Lessons Learned from the Pandemic (ft. Dr. Bruce Darrow)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Ed here, Digital Voices. Really pleased to have Dr. Darrow with us from Mount Sinai in New York City, and we're going to talk about digital leadership and also the pandemic response, because we'll get a little bit of an insider's view what happened. You know, there's been a lot of talk about the response to the pandemic, which is good because we're all learning and we're able to take those early learnings and apply 'em to, to new areas. And the dust has settled a little bit, but as we all know, we're, we're very cautious about new variants. But it's kind of interesting now to take a step back, you know, a year, 2 years later after the, the initial surge and think about lessons learned and how they might help us in the future. So Megan, before we get started with Dr. Darrow, where were you during the pandemic? And if you weren't in New York City, were you keeping an eye on New York City? I was at home. I live—

I'm in Virginia, so I was sheltering at home in Virginia. You know, I work from home. Everybody was home. It didn't feel too, too different for me, but keeping an eye on New York. We have an aunt who was living in Brooklyn at the time, so we would keep in touch touch with her and kind of she would tell us what's going on. And a few months later really is before I feel like we really even started to see the things that she was talking about. So yeah, definitely along with the rest of the country, had my eyes on what was happening in New York during the thick of it.

Yeah, I'm really proud of the way the city responded. As you know, I've got some roots there as well. And one of the individuals that was in the thick of it with all of Mount Sinai and other organizations is Bruce. So Bruce, welcome to Digital Voices.

Thank you. Thank you so much for the invitation and the introduction.

Yeah, so Bruce is a longtime CMIO and Deputy CIO over at Mount Sinai, and he's an executive, you know, as you'll see if you don't know him already, and also a traveler. So Bruce, I know you recently Did a little bit of safe traveling. And where was that? I think you went overseas someplace, correct?

Yes. And as with most people, traveling over the last 2 years has been a little bit fraught. I'd hoped to travel with my family around December of last year to Italy and show my 2 daughters, along with my wife, what Italy was like. We were not able to do that. I actually had COVID with that first wave of Omicron, the BA.1 wave, back in December. And so we were able to go in June and it was great. Thank you.

Oh, that's awesome. Yeah, you can definitely do it, but you have to take, uh, as we all know, a lot of extra precautions. So I think we first met— so we've been in the same venues many, many times over the many, many years, but we first actually had a chance to sit down in New York City just a couple months ago, and I just loved your, your style and your leadership and, and your insights. And I was like, please, please, please be a guest on Digital Voices. So thank you so much. And Bruce, as you probably know from our previous podcast. The one thing— there's 2 standard questions. The one thing everyone wants to know of our guests is what's on their playlist. So, like, what kind of music do you like to listen to?

So I will listen to a lot of different styles of music. I think I would describe it as '80s music and anything that sounds like it could be '80s music. So, you know, there's a lot of, you know, whether it's Vampire Weekend or, you know, it doesn't matter when it's from. If it sounds like it could have been on the radio in the 1980s, certainly I'll listen to it.

That's funny. You know, I had my oldest daughter, who's now about 26, 27, She confessed to me because she grew up with '80s music, right? Because me, I'm an '80s person myself. And so she's like, Dad, I should have grown up in the '80s because she listens to the same music now. And I kind of did the same thing with my parents, right? When I first came to the United States, my parents were listening to Frank Sinatra and stuff like that. I actually like that stuff now today because the influence of your parents, it's kind of interesting. What about your life message or mantra? Is there some words that you live by?

I wouldn't say that I necessarily have a mantra or words to live by, but Certainly, I put a lot of emphasis in competence, in being able to say anything I try and I'm going to do, I'm going to do well, or I'm going to leave it to the professionals. So for example, I cook and there's a lot of stuff that I will make in the kitchen and there are some things that I know I'm just going to leave to the professionals. I don't work with phyllo dough. I don't make, you know, lobster anymore just because I know that if I, if I worked at it, I could. I'd just rather, you know, understand my limitations.

I like that. That's, that's great. So I gave a super high-level introduction. Do you want to tell us a little bit about your story, either personal, professional, how you became who you are and CMIO at Mount Sinai?

