshots,” said Mary Stein-Ferrer, director of clinical informatics.
In the situation with acutely ill COVID-19 patients on ventilators, the remote data capture also allows close monitoring and management of the patient data without the need to enter the isolation rooms frequently. “The remote monitoring functionality allows nursing and respiratory therapists to closely manage and monitor COVID-19 patients on ventilators without having to be physically close, limiting the caregivers’ exposure to infection and reducing the consumption of personal protective equipment,” said Stein-Ferrer.
Read: Nurse manager offers a view from inside the UHealth COVID-19 unit
Getting the medical device integration system up and running at UHealth Tower involved preparing the patient rooms with the necessary hardware and network components, setting up each device, and mapping data points from the machine into UChart. In preparation for the pandemic, UHealth IT set up 133 rooms to treat COVID-19 patients, which involved integrating 102 bedside monitors to send patient vitals to UChart and configuring 79 ventilators, 59 anesthesia machines as back-up ventilators, 20 high-flow respiratory support machines, and 11 dialysis machines. Concurrently, the team installed 133 cameras—one per room—and deployed new technology to meet the remote alarm surveillance and monitoring needs of ventilated COVID-19 patients.
The medical device integration system removed duplicated effort of respiratory therapy technicians by automating the admit/discharge function. Once the patient was admitted and attached to the ventilator, the data capture was automatic at the centrally located workstation, in addition to being available in UChart for documentation purposes.
The team worked closely with intensivists Dr. Daniel H. Kett, Dr. Tanira D. Ferreira, and Dr. Hayley B. Gershengorn, who were advocates for adopting several additional features and expansion plans in the near future. These include expanding the technology to the intensive care units, setting up a command monitoring center in the respiratory department to readily view all ventilators throughout the hospital, and sending notifications to identified phone numbers or certain alarm alerts.
Read: Dr. Hayley Beth Gershengorn cares for the critically ill
“The University of Miami can proudly say we were one of the first Epic Organizations to implement Epic Monitor as a method of observing patients with airborne precautions from a remote workstation and in a time frame of 4 weeks when the initial plans were estimated to be 3 to 4 months,” said Thomas Benel, senior clinical analyst. “COVID-19 required a lot of teams to collaborate together quickly to allow this project to launch.”
Multiple system configurations provide clinical staff the ability to view a census of the unit or toggle through individual patient-specific information, including vital signs and lab results in a dashboard. At a glance, clinical staff members can view a patient's status using 10 camera/room feeds at one time and by accessing key vital statistics—including code status and infection, temperature, heart rate, blood pressure, and oxygen saturation levels. Camera operators can pan or zoom into a particular area of the room from their remote workstation and have two-way communication with the patient using built-in microphones. All camera feeds have encryption to prevent unintended access.
“The feedback has been positive as monitoring patients quickly without risking patient contact was important. The dashboard information with metrics and trends is also impressive,” added Benel. The team is working to scale the possibilities into ICU monitoring and remote sitter capabilities, which allow at-risk patients to be monitored remotely.
The team continues driving change in clinical practice and providing technology solutions. “Our focus is centered on anticipating the needs of our operational and clinical partners,” said Dr. Suarez. “Most recently, ramping up due to COVID-19 has shown us the importance and role of a technology push.”
