Coordinating Clinical Workflows at CommonSpirit

[00:00:05:11 – 00:00:22:13] Dr. Will O’Connor: With us today, we have Denise Pimentel. She is the CommonSpirit Telehealth Network System Manager, clinical. She is a nurse by background and holds multiple advanced degrees in nursing and health information technology. Denise, welcome to the show.

[00:00:22:14 – 00:00:23:06] Denise Pimintel: Thank you, Will.

[00:00:23:07 – 00:00:35:19] Dr. Will O’Connor: Thanks for coming. So let’s start. I’d love to start with the origin story. Tell me a little bit about when you first started thinking about becoming a nurse and a little bit about your background in nursing.

[00:00:35:20 – 00:01:04:15] Denise Pimintel: Yeah, I guess I always thought I was going to be a veterinarian and that moved on to nursing. I went to nursing school in San Francisco in the early eighties, went into the Army and became an army nurse for a period of time. And while I was in the Army, critical care was my specialty. About 13 years ago, I began working for the prequel to Common Spirit Health, which at that time was Catholic Health Care West.

[00:01:05:22 – 00:01:33:07] And I participated as an ICU nurse in an EHR Big Bang event where we took five local hospital live withan EHR. So we went in to design, build and implement. From there, my interest in technology was sparked and how it could help what we do with patients and how we take care of them.

[00:01:33:23 – 00:02:05:09] So I went back to school in health information technology and got a degree in that so that I could learn more. My desire has always been to bridge clinical folks with technology, to do our jobs more efficiently and to do a better job for the patients that we serve. So for eight years, I’ve been with the telehealth network here now CommonSpirit, and we consider ourselves a service department.

[00:02:05:18 – 00:02:15:15] So we bring physicians services and technology to areas of need and we help them augment the care they’re delivering.

[00:02:15:20 – 00:02:30:02] Dr. Will O’Connor: What do you find is the biggest difference? And I’ve talked to folks before who experienced this. It’s quite different being a caregiver in the military versus being a civilian. Well, what was that transition like for you?

[00:02:30:07 – 00:02:59:21] Denise Pimintel: It was eye opening. You know, the military has a lot of change and a lot of new blood coming in and has standardization across the board. And so coming in to organizations where people hang out for quite a long time, culture is well seated. Change is a lot slower and resources are different. So it was eye opening.

[00:03:00:01 – 00:03:04:20] Dr. Will O’Connor: Well, tell me a little bit. About eight years is a long time to be in and really one job and working in one area. Tell me a little bit about the Common Spirit Telehealth Network.

[00:03:04:21 – 00:03:19:06] Denise Pimintel: Oh, yeah. So it’s interesting because we began in 2008 and I was an ICU nurse on the floor and happened to be in the unit that was the recipient of the first robot that was rolled in at that time. And it started from the generosity of a grant from a local family who had a matriarch in the emergency room for a neurology condition.

[00:03:53:05 – 00:04:19:15] And the neurologists were 15 minutes across town. And out of their generosity, they decided, what do we need to do to get the neurologist closer so that anybody who needs a neurologist in the event of a stroke or any neurological emergency could actually have those specialists. And off we went. And, you know, that’s really the genesis of it.

[00:04:19:15 – 00:04:40:11] And it has grown since frequently. We now do ICU services, neurology and stroke services, behavioral health services, infectious disease. We can bring specialists in just about any area of care to any one of our sites.

[00:04:40:21 – 00:05:02:05] Dr. Will O’Connor: Denise, talk to me a little bit about how telehealth evolved at Common Spirit during the during the pandemic. And it seemed, you know, to us that, you know, there was a growth of telehealth everywhere, but you already had a very well established program. Tell me what that was like.

[00:05:02:09 – 00:05:34:08] Denise Pimintel: You know, we went from being an established program that got attention when people needed us to all of a sudden everybody needed us. And the the bonus of of common spirit is our size and our diversity and our ability to leverage across that. We had different telehealth projects going throughout the U.S., not just to the one that the telehealth network supports.