Sure. My background, I grew up in the New York area in White Plains, which is about 20 minutes north of New York. And after Doing my medical training and PhD in St. Louis, I came back to the New York area and I came on at Mount Sinai first for fellowship training in cardiology in 2000, and I stayed on clinically. And I sort of got into the technology space accidentally by whenever they gave me an opportunity to do something, I said yes. And I think I heard Atul Gawande once at a talk say that up until the age of 40, if anybody gives you an opportunity, you should say yes. And after the age of 40, if anybody gives you an opportunity, you should say no. I would I was on the early side of 40 at the time, so I was saying yes to things, and that ended up putting me in a position where I was directing the team that was implementing our electronic health records when we implemented at Mount Sinai Hospital. From there, about 10 years ago, I ended up joining formally the technology team as Chief Medical Information Officer, but it's been great. One of the people I compare myself to is my clinical boss, Valentin Foerster, who's a cardiologist at Mount Sinai. He's one of the most influential cardiologists in the world. He's been, you know, head of the American Heart Association, American College of Cardiology, World Health Organization. He's been the Pope's cardiologist. He is a multi-threat in terms of research. He has his own Muppet named after him. And I think to myself, when I think about what he does, he touches the lives of his individual patients as well as people around the world with the research and the sponsorship and advocacy he does. I will never have that kind of reach, but if through the work that I do at Mount Sinai with technology, In addition to the patients I see every Wednesday morning or in the hospital or when they call me and touching them individually, I am helping to make the care safer, better for the millions of patients who come to Mount Sinai clinicians every year, then that's my equivalent.

Yeah, no, I love that. I'm really curious too, Bruce, when did you have an inkling to become a physician? Like when you were growing up, was there like a trigger point that happened and you said, hmm, I'd like to— I might want to be a doctor?

I was always Interested in the sciences in general, and I had this sense that I could end up being a doctor. I went through a phase where I was more interested in being a bench scientist or researcher, and then I sort of found my way back to medicine. And it was again sort of accidental. I was going through my training. I had been planning on becoming a pathologist, and had I done that, I would have gone a very different route. And then I decided— you know, through my rotations that I like talking to people and was interested in more of a sort of patient-facing or person-facing area of medicine than pathology. And I ended up in internal medicine and cardiology. And so it wasn't like I always knew I was going to be a doctor. I knew what kind of doctor I was going to be. It sort of evolved over time.

Yeah, no, so I always find people's stories and journeys, uh, super interesting. And I love the Atul Gawande advice that you gave as well, that you say yes before 40 and no after. I love that. That's good stuff. So we're going to talk a little bit about pandemic, some lessons learned. Then we're going to go into pandemic and leadership. So tell us about the pandemic from the start, from your point of view, and then how your team responded. And then after that, I'll ask you about lessons learned.

Sure. And looking back now, it's clear that there was a period of about 8 weeks in from the middle of March to the middle of May in 2020 where New York was really intensely involved in a new disease that was highly lethal, and it was a very scary time. One of my colleagues whom I work with reminded me the other day that he had come past my office in January and he said, you know, we're starting to hear things about this virus in China. What do you think is going to happen? And at the time I actually I think this is going to be the biggest professional challenge of my career. And I didn't know what it was going to look like. All I knew was that it was going to be something. The first case of COVID that was diagnosed within New York City was diagnosed on March 1st at Mount Sinai in our emergency department. And at the time, the ability to test for COVID was very limited. We had like the state lab in Wadsworth, New York was doing like 100 samples A day. That was it. A lot of the story of COVID at Mount Sinai and throughout New York is the story of the people on the front lines— the doctors, the nurses, the clinicians, the respiratory technicians, the people who treated all of those patients and dealt with intense stress daily. The story is really theirs, and the recognition should be theirs. From the standpoint of the work that I and my team did, We wanted to be in a position where, from a technology standpoint, nobody ever didn't have what they need— what they needed. We wanted them— if we needed to enable lab testing, and Mount Sinai was one of the first 4 laboratories in the country, I think, to be approved to do in-house testing for COVID. If that meant we needed certain processes in the laboratory that were technology-based, if we needed orders, if we needed results, if we needed flow sheet roles, reporting, dashboarding, whatever it was, we had to do that. If we needed to We had to make sure that we had an extra 1,000 iPads on stands so that if a patient was in the hospital and visitors weren't allowed, but they were still able to be in touch with their family members, we had to have those. We had to be able to deploy them. We had to make it easy. We had to get them on the network. We had to have all the security in place. If we needed to open up tents and spaces and a tent in Central Park, we needed to make sure that technology was there to receive and understand all of that. of these requirements and deliver on them. And at one point, I think we had 14 different work streams that we were working on, everything from ensuring our employees' safety when they went into situations where, you know, technology employees generally aren't dealt— dealing with, you know, wearing personal protective equipment, you know, to go into rooms to fix something if it's broken. But we needed to do that. We have a medical school, we needed to make sure to flip the classrooms. The first thing we had to do was we had to make sure that 10,000 people who were working at their desks had remote access to their computers and continued to do their work. So from a management standpoint, managing all those concurrently was an enormous undertaking that required roughly 500 people on our technology team to support what an organization of 8 hospitals and 40,000 people needed to do.

