The COVID-19 pandemic has brought unprecedented challenges to the healthcare industry, prompting a rapid shift toward digital transformation. This session explores the significant impact the pandemic has had on hospital attitudes towards technology change and highlights trends developed by Palo Alto Networks to support healthcare providers in delivering care remotely. Additionally, Stephan Rockwell will address the crucial considerations for technology leaders in supporting a hybrid workforce within the healthcare sector. Join this insightful session to gain valuable insights into the future strategies and technologies shaping the healthcare industry in the wake of the pandemic.
Stephan Rockwell
Sr Director of Systems Engineering,
US Healthcare Palo Alto Networks
Megan Antonelli
Chief Executive Officer
HealthIMPACT Moderator
Delivering Care from Anywhere; How the Pandemic Accelerated Digital Transformation
[00:00:00]
Guest: Good afternoon everyone, my name is Stephan Rockwell I'm a senior director at Palo Alto Networks. And lead healthcare practice from a engineer perspective. I'm gonna take us through a little journey today what we call enabling care from anywhere. But I'm gonna take a little different twist because I think the audience kind of thirsts for this type of kind of storytelling piece where I'm gonna talk about how the pandemic actually, if there was a silver lining to the, the pandemic it, it really accelerated the digital transformation within our healthcare providers.
So I'm gonna take us through kind of pre [00:01:00] pandemic, like where we were prior to the pandemic from a hospital system or, or care provider threat landscape, you know, what changed you know, during during the initial impact from, from the covid pandemic, kind of what, what do we learn from that?
And, and really from a digital transformation perspective. What was done to react to some of those initial reactions that were made throughout the, the, the pandemic period. And then we'll kind of go through from a care perspective, how did technology enable care from anywhere? Meaning that, how did care improve, how did patient care improve as a result?
So from a, from a traditional set, from a pre pandemic, we're talking. 20 or so prior to this is the way a, a hospital system looked. And I, I like to use the reference, meaning there's really hard and. There's the hospital, there's the data center. Everything is inside your, your EMR is inside your applica.
All your applications reside [00:02:00] within your hospital data center walls. Your staff and your patients absolutely are, are receiving care within those same hard walls meaning that, In order to, anything that didn't exist or didn't happen with the walls was really by exception. Meaning that if, if, if an application needed to be leveraged from the outside, it was really, really something that was really frowned upon from a security controls and security policy.
The pace of digital transformation as you suspect, when you look at a hospital walls, this isn't exactly a modern breakneck speed technology revolution. This is, this is really a status quo. Let's focus on the patient and, and the care delivered within those walls. Regulations were very much set up to, or, or, or you can think of chicken and, but either the castle was to meet those regulations or the regulations were built to keep the in its state.
They kind of became a symbiotic roadblock or hurdle for [00:03:00] digital transformation. If. What's interesting is the patient's expectation of care was, if I am sick or if I need treatment, I, the expectation is that I go into that hospital and receive it from the, the clinical staff that, that is existing in, inside those patient walls.
So it's almost like the, and, and, and as well, the staff or the, the clinical and nonclinical staff, their expectations of when I go to work, I, at the data center or within the hospital status quo for a very, very, All, we all remember Covid when the Covid impact hit particularly very carnal for someone who lives in New York like myself, I mean, it was extremely, extremely chaotic and, and catastrophic.
And why is that? 'cause if you take that look, that same look up on top, you've got your E M R, your apps, your critical patients, and your essential CRI clinical staff within the hospital walls. The, the data center and the, the, the, the non-essential employees were basically not allowed in the hospitals.[00:04:00]
They were all sent home or away outside the hospital walls. So the data center was sparsely staffed at all. Really, the hospital walls were really reserved for care clinicians and, and, and those who were providing care to patients.
Then they, they tried to leverage because of the capacity, because of what was going on within the hospital walls. They tried to push all of the non-acute care out to a clinic-based care. Now, the clinic-based care that we know and love today was definitely not set up to, to to support the amount of patients and the amount of testing that was going on within those clinics.
