Building Resilience in the Cloud

Melanie Green (host):

My name is Melanie Green.  You’re listening to Remote Works, an original podcast by Citrix.  Over the past year we’ve gone through so much. On this show we’ve been looking at the incredible changes people have been making to how they work.  And perhaps no one has had to change as much as those who provide our health care. They will be the first to tell you that the past year hasn’t been easy.

Teniesha Wright-Jones:

I have two young kids. I remember when my husband told them I was COVID positive. You might've would've told them that I had cancer or I was dying because they were just nervous and scared and they cried and,and I think it, it resonated with me that this is a serious disease.

Melanie Green (host):

Dr. Teniesha Wright-Jones heads up the family medicine program at the Ascension Providence Hospital in Southfield, Michigan. Her husband is a doctor too. Dr. Lamont Jones is the vice chair in otolaryngology - that’s the ear, nose and throat department - at Henry Ford hospital in Detroit. They both remember March 10th, 2020. 

Teniesha Wright-Jones:

It actually was on our service. We had the first two cases in Michigan. One was at Providence hospital and was on our family medicine service. And so I remember it quite well because the Tuesday night, we all knew COVID was coming. I have lectures for the residents on Wednesdays. So Tuesday night I was preparing the lecture for the residents to go over COVID, kind of what to expect. And that night I remember my kids, I have two daughters and they were, you know, kind of going over things with me as I prepare for the lecture, they were interested. And I had a slide that said, you know, how many cases there were in the United States. And I had Michigan and had zero cases and at about 11 o'clock that night, my daughter ran downstairs to tell me that I had to change my presentation because there were two cases in Michigan now. And I was like, no way, like I just did the presentation and on my way to work the next morning a colleague called me at about six in the morning to tell me that, you know, there's a case. And I was like, I've heard. And she's like, no, it was on our service. And I was like, Oh, I did not know that.

Things were changing rapidly and Teniesha’s department at Ascension Providence had to react quickly.

We felt a little prepared, but we did not know enough. Being primary care, we are the first ones to see a patient often. We had to decide how do we start seeing patients knowing that we may have patients are bringing illness into us because they aren't feeling well.

Melanie Green (host):

Then Teneisha’s entire world turned upside down. Just a week after the first cases appeared in Michigan - in the midst of ramping up to treat COVID patients, Teniesha was diagnosed with COVID. 

Teneisha Wright-Jones:

I knew at work, I just wasn't feeling well. I knew I was getting tired, you know, cause I had meetings all day long, but something felt different. So now I was tired and short of breath.

And so I remember coming home from work and I told my husband, I need to be tested. Got my test back and found out that I was COVID positive, which was a challenge because at that moment I still needed to figure out how do we make these changes in the hospital that was gonna affect my entire program.

Melanie Green (host):

Teniesha’s husband Lamont was the one who had to tell their young children that their mom was ill.

Lamont Jones:

We discussed it, um, with our kids. We, you know, we, we told them that we loved them and that we reassured them that we would all make it through this. And the other thing that we told them that likely when this is all said and done, there would be more people that knew people that had had it than not.

Melanie Green (host):

Then, the second shoe dropped. Lamont tested positive too. The whole family quarantined together at home. It was tough taking care of their two young daughters and themselves -- but on top of that both kept working remotely through their illness. 

Melanie Green (host): I am curious, what was it like for you doing all of that in that moment, you kind of realize, wow, I have COVID.

Teniesha Wright-Jones:

At that moment I still needed to figure out how do we make these changes in the hospital that was gonna affect my entire program. The challenge was in being healthy enough and able to be strong enough to sit through meetings for multiple hours of the day even though I wasn't feeling well.  

Melanie Green (host):

There were times that Teniesha couldn't even talk. So she'd use the chat function to communicate with her colleagues on the frontlines in the hospital instead. She didn’t know it at the time, but Teniesha and her husband Lamont were mapping a new and safer way to practice medicine in a time of crisis. A map that is being redrawn in hospitals all over the world. Teneisha powered through. And she says what really mattered in that time of change was safety, support, and perhaps most importantly, a deep understanding of her patients’ needs. 