Yeah, you all did an amazing thing. You know, we were all watching in awe, you know, hoping Everything for the best. And the response that you all had and others is tremendous. Yeah, I know you also serve with a gifted CIO there, Krista Myers, and Robbie and the CNIO side, and you all did amazing. What were the— you just spoke about probably 10 to 15 different things that you all had to do. It was quite impressive, especially because of the unknown, right? We were still dealing with a lot of unknowns. Learning every day. What were maybe the top, uh, one or two lessons that you learned that, that we all might glean from for the next pandemic, whether it's a pandemic or some other sort of emergency we might deal with?

One of the things that I learned at that time, which I guess we're all dealing with even 2 and a half years later, is that you have to be able to make do with the equipment that you have on hand or the resources that you have on hand. You can't guarantee that you're going to get anything else. We were very quick to pull the trigger on equipment purchases because at the time, whenever somebody in a warehouse in Arizona would get COVID, they would close that warehouse down and sterilize everything, and then you couldn't get equipment from it. You know, that was sort of the first wave of supply chain problems. And so we were buying forward, and it was largely equipment that we were going to need anyway. You know, I know that I'm going to need desktop computers, I'm going to need iPads, I'm going to need stands, I'm going to need cabling and handheld devices. That stuff has a pretty good shelf life in many cases. So, and afterwards we really looked at, you know, what are the things that you would need to have on hand or within 48 hours of reach to be able to set up if you needed to increase the capacity of your hospital for patients by 30%. And that's what we used as our benchmark.

That's really good. I think, yeah, the We all learned a lot about supply chain and, yeah, just how to best manage it, and especially when dealing with the unknown. So you did a fantastic— because I happen to know your story because we've talked about it before, and I've certainly heard about it. I want to switch gears a little bit and talk about just leadership and pandemic. And how did the pandemic change you as a person?

It was a really intense experience. I worked for the most part Out of my apartment in Manhattan, which is about 2 miles from Mount Sinai Hospital. It's actually a couple of blocks from our Mount Sinai Morningside Hospital. And, you know, I would get up and I felt like I was in a cockpit. You know, I'd strap myself in at 6 in the morning, and I had 2 monitors, and I had a laptop, and I had 2 phones. And I would basically sit there for about 12 hours just directing traffic and staying on top of things. My team was amazing, and I did that basically for, you know, 6 or 7 straight weeks until it was time to go in. I shaved off my beard and mustache so I could go in and get fit tested so I could wear my PPE to see patients at the time. And that's how I knew I was coming out the other side, is I told people 2 things I told them. One, when you see me without a mustache and a beard, you'll know that we're on the other side. The other thing I told them is, you know, we were all using Zoom at the time. Mount Sinai made an, you know, fortuitous decision. We were using some other tool for video and call, you know, coordination, and we switched to Zoom actually in the 4th quarter of 2019. So we already had it on an enterprise basis. It was really easy to virtualize a lot of what we were doing. I told people, you're gonna see forests, you're gonna see trees in my background, and the more light there is at the end, the thinner those trees are gonna get. So people were able to get on and just look at my Zoom picture and say, okay, even before the meeting started, I know where we are as an organization.

Wow.

We ended up peaking in terms of the number of patients we saw at the hospital around April 6th. But from a leadership standpoint, it taught me a lot about the importance of getting into a rhythm with your team. We got into a rhythm where we had twice-daily huddles. We had a morning huddle that was informational. Here's what's going on, here are the important things we're dealing with, here are the requests, any questions? And that was mostly optional, but people wanted to hear that information, so they came on. And then we had an afternoon meeting where I would go down the list and say, okay, let's report off the leads for these 14 work streams. What's going on with hardware? What's going on with education? What's going on with security? What's going on with applications? And that's where we made sure that the information that people were working on over the course of the day got into broader dissemination. That worked very well. It taught me a certain amount about myself. I have a background in hospital quality work, and I've also taken FEMA training. So, it was sort of a perfect combination. It wasn't The way you'd never do something like this intentionally and say, well, I'm going to train somebody to be ready for this situation. But a lot of my background fortunately put me in that position.

Yeah. So Bruce, did you have FEMA training prior to the pandemic?