At the time there was also a, an idea to leverage telemedicine Now applications. The the, the telemedicine that we were allowed to prov to access today was not in place, was really, really not widely used whatsoever. So, telemedicine really happened over zoom, over phone calls, basically, you know, anything that could be done without breaking regulations or, or, or really causing the hospital.
Some, some [00:05:00] legal ramifications was leveraged as a result. Really in general. If you weren't being treated inside the hospital walls, your care was, was highly, highly impacted by this by the, the, the, the lack of technology and the lack of means to provide care. El Elsewise, interestingly enough, the compensation model really wasn't designed to handle this distributed care model, meaning where they, you know, the acute patients were treated inside the hospital and really all other non-acute and.
Otherwise we're, we're, we're done outside the hospital walls. Now this really resulted in a, in a chaotic world where compliance was pushed to the limits from a security perspective. Huge remote access type concessions were made to access internal applications. And the capacity, as we well know from a hospital perspective, was pushed extremely beyond wellits limits.
So, [00:06:00] you know what changed? Hospitals well over capacity. I think we talked pretty clearly about that care was really restricted inside the hospital walls to the acute covid related patients, staffing models, completely shattered. Staffing models did not really weren't adequate and weren't designed for that type of flexibility.
Certainly within that, within that short term where you know, COVID impacted those hospital systems. Technology was not set up for, for, for that type of flexibility. You know, the security controls were really designed around keeping everything inside the hospital walls and, you know, the application and data within the hospital walls and not to be accessed generally outside the, the, the, the data center and billing and compensation.
You know, hospitals are really just trying to keep their patients. Treat treated, you know, obviously alive when it came to the, the acute care, but also the, the, the non-acute patients still needed treatment. You know, dialysis still was still happening. Cancer treatment was still happening. Things that were critical for, for care [00:07:00] other than covid was, was, were still required.
So, you know, by the way, hundreds of millions of non-acute patients were sitting outside hospital walls saying, Hey, you know, I need my medicine. I, I have the flu. I have a fever. All of this treatment still needed to happen. And they were, they were deprioritized for all the right reasons. But, you know, there was certainly an impact to the care that those patients were being provided.
Now,
What we did and how we were impacted and where we might have maybe not had that type of we didn't have to make some of the decisions we had to make was the reliance on the physical infrastructure is a real liability. Meaning that if a data center is the only place that your data is. Is it, it resides, it's controlled, so you're not able to access it for, you know, external access to that data, that's a real liability, meaning you can't flex at any point in your in during the pandemic.
That was, that was really it, it, the [00:08:00] impact was greatly felt by the patients.
As a result, you know, the, our, the patients that were going to the clinics, going to the non-acute care or going to see or receiving care via telemedicine, they kind of realize, Hey, maybe I don't have to go into the hospital for non-acute care. You know, maybe I don't need, you know, if I've got a, a cough or a sniffle, I going to the hospital seems like a less optimal for me.
Their expectations, they. Realized there was a better way to do it, and the hospitals kind of had to meet them , where their expectations were. You know, ho hospital capacity, meaning if you have X amount of beds, that's the amount of patients that you can treat. Now that's in a normal non pandemic era, that's okay to, or you typically don't hit those a hundred percent capacity, so you're you, it's less.
Felt, but when you do flex into a, a pandemic, hopefully [00:09:00] we don't see it obviously anytime soon. But if that happens again, you have to be prepared to be able to provide care in a different form so you don't hit that capacity limits that hospital system. Now in turn, you know, the hospitals meeting their, the, the patient's expectations, meaning that that, that there's only certain care that.
Deems the need or deems the requirement to be in the hospital wall if you need an X-ray, sure. It's most likely in a hospital, if you need to see, you know, four different types of doctors in order to receive treatment, sure the hospital probably makes sense. But if you're gonna go and get a, you know, a physical for, for, for some purpose, or you're going to, you know, get your flu shot probably doesn't need to be happening in a hospital within the hospital walls.
