#09 - Critical Resources Tile

Jeff: Hello and welcome to today's webinar. I'm Jeff Terry. We'll talk today about the Critical Resources Tile.

There are two versions of this, one which does not require PHI and is used in regions taking data from different health systems. And the other, which does require PHI and is usually used within a single health system. We'll focus on the regional version today, although they are quite similar.

This Tile is in use at 168 hospitals in North America and Europe. It was built for Covid. It's all about making it easy to see the status of our critical resources, beds, ICUs, ventilators in some cases, COVID-19 hospitalization, so that we're not clicking around or looking at outdated information or looking at manually-reported information, but instead, we have realtime or near-time information that's reliable and pulled right out of the source systems in a very easy way. By going to the Tile, showing an example from Oregon, which really pioneered this. This is in use at about 60 hospitals in Oregon.

The data here is not real, but it is representative of what you might see in practice. In this column, you see the State of Oregon, and out to the right, you see the different American trauma regions, that's how Oregon is divided up by the American Trauma Association. We can divide it up differently. Let me just walk you through it a bit. Of course, up here I can sort of group it different ways. I can see all, which is adult ICU, PCU, Med tele, peds, OB, NICU, psych, rehab, adult obs, negative pressure, vents, ventilators, or I can group it. The most common grouping would be just to look at adult.

If I go down the rows you see, again, the total beds and then those different breakdowns of the adult ICU, PCU, down to NP and vents. Then in each column, what am I getting? Well, I know there are now 1,956 beds available in Oregon, adult beds. There are 3,433 that are occupied. Then within each of these quadrants by region, I can see the same. Unoccupied capacity in that region. We break out the negative pressure, so 129 negative pressure beds are available out of 353 total, the census.

All the same for the different bed types, and then the ventilators is a little different. So we have 505 ventilators not in use, 155 ventilators in use, and you can see the breakdown across the regions. Now, what's nice about this, in the case of Oregon, it pulls from 20-something different EMRs in one health system. We're pulling from 14 different EMR instances from three different EMR providers all in the same health system, but they see something here that's no harder to learn and navigate than Uber or anything else. Like any Tile, of course, I can go to the settings button and navigate around that way. I can save my settings so every time I land on the tool, it's configured the way I want to see it. And then it's just very easy to navigate around.

So I've drilled into the Portland region. Again, data is not real, but you get the idea. Then you can see the breakdown for the health systems in Portland. I can drill into the OSU health system and see the three OSU hospitals.

I can drill even down into that hospital to see the different adult ICUs. Well, there's three unoccupied ICU beds in that unit. What are they? There are two ICU beds in use on that unit. What are they? So very easy to navigate, as I mentioned, you can also navigate from here. But super-easy to click around. I also get definitions behind my info button. So what hospitals participate and what are the different symbols and statuses mean? Obviously, the thresholds and things are all configurable for when these different dials turn green and yellow.

In the case of Oregon, or actually frankly most of the organizations that use this Tile will publish a once-a-day report that's pulled off the backend that gives a snapshot view of the state of the beds and the ventilators in the region or in the state or whatever it is. Because again, what we have here is all in real time. So what's the realtime status? The original use case for this was in Oregon.

OHSU really pioneered what turned into this Tile that's now in use around the world. The original use case was to have a switchboard with an intensivist, an advanced care practitioner that would be allocating patients and maybe caregivers or ventilators between the different hospitals in Oregon and even the temporary hospitals that were being built. So to do that, if you get a surge, you have to have realtime, reliable information, and that's what this was built to provide.

So that's it. In use at 168 hospitals. Takes information out of all these different EMRs, all these systems in real time to tell us how many ventilators are in use, how many are available, how many ICUs are in use, how many are available, how many beds of all types in a way that's real time with data that's fully-automated and reliable, and therefore we can make decisions on.

Thanks very much for joining today.

Dr. Merkel:

If it works at our health system for 4 different hospitals to organize us and help us to get the right patient in the right location to the right team in the right time, this might be very helpful in a pandemic situation where you have a massive amount of patients in many, many areas and essentially just have that multiplier around that.

And this really, this idea in the first 2 weeks of Covid-19 arriving in our state, it became very clear that as part of our preparation plan, we need real, live data who are not depending on people communicating with each other, because if the surge comes, we don’t have that bandwidth to do this. And in collaboration with GE HealthCare in this setting, we're kind of like, “Hey is that an idea, is that something you can actually operate in a very short period of time?” because it was like, "This is not what we need with 6 to 9 months lead time, we need it now. And from the initial idea to the first data was 14 days.

And within a 3 week period, we were above 80% of our statewide beds being visible on an electronic tracking board using the technology we used in our Command Center. So that kind of really allowed us to create something pretty unique, which is updated every 5 minutes to kind of create that.

Getting all of these various health systems together was possible because of Covid-19. Everybody faced the same daunting ideas like, how do I make sure that I don’t make isolated decisions regarding ‘Do I have a ventilator? Do I have an ICU spot? Do I bring a patient in on non-ICU, but they should be in an ICU?' while some were in Oregon, there might be an ICU bed still available, very appropriate for this patient.

Mikey Kay:

If there were 3 things that you could implement across the United States, in terms of ameliorating the effects of such a pandemic in the future, what would they be?

Dr. Merkel:

3 things? A US wide bed tracking system, so that we can really filter very quickly what we would need, like ICU beds, number of ventilators, ECMO centers, and divided by region who conceptually makes sense. A robust infrastructure for airlifting patients. And a 3rd would be a way to take away the financial burden of medical care for the individual patient.