Question: Thank you for making time in your busy schedule to talk. How prevalent is Covid-19 across the communities Novant Health serves? And, overall, are your Covid-19 volumes going up, going down, or plateauing?
Eric Eskioglu: We've been aggressive on testing. We've now tested over 59,000 people and have a positive test rate of around 10%. System wide, we have successfully admitted, treated and discharged over 1,000 moderate to severe Covid-19 patients. Sadly, we also experienced a very small percentage of inpatient deaths.
But I want to unpack this overall data for you. We have a robust data analytics and predictive modeling team here at Novant Health. In the very early stages of community spread, we built a Covid-19 interactive dashboard to display useable, real-time data at the system, region, facility, and clinic levels. The system-level data masks significant variation in what local communities are experiencing at different points in time. Drilling down just one level, you can see that each of our four regions are at different stages of the pandemic. We're past peak in Charlotte, just recently peaked in Northern Virginia, and starting to peak in the Winston-Salem, NC, area. In even greater contrast, Rowan County, just north of Charlotte, has largely been steady.
We're now working to better understand why disease transmission has followed such a different arc in Rowan County, but my more immediate point is that this disease is following different paths in different communities. And having a clear, real-time window into these differences—where the peaks and valleys are—can really help systems ensure that needed resources are available at the right place at the most critical time.
Question: So this dashboard enables you to see real-time numbers on Covid-19 patient volumes down to the facility level. Are you tracking supplies and staff the same way?
Eskioglu: Yes. Our data and analytics teams incorporate bed type into the dashboard so I can readily see how many available ICU beds we have at any given time, broken down by individual hospitals. The same goes for supplies ranging from ventilators to IV pumps and even staffing and pharmaceuticals.
So, for example, when I click into Prince William Medical Center, one of our hospitals in northern Virginia that's recently been inundated with Covid-19 cases, I can see they're really close to maximum capacity. They still have an ample supply of ventilators but are down on IV pumps. I can then readily scan the rest of Novant Health's facilities for available IV pumps and shift physician resources as needed throughout our system. Using the dashboard, we've been able to anticipate shortages in not just IV pumps but also ventilators, IV drugs and staff, and preempt them with real-time shifting of resources elsewhere in the system.
Right now hospital supply chains are badly stressed; some would even say broken. That is not the case at Novant Health. At no point have we been at risk of running out of ventilators, IV drugs, IV pumps, PPE, or other resources at any of our facilities. Interestingly, we just announced that Novant Health received a part 107 first time ever waiver from FAA to operate fixed wing Zipline drones to transport our PPE from our distribution center to our facilities—making it easier for us to have just-in-time supplies on hand. We are planning on deliveries of pharmaceuticals with a radius of 50 miles soon. This transformational medical supply operation was made possible by an unconventional partnership with Novant Health, NASCAR Stewart-Haas racing team and Zipline.
Again, a big part of the story behind this accomplishment is our ability to anticipate any potential shortages with sufficient time to shift supplies and staff from valley areas to peak areas, and it's advanced data and analytic capabilities that have made this possible.
Question: You mentioned shifting drugs, vents, and staff. Have you shifted patients too?
Eskioglu: No, we really haven't shifted patients, in large part because early on we took a different strategy for where to treat our Covid-19 patients. In January, we decided to cohort Covid-19 patients at four hospitals, one in each of our markets. Our aim was to focus our Covid-19 expertise and capabilities while keeping our other hospitals largely free of Covid-19 and safer for other patients. I'd estimate about 90% of our Covid-19 admissions went to one of those four hospitals.
Question: That's impressive—you started in January, built a Covid-19 dashboard to shift resources real-time, cohorted patients by facility. You did a lot of things to get far out in front of problems you saw coming. Looking forward, how are you thinking about reopening?
Eskioglu: That's an important question. We know Covid-19 is not going anywhere anytime soon, so we need a system that naturally flexes capacity to safely treat new Covid-19 patients as well as all of our other patients who need care.