[00:05:34:17 – 00:06:11:19] So the demand was spread across all of us. I would have to say that all of a sudden what was seen as a niche way to deliver health care and the ability to augment people who really needed help became a vehicle that everybody wanted to use. Whether or not they needed extra provider. You know, it became, you know, especially in the ambulatory care setting, when patients could not no longer come in to the clinics, they needed to find another way to get the physicians out to the to the people.

[00:06:12:00 – 00:06:26:06] Right. The patient. So that was and, you know, us having contracts and experience and the knowledge to help, educate, help scale these programs quickly was definitely a bonus.

[00:06:26:22 – 00:06:41:15] Dr. Will O’Connor: You know, was there ever a point during the pandemic where you thought like, my goodness, like, are we going to be overwhelmed or are we going to make it? Was there ever any of that thinking going on?

[00:06:41:23 – 00:07:07:16] Denise Pimintel: No. We’re a pretty you know, nurses are pretty resilient. Physicians are pretty resilient. And, you know, those early days of the pandemic, I was in the office 18 hours, seven days a week. You know, we just all you know, head to the ground. How do we solve this problem? How do we extend as fast as we can working with numerous different vendors who are also experiencing the same sorts of struggles?

[00:07:07:16 – 00:07:40:02] We were, you know, scaling rapidly, infrastructure, being able to handle the scale, you know, having the right patient access, having the right staff, training, everything else. So, you know, it was almost like being in the Army when we set up those mobile hospitals, right? Everywhere. And we you know, the difference is, is the learning curve was a little bit steeper, but hospitals and health systems have critical incident teams.

[00:07:40:02 – 00:07:50:06] So those team stepped up and really helped with that as well. And you know, in the early days, it all brought us together.

[00:07:50:15 – 00:08:16:20] Dr. Will O’Connor: Military experience has certainly served, served you well and ways you probably didn’t expect. Denise I noticed that CommonSpirit does an incredible amount of of charity care and working and serving the communities in which its facilities are located. Can you talk to me a little bit about are you involved in does your organization serve some of those patients as well?

[00:08:17:01 – 00:08:39:00] Denise Pimintel: Yeah, I know that we do serve those patients like any hospital with an emergency room. We that population does enter our system. And honestly, they’re like any other patient. Whether you come in in a mink stole or you come in homeless with only the shirt on your back.

[00:08:39:07 – 00:09:06:12] Dr. Will O’Connor: Patients don’t get that type of treatment everywhere. So I think it’s one of the amazing things about about CommonSpirit that, you know, that that happens. I know we were talking about the pandemic earlier and telehealth, but tell me a little bit about your organization’s use of technology and some of the things that you’re using to connect with patients and drive better care.

[00:09:06:18 – 00:09:40:23] Denise Pimintel: So technology, we obviously have electronic cars that we use. We have video applications that we use. We use secure texting applications across. We have patient portals. We have web pages that patients can and apps that patients can follow, you know, their pregnancy journey in or whatever else they’re looking to their health in general. So there’s a diverse amount of technology within the organization.

[00:09:41:13 – 00:09:52:17] Dr. Will O’Connor: Specifically related to secure texting. How are you doing that? And are there any specific workflows that you’ve applied that to?

[00:09:52:18 – 00:10:26:07] Denise Pimintel: Yeah, we do use Tiger text in parts of the organization. It used provider to provider clinical staff to provider call center to a provider or a caregiver that needs to be contacted. We use it throughout acute care. I think we we do use it in home health when our nurses and caregivers are out in the field. It’s really been applied almost anywhere.

[00:10:26:08 – 00:10:37:09] You need the ability to use protected health information to talk back and forth as caregivers about a patient.

[00:10:37:14 – 00:10:55:16] Dr. Will O’Connor: So that sounds like that covers a lot of different workflows that you that you might have. Compared to prior to using secure texting and some of these other communication technologies, what’s the difference now? What’s the impact that you see?

[00:10:55:21 – 00:11:18:09] Denise Pimintel: So I think the impact is huge. So before you had to call the provider and have a live, real phone call with them, which meant stopping to find their phone number, calling them, interrupting them from what they’re doing. They would answer the phone, then you’d have the conversation. Or you’d have to seek them out, or you’d have to email them and wonder, have they gotten the email?

