Ready for anything

View This Article in BOSS Magazine

How crisis propelled one of California’s most innovative regional healthcare systems into a stunning and swift transformation

Digital journeys can be multi-headed hydras under the best of circumstances, but when disrupted by a global crisis, the well-prepared can use the cataclysm as an accelerator and excel beyond their own expectations. That’s what happened when COVID-19 descended on MemorialCare, one of California’s premier nonprofit integrated health systems.

Listed among the nation's Best Health Systems and Best Workplaces, MemorialCare has more than 225 care locations in a catchment area that covers Orange County and parts of Los Angeles County. The system encompasses MemorialCare Long Beach Medical Center, MemorialCare Miller Children's & Women's Hospital Long Beach, MemorialCare Orange Coast Medical Center, MemorialCare Saddleback Medical Center, and a host of outpatient surgical, imaging, breast, physical therapy, dialysis urgent care, and health centers. They also provide ambulatory clinical services in Los Angeles and Orange Counties through MemorialCare Medical Group, a 300-plus multi-specialty medical group and Greater Newport Physicians IPA, the longest-running Independent Physician’s Association in Orange County.

To encourage the growth of innovation, the MemorialCare Innovation Fund invests in privately held companies offering solutions to healthcare’s most pressing problems, such as digital healthcare transformation specialists Avia. The technology-forward system also uses Epic’s intuitive interactive myChart patient information system.

As a regional healthcare system, MemorialCare’s innovative approach to quality care provision is a standout, making the process of caregiving simpler, faster, efficient, and more affordable, ensuring that every patient receives the precise care they need at the moment they need it most.

The organization’s digital journey began when the demands of growth created an opportunity to support their clinicians and patients with leading-edge technology, starting with behavioral health.  As the organization looked to extend the reach of their specialists to each of their primary care offices, they soon found that not every office could have its own specialist. To compensate, they laid the groundwork for virtual access and offer patients access to a self-guided online adjunct to the care being delivered through in-person visits.

The project led to the formal development in 2019 of MemorialCare’s digital strategy, and the creation of a digital roadmap and three-year implementation timeline. The plan included the construction of a digital front door designed to give patients more pathways for seeking and obtaining care, including remote access to clinicians through virtual visits. The soft launch of the virtual visit program was planned for late 2020, with a full rollout planned for mid-2021.

COVID’s March 2020 arrival upended those plans, shuttering offices and drastically limiting access to onsite care. Undaunted, the MemorialCare team devised a plan to rapidly deploy the virtual program. “When we realized we had to expand and have virtual care available across hundreds and hundreds of doctors, we already had some tools that were well along in development. We just needed to change the way we were using them,” revealed Adam Solomon, MD, MMM, FACP, Chief Medical Officer of MemorialCare Medical Foundation.

By leveraging the infrastructure they’d built for virtual behavioral health access, MemorialCare rolled out the broader virtual visit program in just a few days.

The concurrent avalanche of calls from worried patients prompted another fast move. “After launching the virtual visits, we quickly brought on an AI-powered chatbot to help answer patient questions and triage patients in need of care,” Solomon said. “We had a chatbot or some kind of texting function as part of our roadmap, but that wasn't supposed to happen so quickly. The chatbot became a big part of our digital front door.”

MemorialCare’s embrace of Lean principles, which they’ve been using for more than 15 years to reduce waste and improve quality and patient outcomes, helped the group through a series of rapid cycle changes. The team drew up a high-level list of system priorities, at the top of which was patient and staff safety, and then established a command center with high-level representation from each discipline. A single contact number and email address enabled anyone in the system to notify the command center of a question or issue, to which leadership would respond in real time. Daily communications to staff and physicians kept everyone informed throughout the pandemic.

As patients flooded the system, three types of emergency room cases emerged: patients highly suspected of having COVID, those whose symptoms were unlikely to be COVID, and those whose diagnosis was unclear. To accommodate them, MemorialCare redesigned the flow in one of their ERs in a matter of hours.

“Overnight the team in the ER evaluated how they would approach all those cases,” Solomon said. “When patients came to the front door or were brought in by ambulance, they went through the protocol. After a day or so we realized how it was going, made some tweaks, and then we rolled that out to our other emergency departments.”

Solomon credits the organization’s approach to Lean, their ability to prioritize quickly and clearly, and their safety mindset for keeping the system optimally equipped throughout the crisis. “There was never a time during this entire pandemic that staff and physicians had to worry about having PPE or safety equipment. We always had an adequate amount of supplies so they were always able to focus on patient care,” he said.

In the planning stages of MemorialCare’s digital journey, a host of needs and options were considered, from patient navigators to the ability for patients to communicate directly with care providers via text. “We looked at the landscape of what was available to help with these kinds of solutions and all of the potential vendor partners were good at something but not good at what we had envisioned overall,” Solomon said.

To compensate, MemorialCare engaged two companies to co-develop a solution that could cover initial patient intake and triage. If the patient’s care could be managed through texting, the AI-powered system would immediately and seamlessly enable that option.

“AI is able to develop the likely diagnosis and treatment options,” he said. “Once that’s completed, AI prompts the provider with a detailed patient history in a structured note. It offers the clinician the opportunity to quickly review the details, select a treatment option and with a couple of clicks on the tablet or smart device, boom, the prescription gets sent out to the pharmacy, or whatever needs to be done gets done.”

The patient gets a quick and easy solution and the AI chatbot writes the whole note for the provider.

Solomon added, “The breakdown of care coordination and the risk for missing pieces is less likely if you have everything tied together in a system that focuses on simplifying access to care and providing your full spectrum of needs.”

The blend of technology and the system’s proven approaches to integrated care will provide significant benefits to the communities they serve for many years to come.