Overall, we divided elective procedures into four levels that we phased in over time. Level one is outpatient surgery, where the patient goes home after the procedure. The second and third levels include patients who will stay at least two to three days. The fourth level is patients who need complex procedures like open heart surgery and brain surgery, and we know will require ICU care.
We're aiming to complete all backlogged cases as quickly as possible. There are two key data points we're watching to know when to open up facilities or pull back: personal protective equipment (PPE) and Covid-19 caseload. We decided that a region must have at least 30 days of PPE supplies in hand at any given time and that Covid-19 cases cannot exceed 50% of ICU capacity. We apply these criteria at the regional level. For instance, Northern Virginia is only at a level 1-2 because Covid-19 cases just recently started to decline.
Question: Once you've said to a region “you can now go to the next level,” how does that get implemented at the facility level?
Eskioglu: The system gives the green light to a region to reopen and move up the four levels, but each facility has ample local control and latitude to determine how to prioritize surgical cases within each level. Working together, our facility leaders and physician-led institutes have mapped our different patient types to one of the four levels. Individual facilities then decide the time sensitivity of cases within each level and schedule them accordingly. In general, most of our facilities have grouped procedures at each level into two groups: more urgent and less urgent. But again, we entrust our individual facilities, who are far closer to the patients, with determining how best to schedules patients within a given level.
Question: So you've got your reopening plan in place, but what about the fear and anxiety being expressed by non-Covid patients about coming back into facilities that had been closed off to them for safety reasons? How is Novant Health thinking about that?
Eskioglu: We believe our decision to cohort Covid-19 cases in just four of our hospitals will help along with visitor restrictions and other PPE requirements to enhance safety measures. We launched a campaign just last year specifically focused on patient safety. However, yes, this is a real concern, and we're being really intentional about safety measures to minimize the threat of Covid-19 transmission.
We're using hydrogen peroxide misters and UV lighting to clean our spaces. We're taking temperature readings of everyone who walks through our doors. We've put universal masking policies in place to ensure every team member and patient is masked and are practicing social distancing in all ambulatory clinics. And this is just the beginning. How we keep patients safe is going to continue to improve. For example, we're now working toward touchless patient interactions whenever possible, such as virtual care.
We are running a tight ship with a sharp eye on safety and quality. This includes safety of not only patients but also all our team members. But it's not just about the number of safety measures your system puts in place. Ultimately your patients need to feel safe, and that's a much tougher line to define. There are some people who are inherently less fearful and others who are very fearful. And making this second group feel safe will require ongoing community education and time, along with a spotless track record.
Question: You just mentioned touchless care. Are there other big, and hopefully positive, changes in health care delivery you think this pandemic will cause or speed up?
Eskioglu: The obvious answer is telehealth. Both physicians and patients are getting used to telehealth. Imagine—why would you want to drive an hour round trip, wait with other sick people in a clinic setting, and risk getting infected? I think a lot of people won't want to do this anymore now that they know another alternative is available. I predict that 20 to 25% of patients will want to continue seeing their provider virtually.
This, in turn, will impact the physical footprint of health systems. The economics of large brick-and-mortar investments in our increasingly virtual world is challenging, and we are constantly evaluating the best approach for our patients' needs. This may lead to downsizing the physical footprints of some of our clinics.
Another possibility is that AI applications for medicine will mature faster. I agree with your point that the economic fallout may force many clinicians to delay retirement and create a bubble of available labor. But this bubble will burst with so many clinicians feeling burned out and wanting a break. In fact, Novant Health recognizes the burnout and has invested heavily in physician resiliency. AI technologies show promise for not only better diagnostics, but also enabling clinicians to practice more efficiently.
Lastly, let me squeeze in my hope that healthcare applications of 3-D printing will mature faster too. Covid-19 spotlighted just how easily the supply chain can be disrupted. Novant Health, along with a number of other health systems, have turned to local 3-D printing for needed supplies. I envision a world in which healthcare systems can design and quickly mass produce the supplies they need without having to scrounge all over the earth for items like face masks. And looking a bit farther out, I hope our maturing 3-D capabilities extend to the production of precision medicines.
So I believe there's a lot to be hopeful about, but we must find a way through the immediate crisis to reach this future.
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