The hospitals have an incident command structure where it is based on Federal Emergency Management Association rules. And so I and many of the people on my team, because we get involved in incident command situations for like, you know, there's a fire across the street. There was, you know, Hurricane Sandy is an example from the New York area of the kind of thing that we didn't have a system in place then, but we do today, where we would, you know, activate a command structure on the hospital basis and the technology team would be part of that. So I basically used that process within technology to form our own You know, subcommand group. Yeah.

And I love that. And the reason I wanted to highlight that, that's just, you know, perhaps a best practice for those listening that don't have that sort of training. I think in New York City, you're probably— because of the nature of the city, you're probably exposed to those opportunities more often than maybe someone in a more rural area. But no matter where you are, I just encourage you to seek out— right, there's all sorts of government programs, government training, FEMA, and how to deal with emergency response. We did the same in some of the organizations I worked with in big cities. And it's tremendous training. And yeah, you go to it and you're like, you know, 10 years ago you'd be like, oh, what a waste of time, right? You know, nothing's ever gonna happen. But here we are. I mean, we're a lot smarter than we were back then for sure. So Bruce, how would you describe the impact on relationship with peers? I mean, you go through this pandemic crisis together and you must have had some significant bonding that's taken place in the organization. I'm just really curious about that.

Yeah, it was, um, Certainly, those of us who went through that, we can draw on that shared experience in a sense of, hey, you know, we're dealing with this today, but think about what we were able to accomplish. If this is the baseline level of competence and teamwork that we have, then by comparison, we should be able to knock this other one out. It's been very good for creating those Team bonds, and certainly, it showed for the organization what a good technology team could do and the importance of being able to rely on them. As I said, our goal was to never be in a position where somebody said, well, we'd like to do X, we'd like to open up a new unit, offer a new test, open up a testing site, but, you know, the technology team wasn't able to do it. We generated a lot of goodwill along the way there. And again, the heroes here, the story here is only about what the technology team contributed to the overall effort.

Right, for sure. Without a doubt. So as I try to sum up sort of this section and try to give some practical advice to our listeners, and so this is what I've come up with, Bruce, and tell me if I've missed something or if there's something else that you wanna add. But if, so if I'm a listener and I'm thinking, okay, in the future, how could I be best prepared looking at Mount Sinai. One is to have strong relationships already with your peer group, right? I think you're already a pretty tight organization and you had a lot of good communication and collaboration. So if you don't, that's something you really should work on now for a lot of different reasons. And the second thing was supply chain, just really understanding supply chain and how to— the word you used was sort of forward buying, forward, you know, having sort of those processes Ready to go in the event that you need them so you're not scrambling. Third thing I heard was you had huddles. So you have huddles, you had twice daily huddles. I imagine you probably still have huddles today. So it's just a way of working that organizations in the past necessarily didn't have alternative work sites ready. So a lot of organizations are already hybrid today because of the pandemic. But if you're not, or if you've had everyone come back, be always ready to be able to Pivot back towards, you know, sort of a hybrid environment. Uh, we talked about take training, get training now while you have a chance, not under stress, and it could be FEMA, other government programs. So those were like 5 that I picked out. Bruce, is there another one I may have missed?

No, I, I think you got it. And along with the training, I would say practice, you know, and take the opportunity, you know, even if you don't have drills, you know, take the opportunity when there's a, you know, there's a problem in the parking lot, you know, whatever it is, Take the opportunity to use that as a chance to use your command structure and, and your emergency processes. And our emergency management team was amazing, and we've continued to have a great partnership with them as well.

Yeah, it's kind of radical. I know it impacts resources and things like that, but I have a lot of Army training, military training, and a lot of our exercises were complete surprises to us, and we went into full drill mode. And there's nothing, nothing to show you the weaknesses of your Readiness and preparedness than an actual drill. And we would do that with cyber for sure. And again, it's costly. It takes a lot of resources, but man, the, in the world we live in today, it's probably time and effort well invested. One question related to virtual, and then I wanna switch and talk about CMIO relationships. I imagine, I don't know what the exact percentages was for Mount Sinai, but you know, we went from an average, like whenever I see the average of average, like 1% of virtual visits for outpatient care, let's say. We went up to 80%, some organizations maybe higher, some lower. And today, the last stat I looked at was about 10%, and I was sort of dismayed and shocked a little bit that it went that low. What is your sense about— and it may be different in New York City for Mount Sinai, but were you surprised by the reversal of virtual care? And do you think it's gonna— do you think we've hit bottom and it's gonna go back up, or what's kind of your view on it?