So you leave that capacity for those most critical of patients. And, you know, from, from an IT perspective or really an overall technology perspective, technology was always seen as a, a threat vector. But in [00:10:00] reality, if you turn it inside out and try to support something like we're seeing here that technology can be the extreme enabler.
Meaning if as technology is way, way further advanced or way further along in the the digital transformation than most hospital systems are today. Meaning that the, the, the hospitals almost need to catch up to that technology and understand that it can enable what they're trying to do from a care perspective as opposed to threaten it.
You know, legacy network, legacy networks that existed prior to to the pandemic were really really hampering their ability.
And, you know, we all know that billing and compensation wasn't designed for care outside the hospital Walls. That also has needed, or has made significant progress in evolving and meeting, you know, the different types of cares that can get care that can be provided outside the hospital.
I wanna dig down a little bit into understanding, you [00:11:00] know, what was done, what was the reaction to to the pandemic? Meaning we understand what we had done what the, the, the evolution that we didn't make. Okay, so what was the evolution we did make as a result? You talk about the journey to the cloud, journey to the cloud from a cloud, from a, from a care provider perspective, isn't the way most say commercial enterprise customers.
Appreciated as such, journey to the cloud doesn't mean running to the a w s Azures and gcps of the world per se, and from a care provider's perspective, going to the cloud meet really means pushing your data and your, your applications outside the data center walls. Meaning you're gonna leverage third party applications.
Ones that maybe existed in a on-premise form factor in your data center. You're gonna leverage that same vendor and that same application for, but in their SaaS format, meaning it sits in their environments. And they provide that, that application to you. Some, some healthcare providers. Even moved as far into the digital [00:12:00] transformation journey to start develop their own cloud apps.
Ones that might access their EMRs that aren't provided by their EMRs today. Maybe it's an application that you know, that, that helps 'em onboard patients better or bill, you know, do proper billing or, or accountability throughout their their check-in their, their coming into the hospital and dividing receiving care and checking back out.
You know, a lot of hospital systems are now either looking or have made the journey where they're actually moving their EMRs into a hosted or a public cloud environment. Meaning they, they're either either buying it from their current E m R vendor in a hosted environment, meaning in their data center or in their cloud environment, or they're actually leveraging their E M R and moving it into their own public cloud environment.
A Ws G C P Azure, for example. Now when this happened, you know, as a result of the pandemic as well as, as a result of the technologies that they've adopted, they've been able to, you know, push the same technologies that they have within the, the [00:13:00] hospital walls. Outside the hospital walls. They're able to provide more unique caress within the clinic environments. They were able to push non-acute care out to a care center outside the brick and mortar hospital walls. Some have even gone as far if not are, are investigating forms of home care and telemedicine that they can provide that care to their patients in a.
What a hospital, what a hospital system is trying to do. They're trying to bring patients into a hospital, into a hospital setting or a care setting, provide care allow them to go home and return and, and, and not return to not return to that same care provider, meaning they stay healthy after they leave that home care.
And telemedicine allows for that that to happen without them having to return to, say, the clinic or the, the hospital setting. Now, A lot of those hospitals have actually used this same transition to provide, I'll say a little flexibility for their, for their home workers or their [00:14:00] remote workers. They, they provide hybrid environment so they can retain this talent within their their staff to be able to give that, that flexibility for that employee so they don't go and move onto a new hospital system down the street.
So they're able to retain and, and prevent attrition with their, within their staff. Hospital systems have also taken the the approach, opportunity for. Now when, when application sat inside the data center, implementing zero trust within a, in a long established environment is a very difficult thing to do.
But when you start moving things outta the cloud, it doesn't have those same rigid walls and those same rigid paths in and out of the networks Where Zero Trust is, is able to, you're able to implement zero trust in a, in a a much easier fashion and, and build policy around it. Now because your applications don't sit in the cloud excuse me, your applications don't sit in the data center where you had traditional security [00:15:00] controls that were really based on predictable past, in and out, out of the network.
