JUNE - 20219Workflows for remote employees had to change to ensure compliance with all aspects of HIPAA, going well beyond cybersecuritybeyond cybersecurity. Picture an employee office or a cubicle. There will be a computer and ­ no doubt ­ different piles of paper and filing cabinets. That may be fine from a patient confidentiality standpoint, as offices are likely to secure areas. Many cubicles are in areas where the potential to see confidential information on paper documents can be easily controlled. Alas, not so much in home office environments. Extra care must be taken to keep paper out of the home office environment, so family members or other unauthorized eyes do not inadvertently see protected health information. Policies about printing have to be re-examined. So it is a huge deal and one that hospitals have had foisted upon them rather abruptly earlier this year. Another thing that changed almost overnight was having physicians embrace telehealth virtual visits through smartphones, tablets or computers. Since patients were very reluctant to come to hospitals for care in many cases, CMS relaxed many of the limitations previously in place for reimbursement for telehealth visits, which catalyzed virtual visits almost immediately. From an IT perspective, the right telehealth vendor had to be selected, configured, and workflows had to be established to allow providers and patients to get the most out of the virtual face time by making sure the connectivity worked by setting up reminders of the upcoming visit for the patient, and other things. The advent of telehealth also meant having to purchase webcams for computers that previously lacked them. We have said in jest that webcams were the "toilet paper" of the early stages of the pandemic-- flying off distributors' shelves and thus IT departments had to be creative about how they procured these badly-needed webcams.Along with the surge in COVID patients came requirements for reporting to different governmental agencies, each of whom had their own methodology for reporting that had to be adhered to precisely. Those requirements also changed with some regularity, further exacerbating the pressure being borne by already stressed-out caregivers. There were mandates from different sources to report on a number of tests, number of positive patients in-house, in the ICU, on ventilators, and also to report on inventories of PPE on-hand. There were separate mandates to complete applications for different Federal funding programs (and, yes, we are all grateful for having access to those programs during these extremely difficult times!). And that only spoke to the external reporting requirements. Internally, hospitals had to have easy-to-digest dashboards to help drive their ongoing care processes in near-real-time and the wherewithal to communicate and act upon any situations shown in those dashboards that would merit attention.Possibly the biggest COVID-related challenge with the potential for the most long-term adverse consequences is the immense financial impact felt by hospitals. It was because of the mandates to suspend elective surgeries to allow for medical resources to be optimally deployed to the wave of COVID patients arriving at hospitals. Elective surgeries are the "bread and butter" to most hospitals' bottom lines, and having those cease or be sharply curtailed meant, in essence, pulling the financial rug out from under hospitals just as they are being hit with overwhelming overhead in taking care of patients in a pandemic. While hospitals did get assistance from some of the COVID-related Federal programs, for most, it did not come close to covering the out-of-pocket hit hospitals took and many hospitals, especially rural hospitals in underserved areas, are in tough situations as far as continuing to be able to take care of patients as they historically had. We are not out of the woods yet as far as this pandemic goes, and many of us are still right in the peak of things. We learn more every day about the damage the COVID virus does across so many different dimensions, and we are hopefully learning to react and respond in ever-improving ways to continue to serve our communities during these challenging times.
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