Teniesha Wright-Jones:

As I'm pushing out directives to my residents and my faculty to, to now kind of, you know, suit up and go into the trenches, so to say, how do I do that? But with enough empathy and compassion, the PPE that you need, to kind of prepare you to go and take care of these patients. And so my assurance to them was if you ever get to the unit and you don't have PPE, don't go in. But I was assured by my hospital that we were going to be okay when it came to PPE. But you know, you hear the fear. We saw what was happening in New York and on the East coast where people were going in in garbage bags.

Melanie Green (host):

I don’t think I’ll ever forget those images of the early days of the pandemic. But along with the people on the front lines, there were many others behind the scenes working to support the fight.

Al Taylor:

The depth of quality of value of the professionals that we've all been reliant on, during this extraordinary time and the fact that they are willing to go in, in a garbage bag and to try and prevent themselves becoming potentially very ill, with arguably inefficient materials and uh, inefficient mechanisms to basically manage the risk.

Melanie Green (host):

Meet Al Taylor.  He’s the co-founder and CTO of a company in the UK called cloudDNA.

They provide the tools users and devices need to connect with each other digitally.

Al Taylor:

And really that resonates with our IT teams, who've had to find ways to overcome some really significant challenges potentially without the tools that they'd need to be able to go and fight the fight on behalf of those healthcare professionals on the front line. But we forget sometimes about the huge volumes of teams that are sat behind those individuals.Those very visible images we see in the press and in the news. Those folks that are working in those ICU's and trying to deal with what is arguably a very challenging time for all folks, but the same goes for those back office teams that need to be able to access information and data.

Melanie Green (host):

Being able to share and store information remotely, while ensuring quick access, is what the cloud is all about.

Al Taylor:

It would be managed and it would be looked after by the IT teams on physical servers, in data centers that needed patching and maintaining and looking after, practically needed as much healthcare as the individuals that you are trying to treat. It really becomes a kind of a balance of managing infrastructure. And the only reason we do that, Is to then ultimately ensure that that data is available and secure and available in a timely fashion. So, we're no longer just managing the data in there, but we're also managing the infrastructure to ensure that data is available to the healthcare professional when they need it. So in a scenario where we're suddenly having to do things like remote workers and being able to give those remote workers a greater freedom, what the cloud has been able to do is, is allow those organizations to lean on somebody else's infrastructure.

Melanie Green (host):

The cloud became a critical tool to making the transition to remote work. Instead of being tied to the hard drive in the computer at the office, people could now access their data anywhere.

Al Taylor:

Let's get away from this whole concept, that data just exists and floats around the sky and just appears, and our devices on demand when we need it. That's not the case, but the idea behind cloud, it's always there. It's always available and assuming we've got internet connectivity.

Melanie Green (host):

In the UK as in so many other countries - the pandemic pushed the healthcare sector towards a new way of working.  This meant Al's job became even more important. Back in Detroit, for Lamont Jones and his colleagues, that meant working from home while ensuring that the ear, nose and throat department at Henry Ford Hospital was still connecting with their patients. Fortunately, the hospital was already ahead of the curve. The push to online appointments had begun before COVID.

Lamont Jones:

We had already started doing remote patient evaluations where we were using our electronic medical record, to do consults remotely, ear, nose and throat. We had actually for the last two years, we were working on processes that allowed us to do those types of exams and video them anywhere in the United States. So we were in the forefront with the speed that COVID hit and how we had to change our practice. It forced us to adapt quickly.  Henry Ford did a great job. We went from a few hundred televisits a week to 10 or 12,000 a week. For a health system, we scaled up quickly and actually did a great job of staying connected with our patients and providing the services that were necessary.

Melanie Green (host):  And what was that shift to telehealth like for you Teneisha?

Teniesha Wright-Jones:

By April, end of March, beginning of April, we were probably about 75% tele-health. At some point we only brought in people who had to be seen in the office for you know, different reasons. It was a quick shift for us, um, to change into what we call tele-health.

Melanie Green (host):

Al and his team enabled the acceleration of telehealth and remote healthcare.

