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Global lessons learned in responding to an unprecedented crisis – the next phase

As of Fall 2020, we’d seen 37.5 million COVID cases, and 1 million deaths, all over the globe. In these conversations, clinical leaders weigh in on their organizations’ responses to the pandemic, their perspectives on IT infrastructure and supplier support. They discuss the unique regional challenges they faced and the surprising lessons that are globally applicable.

The following clinicians saw COVID enter their region after others had been impacted. They share the crucial steps they took to prepare for the virus, based on what they observed.

Trevor Lee, MD, Digital Health, Shared Health Manitoba CMIO (Canada)

As COVID was emerging, we watched what happened in places like Toronto, and were therefore able to respond in advance of the first wave in Manitoba. For the first time, we initiated a province-wide command structure, utilizing our network and data to track how the virus progressed. We moved quickly to virtual solutions and more effective communication channels.

Our major unexpected issue was with respect to hospital bed-map capacity and reorganization. We needed more ICU capacity, particularly to allow for the separation of COVID positive from COVID negative patients. As more testing sites developed, and more public health measures were put in place, patient flow increased back into the hospital, helping us move through our backlog.

I was impressed with the response of our vendors, both IT and suppliers. A major improvement in our communications efficiency occurred when we implemented wide-scale secure-texting for clinicians. While we had to work to procure enough hardware like laptops initially, our system supported our increase in teleconferencing, expanded telehealth options, and accelerated plans to make the inpatient electronic record more available at larger tertiary care centers in the Province. dbMotion particularly worked as expected and helped us to coordinate across the Province.

I’m looking forward to seeing how these new measures will continue to work in the future. I think a vaccine will be essential for returning us to normal, but meanwhile we will focus on rapid testing and continued public health measures to keep our COVID response functioning well.

Vern Behl, MD, Saskatchewan Health Authority, Senior Medical Information Officer (Canada)

We also saw how COVID impacted other locations and had time to consider our own strategy. Still, it was a quick change, and we weren’t fully prepared. We were already managing our transition to Health Authority, and had to speed this up to ensure we were getting information to potential patients.

Those patients then had to learn new ways of connecting with their providers. We struggled as our nurse support line at first lacked capacity. Videoconferencing had the same limits, though we could eventually provide a single solution to everyone in the province. It was exciting, actually, to start off with limited technology.

We had to be nimble, agile and ready to change on daily basis. Constant communication was key, as we managed PPE and worked through a number of scenarios involving different technology and platforms. For those solutions, we went from 50 licenses to 2 or 3000 of them in the space of a couple weeks. We always looked for enhancement opportunities.

It’s been crucial for us to send and receive testing data and maintain information flow overall. People across the board must understand what’s going on. I foresee this kind of management among health providers, along with continued precautions against COVID among the population, to continue and be improved, while working on vaccine distribution.

Neville Board, RN, BA, MPH, FACHE / Department of Health and Human Services, Victoria, Chief Digital Health Officer (Australia)

Australian governments kept a close eye on the pandemic’s impact in Europe and North America. Many of our doctors had close ties with UK colleagues, and we were aware of the high hospitalisation and ICU admission rates there. Australia’s response focused on limiting inbound international travel, increasing social distancing and launching pro-active testing programs, including mobile sites in high risk areas. Each state has accountability for its public health system. Due to the different rates of incidence and prevalence of COVID-19, state borders became significant in a way they hadn’t been for a century. When Victoria’s second wave started, New South Wales and other states closed their borders to Victorians.

Overall, the Australian response was effective, and we saw lower numbers of cases, hospitalisations and ICU admissions than most other OECD nations. Victoria’s second wave, starting in late June, had a higher impact on privately operated residential aged care facilities and a period of significant community transmission. A harder curfew and restrictions on local movements and workplaces was put into place. A partnership between state and private hospitals ensured both were resourced to maintain capacity, while elective procedures were severely limited. ICU capacity was increased. Private hospitals also absorbed some residents from care homes. We all worked to speed up notification times, manage isolation and categorize patient risk level to distribute our clinicians’ attention. As COVID protocols shifted over seven or eight months, hospitals continued adapting their services with agility and speed, including establishing hospital care in the home and remote monitoring for COVID positive cases.

Throughout, our suppliers put their energy and skills into offering tailored support. Most EMR vendors had developed COVID-specific modules or protocols. Our telehealth consults with patients from hospitals, community services and GPs went through the roof.

It’s clear the virus isn’t going away. Victoria is now experiencing a second wave, which accounts for most of Australia’s deaths. But we’ve progressed from where we’ve started and are committed to quicker acute and primary care acceleration. Infections like the flu have also decreased dramatically.

In the future we’ll also focus on supporting more virtual care and creating an effective blend of onsite and remote support for patients, especially for the elderly and frail, and those who risk infection from working multiple jobs. We have the foundation to manage this going forward.

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