They're now sitting in cloud environments, whether it's SaaS, public, cloud, hosted environments. You've gotta really change the way you secure these these, this data and the, these these sessions between the user and the, and the application. We need to leverage things such as cloud deliver NE network security, sass e if you've heard the term cloud native security, maybe a you know, native cloud toolkits from a security perspective, D O P C A S B, from a data loss prevention or a patient data records security perspective a p i, to be able to talk to those applications within cloud environment SD-wan.
That predictable route and path selection in and out of those cloud environments where you know, your data resides. Now from a, to really wrap this up, you know, how is technology enabling care from anywhere? Meaning how, how, how has care improved [00:16:00] as a result, you know, care. The care providers and the, the patients have really kind of met in the middle and said, this is how I wanna be treated.
And the hospital systems and care providers are, are kind of meeting them at that point. The hospital itself, the, the, you know, the, the lifeblood of that system becomes the, the, the priority for only critical care, meaning you've kind of freed up within those hospital systems to provide those critical acute patients within the hospital.
In turn, you've kind of freed up. Those beds for so you're not really clogging up the, the capacity or clogging up the system with non-acute patients as a result. It really, from when you leverage these newer technologies too, they're, because they're cloud resonant, they don't have those. Those kind of rigid paths in and out of the network.
So it really opens up the door to, to further evolve tech the care perspective. So, you know, really this, this is really the start of a digital transformation journey. [00:17:00] I think if you look at the, the way the, the payers and the, the, the federal regulations are exist.
They are able to kind of see that that hospital systems have to move forward to this on this digital journey. So they're really looking at changing the way that reg regulations are written and how insurers are able to compensate those systems as a, as a result.
Now I think I'll pause right there and I'll take a few questions.
Host: Well, thank you so much. That was great. I really enjoyed hearing it, also hearing it in, you know, where I can really focus on it. And I think when we. Participated in at Health Impact. We heard a lot about the changes that came outta the pandemic and how technology accelerated, you know, and the technology adoption was accelerated and I imagine that with all the customers that you have, there was varying degrees to which this was impacted.
So tell us a little [00:18:00] bit about where you saw some of the greatest impact and some of the, you know, biggest sort of shifts in attitude. You know, not just during the pandemic, but after as well.
Guest: Yeah, that's a great question. I would, I would kind of break it down into two different categories. You had the large, really well-funded hospital systems who were kind of, their head was already in that space anyway.
We were gonna provide care in, in different forms and really branch out and, you know, move forward from a digital perspective. But what we, interestingly enough, they moved, I would say, a little bit slower. They were already on that path. They, they, they weren't really surprised as much as, as, as the more rural systems, because if you think about it really from a, from a large fund, large, well-funded hospital system in, say, Metro, New York City area, they're really just trying, trying to really keep pace or compete with others as far as providing that, that.
Splitting the atom, you know, type care. So they were really on that path already. This [00:19:00] certainly, don't get me wrong, still accelerated, and they, they were heavily impacted by the pandemic. But if you look at the rural systems, the large rural systems, not only were they further behind and less or, or, or less well funded than those larger hospital systems, they also, their, their patients were more remote.
Meaning, meaning that if they did were impacted by the pandemic or were impacted by the lack of care, they were, were able to receive as a result of the pandemic. They were, they, they really needed a unique way to, to reach them. You know, they had to reach further into the, the rural community hospital systems to, to provide that care, meaning they really had to catch up and, and go, you know, go beyond that.
From a staffing perspective, some of those community hospital systems don't have the, you know, large staffs or large talented staff, so they, they had to leverage a lot of those SaaS applications or manage services or manage SOCs, all of all, all of these technologies that really. I wouldn't say spun up, but really became a, became, became a topic of conversations for those hospital [00:20:00] systems.
Right.