Al Taylor:

We found ourselves in this bizarre scenario where we needed to scale those services and find ways for folks to be able to work remotely. Our digital transformation projects, as we read here in the UK press, have been accelerated between anything between five to eight years.

Melanie Green (host):

That’s pretty impressive.  And for Al - this has been one of those moments in time when a need for rapid change, comes to the fore.

Al Taylor:

I guess what we've seen in the healthcare sector is this rise in innovation. And need brings about innovation. And catastrophe for argument's sake brings about innovation, where there's a very definite need and urgent need to solve a problem. Because really, if ever there has been demand on our healthcare professionals it's right now in this time globally. And so subsequently if we can put that information in that healthcare professionals' fingertips, right in real time, in a very fast fashion, certainly significantly quicker than we used to be able to. We can then start to provide the innovation and start to push these services away from the core, away from the hospitals, away from the clinics and further out towards the patient. And that started by going to GP surgeries and pop-up clinics and little satellite type locations. But now as network connectivity and innovation in these devices has expanded and extended we've been able to push that further and further out to the point where it's now potentially even actually within the patient in their home.

Melanie Green (host):

As we’ve seen in so many parts of the world - the rise of telehealth and the change to delivering medicine remotely - is becoming more permanent. But health care is different from other industries. It’s traditionally been wary of technology. I mean, you’ll still find doctors with beepers using fax machines to send prescriptions to the pharmacy.  So Al Taylor says that even with the rapid evolution of technology, the path to making healthcare more remote will be challenging. Not just because doctors love their beepers, but because healthcare is all about the one-to-one connection.

Al Taylor:

I've actually seen this with my own father. We got to a point where he had a device similar sort of size to a USB dongle actually inserted under the skin in his chest, so that if he had an episode for want of a better term, there would be a record there. And he would go to a physical location, his local hospital, following one of those episodes, a dizzy spell. And he would have that information downloaded by the professional. The professional will observe that information and come back with a diagnosis. Now, when we moved that fast forward to today, that information can be automatically uploaded to a system and that system can automatically tell his consultant. This scenario has happened. There's no manual intervention in that. And the consultant often now is actually able to review that information.That consultant can actually see that information potentially even before my father would have known that was the case.

Melanie Green (host):

And as we rush to lay new and better foundations for working remotely, Al says there’s a critical component to consider.

Al Taylor:

Network connectivity is really going to determine how well those devices can communicate back to base, whatever that base may be and whatever that organization does to serve the community, serve their customers, or serve whomever it is they're looking after.

Melanie Green (host):

The pandemic is rewriting the timelines for how quickly this technology could forever change healthcare. Teniesha sees how the innovation in technology Al talks about has the potential to make her job as a doctor easier - and more efficient.

Teniesha Wright-Jones:

I think there's technology for a lot of stuff that we just have not pushed the pedal on getting it to where we need to have now. There's always been tele-health, blood pressure monitors, blood glucose monitors. Those things exist. They just were so far out-priced that people just didn't use them. But now you see different companies like you know, Apple watch and Fitbit. Everybody's trying to figure out how do I get a Pulse-X on my watch and how do I, how can I take a EKG and a blood pressure? As a primary care doctor, if my patient has some of those key points that I need, I could manage very well from telehealth.

Melanie Green (host):

So Teniesha is looking to the future in her profession - and Al says that the future is already here in many parts of the industry.  And a key part of moving into remote healthcare is keeping information accessible and secure.

Al Taylor:

Look up those patient records, send your emails, communicate, collaborate with your colleagues, perform your teachings, functions, deliver a conference online, these kinds of services. When we hear multiple devices, multiple stories, locations, services coming from multiple locations as well, surely that's got to be a good time to at least investigate the idea of pulling all of those disparate service providers together into a single coherent workspace. And then allow that workspace to be accessible wherever my users need it when they need it. And then just have that ability to control that access scenario when the risk associated determines it's necessary. And of course, it's an interesting kind of conversation. It means a lot, a lot of different things to different people, but pulling all of that information into one place, given the ability to be able to access it whenever they choose it just really, it just helps productivity all the way through. Productivity in this case may be an extra two or three patients a day. That's got to be a good thing.

