Academic medical centers are paving the way to a new tomorrow by changing how health care is delivered. Among its innovations, Upstate University Hospital is using advanced technologies such as AI, robotics and drones to serve as workforce multipliers, and expanded telehealth platforms to improve access to patient care.
Construction on the building across from University Hospital, the Nappi Wellness Institute, is expected to be completed in spring 2023.
Adapting to the pandemic resulted in the acceleration of new ideas and technologies, some of which were already underway at Upstate and were brought into newly relevant focus when COVID hit. Leaders specifically sought innovations that addressed the needs of the workforce — both to retain staff and reduce the risk of burnout — as well as to support optimal patient care. The C-Suite empowered staff to collaborate on projects across the entire Upstate system, headed toward the vision for the hospital set by the hospital CEO: To evolve to care that is first predictive and preventative, then personalized and participatory for every patient.
“Centralized systems don’t work well in a pandemic because large numbers of sick patients overwhelm the hospitals,” says Robert Corona, DO, MBA, CEO of Upstate University Hospital and a professor at SUNY Upstate Medical University. “To remove those pressure points of entry, we need to look at ways to decentralize. When you’re not solely defined by the bricks and mortar of the hospital, you can distribute medical resources in a way that allows for such options as point-of-care testing, home testing, home monitoring, and telehealth — all of which balance who needs to come to the hospital itself.”
For example, Upstate partnered with Microsoft to create a series of chatbots for virtual assessment which could be done at home. The first chatbot determined the need for COVID-19 testing for any member of the community. This was followed by a daily self-screening tool for employees to use prior to entry of an Upstate building. Both projects reduced the demand on telephone operators and screeners.
The hospital also created an influenza-like-illness (ILI) clinic equipped with necessary resources to test and treat patients with upper respiratory or flu-like symptoms and isolate those who may be positive for COVID-19 from other potentially vulnerable patients. The ILI was an effective and efficient alternative to the busy emergency room.
Upstate was an active participant in clinical trials to test the safety and effectiveness of COVID-19 vaccines for adults and children. The saliva-based COVID-19 PCR test developed at Upstate received FDA approval and is capable of processing 15,000 tests per day. Upstate also was involved in the development of a saliva-based COVID-19 antibody test to identify IgA, IgM and IgG antibodies. That test is under review by the New York State Department of Health.
Hospital without Walls: The Telehealth Boom
In many instances, the pandemic shifted the delivery of ambulatory care to a telemedicine platform. Upstate recognizes the value in making telehealth a permanent way to deliver health care when it makes sense to do so for the patient.
Use of telemedicine has surged at the hospital and a new $2 million FCC grant will support additional infrastructure in the EMR system.
Through telehealth, Upstate is aiming to provide the same kind of care patients would receive in person using advanced computing and communications— a goal made more attainable following a recent $2 million grant from the Federal Communications Commission for telemedicine upgrades.
“We were thrilled to receive a grant of that magnitude and opportunity, and it’s going to go to very good use,” says Nancy Daoust, EdD, LNHA, FACHE, Chief Ambulatory Officer at Upstate University Hospital. She says the grant will facilitate a system-wide integration of its telemedicine infrastructure within the existing electronic medical record system, making appointments easier for patients and providers.
The grant also will be used for hardware for video consultations and remote wearable monitoring systems to measure patients’ vital signs and to collect other clinical data. The integrated telemedicine platform also will enhance the ability for Upstate physicians to treat critical patients through remote connections to other hospitals, such as what is already being done with its telestroke program.
With remote visits on the rise, Daoust also hopes to see legislative support to ensure all people — rural and urban populations — have unfettered internet access to take advantage of the benefits of telehealth care.
The “Meds to Beds” program allows Upstate patients to get their prescriptions filled at Upstate’s outpatient retail pharmacies, making it easier for hospitalized patients to get their prescriptions promptly upon discharge and more likely to take needed medications once they are home.
Ensuring Continuum of Care
While telemedicine was not used by many departments pre-pandemic, Upstate rapidly deployed telemedicine in many ambulatory settings, improving access to care when many patients were afraid or unable to leave their homes. Mark Zeman, Chief Information Officer at Upstate, says that very soon after launching the COVID-era telemedicine program, the hospital was caring for thousands of patients via the technology. Within two weeks, the number of telemedicine visits grew from 10 to over 6,000 visits — a phenomenal increase of 59,900%. Additionally, without transportation issues or other barriers, such as the need to take significant time off from work, more patients were able to keep their appointments.
“Comparing May 2019, when almost all visits were completed in the clinic, to May 2020, when most visits were conducted via telemedicine, the no-show rate decreased by 59%,” Zeman notes.
