Ashwini Zenooz, MD

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As the world has gone virtual during the coronavirus pandemic, so has healthcare. Digital transformation has accelerated at warp speed, with virtual care delivery going from rare exception to operating norm almost overnight. As our nation, along with our hospitals and clinics, turns to the complex and messy challenge of re-opening, one thing is clear: there is no turning back. We need to harness learning from this crisis, sustain the energy and urgency of the moment, and, as the renowned oncologist and author, Siddhartha Mukherjee, MD, 

, “think not about resumption but revision.”

My recent conversations with healthcare leaders, entrepreneurs and others have converged around a set of grounding truths that will anchor and guide digital transformation through this project of revision. The degree to which healthcare’s leaders and institutions can pivot and respond to these new, or newly urgent, realities will determine their relevance in the post-pandemic world.

Restoring patient trust becomes first priority

“We’re definitely safer than the grocery store or Home Depot.” That remarkable plea to patients by the CEO of two major Virginia hospitals-which I’ve heard echoed by others-highlights the predicament health systems find themselves in as they look to coax apprehensive or fearful patients to return for care. With hospitals hemorrhaging 

 from loss of elective procedures, and widespread concerns about the health impact from delays in care, every hospital and clinic is laser-focused on allaying patient fears and re-building trust with consumers.

As hospital leaders look to get patients back in, a more sophisticated digital engagement strategy will become mission-critical. Hospitals will need to be able to segment and target patients-starting with those whose procedures were postponed and are most at risk from further delaysand assure them that their facilities are now clean and safe for care. Staff and call center agents will need to be armed with the data, training and tools to field difficult questions from concerned patients and get them scheduled quickly and efficiently. With many models predicting recurring waves of COVID-19 into the winter and beyond, having a well-oiled customer outreach and engagement engine will be a make-or-break proposition for health systems.

Trust must also be kept front and center in the context of data privacy. As states and employers move to reopen, the success of contact tracing and ongoing public health efforts depends heavily on assuring people that their personal data will be protected. Although tech companies have devised approaches to contact tracing based on cell phone location data, a recent

 found that locally-run in-person approaches are more trusted and therefore more likely to succeed. We need to move cautiously on any efforts that single out individuals based on their virus exposure and risk factors as the potential for inequities or abuse is very high.

Care that can be virtual will be virtual.

With the flip of a switch, the virtual doctor’s visit went from being a new alternative to an operating norm nearly overnight. According to Saurabha Bhatnagar, MD, Chief Medical Officer, Head of Technology and Performance at UnitedHealthcare Medicare & Retirement, the rapid mainstreaming of telehealth required a number of pieces to fall into place quickly, involving patient optionality, regulation, and infrastructure.

“The technology was primed and ready, then the COVID-19 pandemic led many patients to try it for the first time, gain a comfort level, and be delighted with the experience," Bhatnagar says. "The relaxation of telehealth regulatory restrictions further allowed utilization.”

Having entered the mainstream, telehealth adoption will likely only continue to accelerate and expand. As Bhatnagar sees it, for telehealth to become thoughtfully integrated, patients will need to be educated around when a virtual visit is an appropriate option for care, or even the preferred mode.

“Just as a patient newly diagnosed with congestive heart failure won’t know at first when to see their primary care doctor vs. their cardiologist, there will be a learning curve to knowing when to come in face-to-face vs. check in virtually," Bhatnagar says. "Education on telehealth will be key.”

From its newly established beachhead, we’ll see telehealth rapidly expand into other modalities of care. As Bhatnagar sees it, “right now we’re seeing lots of virtual visits, but as people have more connected devices in their homes, facilitating more remote monitoring with connected biometrics, we’ll likely see telehealth become a first line of evaluation for some conditions.”

Demand for data breaks down remaining siloes.

The COVID-19 crisis has put a new premium on healthcare data. Whether for surveillance and modeling of spread, evaluating which treatments are leading to recovery, or contact tracing to assess risk and aid re-opening efforts, the ability to access and share usable data while protecting privacy has never been more important. And yet, such efforts have run up against long-standing barriers to interoperability and the painful realities of unifying data across siloed EHR systems. Mukherjee characterized the gulf between current and ideal future state as “like moving from a patchwork meteorological system where towns keep their own records of wind and rainfall to a national weather-tracking grid.”

Luba Greenwood, Harvard professor in the School of Engineering, and former Google and Roche executive, thinks the conditions are now ripe for change. “With widespread availability of a Covid-19 vaccine still potentially two years out, people with pre-existing conditions will need to have their conditions managed outside the hospital," Greenwood says. "This will require the collection and flow of as many data points as possible from wearables and other devices.” 

Greenwood stresses that as home becomes the safest place to manage many conditions, we will see end-to-end virtual care models that encompass the full continuum and are 100% reliant on seamless data flow.

Social determinants get the attention they deserve.

Public health emergencies tend to reveal both shameful weaknesses and hidden strengths in our support systems and infrastructure. In New York and other cities hardest hit by the pandemic, low-income neighborhoods that lack access to secure housing, healthy foods, green space and clean air have also 

 of the pandemic-heightening awareness and urgency around addressing the social determinants of health. 

"In the wake of this crisis, we are seeing a greater focus on comprehensive community health,” says Daniel Brillman, CEO of Unite Us, a coordinated care network and digital platform that connects health and social services providers. In March alone, their network saw a 287% increase in referrals for food assistance, housing and income support. “As government officials look to build a more resilient public health infrastructure, we will need to connect medical data seamlessly to social services data to address gaps and track outcomes at the community level.”

Large-scale crises, be they epidemics or wars, shake the foundations of society and throw the status quo into question. Calls for change move from the realm of academic debate to decisive action overnight. Regulatory walls that once seemed impervious are quickly breached. In a matter of months, we’ve seen healthcare’s digital transformation advance in ways it would have otherwise taken years to achieve. Having seen what’s possible and tasted change we can’t put the genie back in the bottle. To stay relevant and competitive, and extract some lasting good from this crisis, we as healthcare leaders must consolidate and build upon recent gains.

Dr. Ashwini Zenooz is chief medical officer at Salesforce.

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As the world has gone virtual during the coronavirus pandemic, so has healthcare. Digital transformation has accelerated at warp speed, with virtual care delivery going from rare exception to operating norm almost overnight.

Ashwini Zenooz, MD

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