Melanie Green (host):

For a doctor, being able to see more patients IS a big win. And for patients, not having to go to the doctor’s office and spend time in the waiting room is pretty attractive. So the push to remote visits can benefit both sides of the equation. Here’s Lamont.

Lamont Jones:

There are some things that we don't need to actually see a patient that we can do the assessment, you know, most of what we gather or what helps us make a decision with patients is the story and asking the right questions. And that's definitely something that's amendable using technology. COVID gave us a sort of crash course on that. And so our goal post-COVID is to figure out how we find the middle ground.

Melanie Green (host):

For Teniesha, finding that middle ground as technology changes patient care, means holding on to the human side of medicine - the face-to-face interactions that make such a difference in treating her patients.

Teniesha Wright-Jones:

It goes back to that, just that human touch, and that human connection. I had a patient that I saw twice with a virtual visit and she just came in to see me and I was like, ‘Oh, you didn't have to come in’. And, you know, for what we were doing, she's like,’ I didn't want to do any more virtual visits. Like I had to see you. And even though she was seeing me, you know, on the video, she just wanted to be in. And so I think there is still something to be said about human contact.

Melanie Green (host):

Supporting a strong doctor-patient relationship is at the core of Teniesha’s practice. I think about when I see my doctor - she always asks, How are you?  Then, she looks in my eyes and asks, No really, how are you?  It’s that moment of connection.  The goal is to create an online environment which can foster that unfiltered connection between doctor and patient. Tech guru Al Taylor says that’s within our reach.

Al Taylor:

There is no doubt that a patient doctor scenario like that, the doctor is looking for a whole bunch of things, besides just the obvious ‘tell me where it hurts’. Losing that as a doctor must be very, very challenging.

Melanie Green (host):

When I asked Al to predict where technology could take us in remote healthcare - say, by the year 2025 - he predicted a future where virtual healthcare connects us even more. In new and different ways. It’s all about creating an online ecosystem where tech supports the human connection. And that can break down all kinds of barriers - like physical distance.  Al looks to his home country as an example.

Al Taylor:

I've got an organization that we look after up in the North of Scotland here in the UK and for an individual to go to see their GP, they actually have to take a flight to do that. So the logistics and the organization of making that happen compared to being able to jump online, with a stable secure network so that that patient confidentiality is not inhibited, but to allow that healthcare individual to be able to talk to that person in a much more timely fashion, either for long-term chronic conditions or just those instantaneous requirements as we have as human beings -  I think that is really, again, one of the places where we all stand to gain and  2025, it isn't a long way away in our industry.

Melanie Green (host):

That really isn’t far off. On the ground, Teneisha says there are some hurdles.

Teneisha Wright-Jones:

We have to continue to push forward with, how do we get out of the old constraints of what we know medicine to be and to use technology to our advantage so that if this happens again we're in a better place for virtual health and telehealth. And we have things in place. Like how to get those blood pressures and the other values where we need to really treat a patient. And I think that technology is coming. I think we're getting there. And I think the idea is going to be, how do we make that accessible to everyone?

Melanie Green (host):

Teneisha makes an important point. Access to healthcare can look really different for everyone. And when Al looks to the future, he is optimistic about tech breaking down all kinds of boundaries.

Al Taylor:

The way that professionals can really stretch beyond the physical boundaries of their clinic, the physical boundaries of their hospital, and take that same level of service out to any individual anywhere on the planet, through a digital means, still keeping patient confidentiality and security at heart, but delivering that same level of care out to those individuals. Again, for me, that, that I think is the way we're forwarding. And as an IT industry, the momentum that we've gained now, I don't see that slowing down. I think if anything, people have really begun to realize the value of innovation and the value of connectivity in this scenarios. And now that we've witnessed it, I think it's going to be very hard to turn that level of interest and innovation off.

Melanie Green (host):

You’ve been listening to Remote Works, an original podcast by Citrix. Subscribe and come back in two weeks when we trace one woman’s path to burnout and the route she took to leave it behind. That’s at Citrix dot com slash remote works.