For Montefiore, 'creative destruction' as a COVID-19 response leads to accelerated innovation

COVID-19 has upended virtually every sector of the economy, and none more than healthcare. Healthcare leaders from across the U.S. have experienced significant disruption, but some have used their response to the coronavirus pandemic to ramp up innovation when it comes to digital health.

In the fall 2020 edition of Frontiers of Health Services Management, leaders at Montefiore Health System in the Bronx, New York, describe a process of "creative destruction" leading to accelerated innovation – especially in terms of rapidly ramping up digital health capabilities. This digital innovation is a fundamental component of recovery for healthcare organizations as they look to rebound from the pandemic.

WHAT'S THE IMPACT?

As New York saw its first cases of COVID-19, Montefiore leadership realized they would soon face an exponential growth rate, leading to shortages of hospital and ICU beds. Citing the classic theory of market disruption and resulting innovations, they leveraged the changing market economy to accelerate innovation by putting new ideas into practice – centered on what they called "creative destruction."

Leadership established an incident command structure, providing the agility to make decisions and react to challenges. Resources were placed under central command. Spaces throughout the Montefiore system were swiftly converted for inpatient use, doubling physical capacity.

Faced with the disruption of normal care, leaders rapidly implemented a digital innovation program. An artificial intelligence-based, coronavirus-specific chatbot was introduced, leading to more than 18,000 engagements within 30 days. Within weeks, the chatbot was extended to inquiries other than COVID-19. Typically these innovations would have taken place over the course of years. Instead, the process took mere days.

Responding to plummeting in-person visits, leaders designed and implemented a new telehealth solution. This became especially valuable, since it was apparent that patients remained hesitant to make appointments, even after in-person visits resumed. Before the pandemic, Montefiore had no telehealth program. By April, more than 80% of visits had shifted to telehealth.

These lessons in accelerated innovation have important implications for the "new normal" in a post-pandemic world. Montefiore leaders have established a new tele-ICU command center, inpatient consultations via telehealth, real-time performance management and the extension of AI as an essential decision-making tool.

The COVID-19 pandemic "continues to demonstrate healthcare's vulnerabilities and is a force with such strength that it affects all aspects of care," according to an introduction by Frontiers editor Trudy Land. "It is imperative for organizations to move forward from a precarious state and develop stronger systems for their communities."

THE LARGER TREND

Telehealth represents perhaps the most common and widespread digital technology response to COVID-19. After the coronavirus began spreading in the U.S. this past spring, telehealth patient rates shot up in response, with some health systems reporting as much as a 4,000% increase in appointment numbers for virtual care.

In many practitioners' minds, there's no doubt that telehealth has filled an existing need both spotlighted and exacerbated by the COVID-19 pandemic. And, despite a dip in the initial numbers, it's clear that it's not going anywhere anytime soon.

Even older adults are taking advantage of virtual health. One in four older Americans had a telehealth visit in the first three months of the COVID-19 pandemic, most of them by video. That's much higher than the 4% of people over 50 who said they had ever had a virtual visit with a doctor in a similar poll taken in 2019.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com