He added that the hospital also bolstered its cybersecurity to protect it from ransomware threats and phishing attacks. “Recognizing the need to be even more diligent in securing our network, we accelerated multi-factor authentication, worked extensively with an expert cybersecurity consulting group to test our defenses and focused on enhancing our endpoint protection.”
At a time when PPE and other supplies were scarce nationwide, Upstate implemented a plan for supply chain integrity to ensure their hospital was prepared, which continues today. Stephanie Shattuck, Associate Administrator for Support Services at Upstate University Hospital, says her team identified key products critical to the pandemic, including PPE, ventilators and other respiratory care supplies, and came up with a plan to maintain a 180-day supply. They built a safety stock to respond to volatility in the supply chain and used data visualization tools and dashboards that give real-time information on stock levels and immediate alerts when stock is low. They also acquired extra warehouse space to store additional inventory.
Nursing Advances New Technology
Despite unprecedented pandemic-related challenges, Upstate achieved Magnet designation this year. “Achieving and maintaining Magnet designations requires us to innovate and push boundaries,” says Scott Jessie, MSN, RN, NEA-BC, Chief Nursing Officer at Upstate University Hospital. “Regardless of current challenges, we will meet patients’ needs and continue to provide comfort and support,” Jessie says. “It’s our mission, and it’s why we chose this field.”
Using a collaborative approach, the nursing staff implemented technologies and practices, such as TeleTracking, which manages bed capacity and tracks patient progression through discharge and into post-acute care. Additional daily patient care technologies include Vocera for communication, vital signs alarms, and remote video monitoring for patient safety.
Nursing also is playing a key role in developing a new Throughput Operations Center to manage all patient movement into and out of the Upstate system, and a “Hospital at Home” model for acute care patients to be treated using telemedicine, the EMR, and workflow intelligence developed by Upstate’s IMT team.
“For the past three years, in part out of necessity, Upstate has become a hotbed for innovation and creative thinking. Our work on data visualization and solutions, drones, chatbots, and even governance and portfolio management is driven by the creative minds at Upstate — and enabled by leadership that is unwilling to accept the status quo and strives to be a technology leader in academic medical centers.”
— Steve Roberts, Director of IMT Advanced Technologies at Upstate University Hospital
Drones As Workforce Extenders
Drones In Flight.
CEO Dr. Bob Corona and CIO Mark Zeman prepare for a drone test flight.
In 2020, Upstate launched the Air Upstate Consortium to test, develop and incorporate drone technology into health care, first delivering COVID-19 testing kits between hospitals. This program received the first waiver ever given by the Federal Aviation Administration to fly over populated areas and deliver medical supplies.
“These flights demonstrated that drone deliveries can be scalable and economically viable, which positions Upstate and the central New York region to be nationally recognized leaders in the application of drone technology in health care,” says Steve Roberts, Director of IMT Advanced Technologies at Upstate University Hospital.
In addition to the drones performing deliveries, Roberts says the hospital is looking at small robots which could be used to deliver food, medications and other materials within the hospital. The efficiencies from robot technology would free up healthcare professionals who typically perform these duties to better utilize their skills toward other aspects of patient care.
Wellness and Prevention
As Ben Franklin once said, “An ounce of prevention is worth a pound of cure,” and the same parallel can be drawn in medicine. Upstate currently has about a 60% inpatient to 40% ambulatory care portfolio ratio, and their goal is to flip those ratios, with wellness and prevention as the basis.
“We know that to do this well and efficiently, we will rely on technology and innovations,” Daoust says. “What’s most critical is that we also keep the patient’s experience at the forefront. While it’s great to have the bells and whistles that technology provides, it’s most important that we’re laser focused on patient care and that our patients feel special.”
The Nappi Wellness Institute, generously funded by the Nappi family, will eventually be the home of several existing ambulatory clinics that focus on prevention, general medicine and wellness, with a special focus on Alzheimer’s disease. Currently under construction and slated to be completed in the Spring of 2023, the Nappi Wellness Institute will be equipped with technologies for appointment reminders and real-time location services to help guide patients to the correct floor once they are in the building.
Focus Groups For the Future
Upstate’s internal focus groups are also a critical part of the decision-making process. A mixture of clinical, administrative, financial, IMT and other staff provide a collaborative approach to solving problems and getting feedback on new processes and technologies. Focus groups allow for a diverse and inclusive perspective.
Moving forward, Upstate acknowledges the tremendous challenges facing the healthcare industry, but the hospital staff are also confident in their ability to find solutions to keep their patients well cared for and satisfied.