Host: Yeah. I mean it really sort of changed, I imagine from sort of, it would be a nice to, nice to have, nice to do to a must do. Right. Were there specific things, I mean, you mentioned, you know, sort of broadly the cloud, you know, cloud, public cloud, some of this SaaS that, are there some specific things that overwhelmingly were adopted that you think will take us.
You know that that will sort of change the face of
Guest: that. Yeah, a hundred percent. I would say in a general format, it was getting everything out of, or not being hampered or really constrained by the ho, by the data center walls or, so a lot of these applications, even the EMRs, like I said, pre pandemic, talking about.
Warn a conversation now, every one of the, the cloud service providers has an offering to move your, your E M R out into their cloud. Mm-hmm. That's, that's amazing because they're meeting the need that the hospital systems have. So I [00:21:00] think that the larger technologies that were adopted, SaaS number one sass e probably number two, and then really you know, hosted in cloud environments for, for an E M R perspective.
Those are, those are really big. kind of paradigm shifts SD-wan when, when you talk about going out and building clinics on every corner, if you could, you can't do that if you have to wait, you know, six months for a circuit to be delivered by your circuit provider. SD-WAN allows for that to happen on nearly overnight if you can get broadband in overnight.
So it's, I mean, you could literally run it on five G if you, if you had the, you know, the ability to do so.
Host: Right. When it comes to E M R in the cloud, what are some of the main considerations that you think hospitals need to take?
Guest: I'll take political aside, you know, that's, that's certainly not my area of expertise, but you have to think about.
Patient records obviously are the lifeblood of a hospital system, meaning there's no, I've never met an industry other than maybe finance and their, you know, their [00:22:00] actual money. You know, the, the, the healthcare system treats their E M R records on par with patient safety. I. They won't ever admit that, but you know, that that is really what keeps them in business, is having those patient records safe and secure and within their hospital walls.
So, moving to the cloud, you have to change the way you secure it, the way you inspect it, the way you monitor it, the way you react. You know, it's a, it's a very different way to do business. Your IT staff does everything they used to do. They don't do anymore. They do it in a completely different way. The rules change, the policies change, the regulations change the way that you do things change.
So moving into a cloud environment is a very scary move, but it opens the door up for so, so much more. Think about like, you know, I'll call 'em third party apps, ones that actually, you know, talk within your E M R, maybe they're developed by your E M R itself. That, that really can't happen unless they're in cloud environments.
You think about things like community sharing of, of these E M R systems, you know, [00:23:00] that that becomes a lot easier. I won't say easier, but a lot more available in a cloud environment when your, you know, your cloud extends across the entire United States.
Host: Right. And then, I mean, I imagine that once that happens, does it, does it change the ability from a staffing perspective for your clinicians to be able to access and, and, and stuff from a, you know, from, as you had mentioned, kind of the remote worker ability.
Is that, does, is it an enabler there and what are some of the considerations there? Yeah, I
Guest: think most of these technologies, much like care, The, the, the way we patients perceive care, our eyes were open and the, the kind of the, the hospital system had to meet the expectation of the patient. I think from a, from a technology perspective, the IT department has to meet the, the staff's expectation as well.
We have many hospital systems that, that they, they're relying on what the, the technologies they put in place during the pandemic. Going forward, they intend to keep them in place, meaning [00:24:00] hybrid work is something that they want to offer their employees because they don't wanna lose them. They wanna make sure that those employees don't, you don't have employee burnout.
You think about remote radiologists, most hospital systems leverage remote radiologists, and they, they literally have worked on the most archaic of technologies in order to do, to do something that really they expect to happen. Split second. Like they, the more, the more patient records excuse me, the more film that a or images that a radiologist can inspect and, and really has a direct impact on the patient revenue that the hospital system brings in.
So, To be able to provide that more secure, that more optimized way of them doing that, that level of work is, is something that the, the hospital system doesn't wanna look back on. So everything is, hey, how can we do this better, faster, more secure? And that's really, you know, a step forward in, in the way of thinking where pre pandemic, it was like, Hey, castle walls, right?