[00:11:18:09 – 00:11:43:23] Have they seen it yet? What’s happening? I don’t have an answer. Moving to secure texting has been huge. It allows providers to speak to other providers. So say a hospitalist wants to consult a specialist on a patient that he’s taking care of. All he has to say is, can you please see Mr. X in bed whatever, I think he’s had an MI or whatever.

[00:11:43:23 – 00:12:10:21] Is the thought process going on. The message gets sent at the convenience of the person sending and when it comes to the recipient, the recipient can choose the to either look immediately, delay that look because he’s in the middle of a conversation with somebody else, or pick it up, pass it on to somebody else if we have rules in it to escalate, if he hasn’t looked at it in 5 minutes.

[00:12:11:07 – 00:12:30:08] And what that does then is the sender if 10 minutes later is curious, did I get a hold of Dr. X can look and see, oh he saw it or oh it’s been escalated or there’s like a closed loop in sending and communicating to each other.

[00:12:30:19 – 00:12:58:03] Dr. Will O’Connor: Yeah. I love that, that transparency of communication and setting instead of leaving a voicemail or sending a page off right into the ether, you know, getting that notification, oh, this person’s read it right and give them a chance to respond. It’s, it’s a much better feeling as a as a clinician. I think so. I agree with you.

[00:12:58:15 – 00:13:05:03] Have you had any have you talked to clinicians, nurses or physicians about that about that feedback at all? Have you got any feedback?

[00:13:05:10 – 00:13:33:14] Denise Pimintel: Oh yeah. It’s [TigerConnect] implemented in my workflows in the critical care area. So a nurse needs to get the critical care doctor on that device in that unit immediately. They love it. They love it because from their computer at the bedside, Dr. Jones, I need you in this boo boo boop right away. And 2 minutes later he’s in and that nurse has gone on to do what she really needs to do with that patient.

[00:13:33:15 – 00:14:05:23] So nurses, I constantly hear about it. And, and on the converse, when the schedule might have the wrong doc in it in the right doctor didn’t swipe in. I hear about it. You know, they’ve become critically dependent on accuracy and being able to contact who they need. And, you know, like all human beings, once we get an easier path, when anybody tries to take that easier path from us or it breaks down, we’re very vocal about that.

[00:14:06:20 – 00:14:22:18] Dr. Will O’Connor: Denise earlier were talking a little bit about using secure texting communication to improve response time and how that’s improved care. Have you noticed any other areas where this type of communication has had a positive impact on safety or quality?

[00:14:22:19 – 00:14:55:04] Denise Pimintel: Oh yeah. In the critical care area, definitely, you know, response times of providers to the bedside have significantly increased or I should say decreased, meaning they get there quickly. The safety wise, the there are innovative markets that are videotaping safety messages or safety wins or risk avoidance, things that go out to the whole market so that everybody gets to see it.

[00:14:55:04 – 00:15:29:01] And maybe it’s a video and they hear the chief medical officer saying something about an issue or it’s a newsletter that reports, you know, what are our COVID numbers? How are we doing? How are our employees doing health wise? Those sorts of things are our innovative ways that I see it being used. We have the ability to notify code teams all at once via Tiger because we set up a group and the code team gets messaged together immediately.

[00:15:30:08 – 00:15:44:23] There’s just it’s really the the innovative uses of it are endless. I mean, whatever you can think of, you can probably set it up and figure out a way to use that communication tool in a secure fashion within a healthcare system.

[00:15:45:08 – 00:16:12:12] Dr. Will O’Connor: That’s fantastic. Well, I’m I’m glad that you and that common spirit is is getting so much benefit from TigerConnect and then it’s having an impact on your staff, on your on your patients. Well, Denise, we’ve we’ve taken up way too much of your time today. Thank you so much. You have delighted us with your presence here today and your perspective and your experience.

[00:16:13:07 – 00:16:15:12] Thank you very, very much for joining us.

[00:16:16:03 – 00:16:32:08] Denise Pimintel: And I appreciate the opportunity. Will, thank you.