I think we've settled into what's sustainable and reasonable. One of the things to keep in mind about virtual is prior to 2020, in a lot of cases, it was a technology that was, you know, was a solution that was looking for a problem to solve. You know, there were niches where it made absolute sense, and there were ones where you could bill for your circum— you know, for, for your encounters. But a lot of times I would be working with clinicians who said things are working really well the way they are, why would I want to change it? I'm optimized for my patients to be here in person. I can get, you know, certain things done. And, and from a regulatory and, and funding standpoint, it made sense. All that changed in March of 2020 when they said that there would be reimbursement and parity. And, and obviously the circumstances made it so that patients in many cases couldn't come in physically. Mount Sinai, we've settled in the roughly 15% of our Encounters are now virtual, and I think that's probably appropriate. I don't think we necessarily need to force more. I think the key is to give people opportunities. I had a patient who just got out of rehabilitation who's due to see me this week, and he said, you know, I'm not going to be able to get anybody to take me over there. Can I do this by video? And I said, yes, absolutely. And so we have a certain amount of back and forth where we'll convert on the fly. Another patient who I saw a couple of weeks ago virtually, who really needed to come and see me in person and get blood testing and an examination and ultrasound. So it's good that it is now part of the options for patients as well as clinicians, and I don't think we have to force it to be more than it is.

Yeah, that— I think that's very reasonable. And as demand— it's supply and demand, and if consumers start demanding more of it, I'm sure, you know, you'll all react like the example you just gave, react accordingly. So I like it. It's good to have a blended model for a variety of reasons. So, you know, I know I know that you've been CMIO, I think you mentioned, 10-some years at Mount Sinai, and you have a fabulous CIO. You have a really good relationship with her, and I know it was similar before, Kristen. What would you say is some advice for CMIOs when they work with CIOs to have a good relationship? What are maybe 1 or 2 keys?

Yeah, and Kristen Myers, who is our chief information officer, she's the one who hired me in the first place To do that first implementation. So she and I have worked together a long time, and I appreciate, you know, her leadership, her wisdom, and her guidance. So she's been great to work with. And I think one of the keys, especially when the CIO is not a clinician, the key is figuring out how to strike that balance. The way that the CMIO role was initially described to me when I took the job 10 years ago was, you're the voice of technology to the clinical world, to doctors and nurses and patients, and you're the voice of doctors and nurses and clinicians and patients back to IT. And figuring out how to balance both of those, there will definitely be times when I go to my clinician colleagues and I say, I know you'd like to do this, but here's the reason why, from a technology standpoint, it is impractical, impossible, doesn't fit with the overall Overall need to give a cohesive experience for our patients. You know, there are times when I will be wearing the technology hat going to the clinicians or the patients to explain to them, but then I have to come back to my colleagues in the technology team and say, look, this is really hampering the way that patients are getting care, that doctors or nurses are doing what they need to do, and I need, you know, some attention and some flexibility here. And I think I think the one key thing you can do as a CMIO in your relationship with your CIO, if you're reporting to the CIO, is to understand how to balance those 2 responsibilities.

That's keen insight. We're going to end this session of Digital Voices a little different than most. We're going to have a cliffhanger. Bruce, I'm going to ask you a question, but you're not going to answer it because people are going to have to come back for the next time that you're with us. But when you and I were chatting, This is a pretty big topic, I think, because I think there's a lot of changes ahead. It'll be really interesting to get your insight because you're one of the pioneers. I mean, you've been doing this for over 10 years. The CMIO role has been around 10 years, but there weren't that many people doing it. You've been one of the leaders of the whole movement and the physician sort of tech executive and things like that, and great experience and great leadership that you've demonstrated. The question, and then we're going to end on that, but before we do, I do have to say, yes, thank you, Dr. Darrow and all of your team. And I know from a technical point that you, and you said this a couple of times, you're really there to support those on the front lines, but did an amazing, amazing job with the pandemic and continue to do so. We're certainly sensitive to the fact that we're not done. We have to continue to remain vigilant for very obvious reasons. And, but you all did great. And I always tell people, like, I was just so proud to be associated with people like yourself because I knew what it took, you know, in the background to enable all the success that we did have when we finally overcame sort of the brunt of, of COVID So thank you to you and your team for all that you did. So the question is, where is the role of CMIO heading? So it's changing, it's transforming like everything else. So where are we headed? So, but Bruce can't answer it. We're gonna tackle that on our next time that you're with us. But thank you so much for joining us today.

Thank you. Thank you for the opportunity.

Yeah, you're awesome. Uh, Mount Sinai, I'm a big fan. Thank you for everything. And of course, Megan, our producer, fantastic. Fantastic job as always. Thank you, everyone. We'll, we'll talk to you at the next drop.

Thank you for listening to Digital Voices Podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.