It started with a call. When Sally Turner picked up the phone on March 12, 2020, she was asked to help open two new testing sites for COVID-19: one at Lions Gate Hospital, the other at St. Vincent's: Langara. But it was Thursday, and the sites needed to be open by Sunday. What would normally take three months had to be done in three days.
"That was a crazy time — it felt like activating a CST go-live with no warning," said Sally (pictured on the right), Executive Director with the Clinical & Systems Transformation (CST) project. "I think our previous experience with high-pressure implementations helped the project come together quickly to develop an overarching solution for testing centres to operate within the CST Cerner system."
To help with urgent changes, around a hundred team members moved to an on-call schedule to support 24/7 coverage, and tackle new challenges and opportunities related to COVID care delivery and operations.
Sites live with CST Cerner across VCH, PHSA and PHC — including larger sites like St. Paul's Hospital and Lions Gate Hospital — needed to leverage COVID-related information documented and stored in the electronic health record. Shortly after the testing sites opened, the project implemented new COVID diagnoses, clinical documentation elements related to screening and symptoms assessment, and the creation of COVID-specific units and locations, in the system. This work enabled the creation of reports to rapidly identify COVID patients and their corresponding locations.
"I think part of the reason we were successful was our ability to leverage our existing enterprise solutions and clinically-led governance structure. Requirements were quickly gathered and options were presented to regional leadership to support decision making and so that we could roll this out in a timely manner," said Sally.
Two unintended benefits that became game changers
Since March, two major benefits for patients and caregivers emerged at live CST Cerner sites that no one expected.
The first was contact tracing. Typically, if a healthcare worker or patient is positive for COVID-19, it can be challenging to do contact tracing on all patients or healthcare workers who have been exposed. In acute facilities, CST Cerner made this much easier.
In the system, caregivers have to self-identify a relationship with every patient to access their clinical data. The system also stores the patient's location as they transition across care settings, as well as who has accessed the patient's chart, and other patients who have been registered in the location next to those patients.
"One of the benefits of the system is its innate ability to support contract tracing through capture of discrete information. It was amazing to see how quickly we were able to generate data required to support clinical care and operational decision making," commented Sally.
The second major benefit was the ease of moving to a virtual health environment in CST Cerner. In particular, remote access allowed providers to use the same functionality and workflows they were familiar with, from home. This included completing a comprehensive chart review, writing prescriptions, generating lab and diagnostic requisitions, and creating documentation that distributes to CareConnect and to the patient's GP via Excelleris.
"This isn't true for many facilities [who don't use a shared electronic system] where documentation is on paper and you need access the paper chart for viewing clinical information and creating paper prescriptions and requisitions. The ability for clinicians and patients to participate in their care from home has resulted in overwhelmingly positive feedback," said Sally.
"Whether patients come into our hospitals or stay at home, our goal is that the workflow still meets the KPIs, or key performance indicators, of the project. And I think we were able to achieve that."
Better together: how the team helped CST Cerner sites join forces
As COVID-19 requirements were identified across the region, through May, CST leaders held daily sessions with site leadership and clinical informaticists to prioritize requests, discuss options and provide updates.
Bringing three organizations to the same table to find solutions is what the CST project has done since the beginning. This need for regional decision-making became heightened during the crisis.
"Historically, in these types of situations, the sites move back to working more independently," Sally explained. "But we're often able to collaborate on solutions that work across the board so that they can benefit from one other, and to create a more manageable workload for all involved."
Furthermore, while the CST project has historically focused on acute and ambulatory care settings, Sally mentioned that the pandemic highlighted the need to expand workflows into the community. This expansion resulted in new touchpoints with community and primary care stakeholders.
"It's all about sharing information. Improved continuity of care is supported through shared access and ongoing management of patient information [by the appropriate clinicians] — regardless of where the patient is seen."
What CST means for COVID and the future of healthcare
It goes without saying: our world will never be the same. COVID-19 has turned our lives upside down, and many changes we've made during the pandemic are likely to become the new normal.
For Sally, her ultimate goal — why she joined CST — is to advocate for patients, like her daughter. Her daughter has special needs and, as a result, requires regular check-ins with several specialists across many of the CST sites. When those consults went virtual during COVID-19, it was a huge benefit.
"She hasn't had to go anywhere," said Sally. "For people who have chronic conditions, it's actually quite hard to make it in to a doctor's office just for a consult. There's also a clinical risk sitting in a waiting room with other people who are sick, when you're just going for a consult that doesn't require you to be there in person."
For years, Sally carried around a folder full of information to her daughter's appointments at BC Children's Hospital, Vancouver General Hospital and St. Paul's Hospital. That folder contained critical details she needed to repeat at each site, because they weren't on the same system. With CST, they will be, and that's why Sally is hopeful for the future.
"It's funny: I came from banking, but I switched over to this world because it had more benefit to me and my daughter, really. Given the amount of effort I put into finance and all I did was made more money for banks, I figured I might as well help here, where it matters."