Everything in here is safe. Everything out there is bad.
Host: Right. And I guess, and that's, I think when we thought about it before, and I [00:25:00] mean maybe even now, sometimes delivering care anywhere you think about the patient, right? You think the patient is getting the benefit of this, they're getting the benefit of having be being able to get care where they need it, when they need it, without going into the hospital if they don't want to.
But it also benefits the employee, you know, the physicians and clinicians who can do some of the work outside of. Those four walls as well. Um, um, yeah,
Guest: If you think about staff, the, the, the, the availability of your staff really affects patient care. You look at the, the nursing shortage, how that has directly impacted the hospital systems still today.
That is, if we can figure out that part, if the clinician, you know, how to, how to keep the clinician burnout. Technology that's really nirvana for these systems, right?
Host: Yeah, no, I love what you said about technology being the extreme enabler, right? I mean, that's what we've always at Health Impact.
You know, that was sort of the beginning of of all of this. Somewhere along the way it became, you know, sort of a burden, a, a [00:26:00] disruption that wasn't positive. And I do think that the silver lining of the pandemic is so much was accelerated and the attitudes towards adoption change that we got to a place where the benefits were, you know, seen on both sides.
Not to say it's perfect. Not to say we're a hundred percent there, but you know, but it, and thinking about some of unintended consequences and, and things that I think obviously were initially thought about, you know, when hospitals thought about patients, you know, having virtual care. When you think about And I read an article recently around sort of schools not being filled, right?
And so when you think about empty patient beds, that's not what hospitals want. That's not their goal. How, you know, as we look to the future, what are some of the things that, that you think, you know, will make, you know, hospitals sustainable? What, what, where are we gonna, where are we gonna go with this?
And, and what's your, you know, give us a few kind of takeaways of what technology is the great [00:27:00] enabler means for the future.
Guest: I.
It's, it's not natural for a hospital system to think, you know, what are we doing gonna do in the future? Well that's probably not fair, but it's, it's certainly their primary focus has always been on sustaining the current state of affairs. But yeah, I think hospital systems are looking at different forms of care that can really rely, or I think a hospital system in general is trying to open up all of the avenues for possible care to provide the best care in the best location.
Ideally, you know, at the, at the optimal time and price, meaning that patients recover best at home, you know, they're, they're more likely to not return to the hospital system, which we all know is a, is a very bad thing for them. I would say home care is really the next frontier from a, from a hospital system.
And that's not, That's not as simple as how are we going to provide the care? Is it, how is that care going to securely communicate back into the, into [00:28:00] the the, the, the care provider, meaning the person that's gonna look at these records and that's gonna make assessments and make and provide treatment paths forward.
How are we gonna do billing? How are we gonna, do, you know, all the things that happen within the hospital wall, but how do you do that over. A cloud network, the internet essentially. Which is a terrifying, it's a terrifying frontier for most systems. But they know it's gotta happen. Whoever figures it out will win.
You know, not that there's a, a winner and a loser and a hospital system, but that's really, you really wanna, most of these hospital systems really want provide great care, but also really be novel in the way that they do it. Yeah. You. Improve care through their efforts and through their technology and their, their leveraging of it.
Host: Well, that, I think that's a great way to sort of close out the conversation. And I think that there's no winners and losers, but the, you know, they want the winners to be the patients and they want, you know, to, to provide that great care and [00:29:00] technology. Is that enabler to, to allow them to do it.
And I think it's, what's exciting is that we've seen it, we're, we're at a time where that's been recognized. So now it's just how do we you know, perfect pivot, change, , evolve and, and use the right, right. Technology at the right time for the right patients. Right,
Guest: right. I appreciate that. Awesome.
Host: Well, thank you so much and I look forward to hearing more from, from you and, and seeing all the great work that you guys do
Guest: at Palo Alto. Thank you. I appreciate, thank you for the time.
Host: Absolutely.