iThings in healthcare…a very unexpected journey: lessons learned from IT | JNUC 2020

Welcome, everyone “iThings in Healthcare: A Very Unexpected Journey.” Jamf has been in the health-care space since 2015, releasing our first health care dedicated solution in 2017, and now again in 2020, which you’ll hear more about today Joining me is James Rafel, the IT program director from Geisinger, and my name is Kelly Offerman I am a health care business development executive here at Jamf Jamf has been supporting three specific use cases for health-care environments historically and now within this global pandemic These key use cases include patient experience with our EMR integration or Healthcare Listener, clinical communications supporting our strategic partners, and telehealth, which has evolved since COVID-19 Now to pass it over to James to learn more about how Geisinger has leveraged Jamf’s platform in these three key areas James? Thanks, Kelly I’m James Rafel I am a program director at the Geisinger Health System in Central Pennsylvania I’m gonna present today on “iThings in Healthcare: A Very Unexpected Journey.” That title kind of reflects as we started a few years ago looking at Apple devices in our ecosystem and how they’ve evolved to today And as you see on the screen there, hopefully you’ll learn a little bit more about iOS and health care, central management and devices, and lessons learned between IT and the operations in health care So a little bit about Geisinger We, as I said, are in Central Pennsylvania, so if you think about everything between Pittsburgh and Philadelphia, that’s usually– that’s approximately our territory And as you can see there, we have a variety of sites That main site is where I work out of in Danville, Pennsylvania, which if you think about Pennsylvania, it is a little bit southwest of Scranton and Wilkes-Barre and about two hours north of Harrisburg So, that being said, Geisinger, we have spread amongst that region about 32,000 employees Of those about 1,800 physicians We’re a physician-led organization, which means in key areas of administration, there’s a physician partner with an administrator So decisions are made collaboratively to take as much of the clinical enterprise into account as we can We go across 45 counties, 13 hospital campuses, two research centers, a school of medicine I forgot to put on there as well a health plan So yeah, we’re a varied health system in a rural setting Device-wise, we are primarily a Windows shop across those 30-plus-thousand employees We also have 30-plus-thousand Windows endpoints But obviously for the sake of this discussion, we’re gonna be talking about iOS devices So our numbers when it comes to mobile, we’ve got an– I won’t read the numbers, specifically, but we have a fair number of devices, and a lot of the focus of what I’m gonna be talking about is on the iPhone and iPad population of devices So I figured since it’s an unexpected journey, I’d throw a little bit of “The Hobbit” into this, and as the quote says, “It’s a dangerous business, going out your door.” And what we chose to do a while back was to head out the Windows door and start to look at what we could do in the Apple world in our health-care environment So also back to the beginning, one of the key things that drives everything that we do is HIPAA, and I’m not gonna dive too deep into that, but just as a framework, when we started with HIPAA, as you can see with some of these dates, a compliance rule came out, security rule came out, and since 2005, if it is not a HIPAA-compliant, HIPAA-blessed system, information security, internal audits, and external auditors will not be very happy with what we do So that piece of the puzzle

drove these dates So back in 2007, you can see first gen iPhone, email on iPhone, and 2010 The first gen iPad, that’s where things started to ramp up And previously to my position that I have today, I was the program manager for our end user computing environment So infrastructure-wise, at that time, I had the pleasure, I guess, of bringing in Jamf to start to look at how we manage our Macs at that time, and it’s evolved from there, and I’ll be talking about that as this presentation goes on But then 2014 through today, all those devices started to proliferate around the organization And in addition to that, I have a requisite Star Trek slide, just because it is an IT type of conference, along with a lot of admins In 2014, we had kind of a paradigm shift, and in my mind, on my team’s mind, we couldn’t really look at it solely from that HIPAA perspective, solely from an IT perspective of making everything as supportable and usable as possible We had to start to remember that we are a hospital or a health care organization So the quote there, I think for anybody who deals with Apple devices, you’ve had people tell you that, and we had a physician tell us that back a few years ago, and that’s kind of what started this journey So we started investigating what we could do with Apple devices We started investigating how we could make them available and kind of Jamf’s pushed the last few years to illustrate getting Apple into the enterprise We were doing that a little bit before I’m happy that Jamf has evolved where it has so that it makes our lives a little easier with the management of devices But in addition to the staff, this is also where we’re focused, meeting patients where they are So in 2014, we were presented with an opportunity to create a system that vendors now have created themselves, but it’s what we call our interactive patient system And we were asked in IT along with the clinical operations folks to develop an iPad solution that we could put at patient bedside to allow them to be entertained, to pass the time, to be engaged, and also to take a little deeper role in their health care So–and I’ll talk about that in a little bit So meeting patients where they are, meeting staff where they are, has evolved to where we are today And the way we do that, obviously, being JNUC, I have to put in the plug for Jamf But without it, without the MDM, we wouldn’t be here But I always put a plus sign next to it because without the operations people helping us to understand what the needs are, helping us to understand the workflows– because in IT, we are not on the nursing units We are not in the ORs So we have to rely on those folks to help us out The security teams, as well as IT– without that combination, we wouldn’t be where we are So the magic Just running through this a little bit, where we started was when there was DEP and VPP Now that’s kind of evolved into Business Manager and School Manager, but it allows us to be very flexible It allows us to use, as that shows, with DEP, we can use all the questions to set up a device or we can switch to none of them as it onboards, and I will be talking, referencing– Kelly mentioned Healthcare Listener in her opening We do utilize Healthcare Listener for our interactive patient system So I’ll explain that in a minute Square peg in a round hole

We have to design systems that can take almost anything into account I know that sounds like a very broad topic, but as it says, lockdown to fully open Our bedside devices are fully open and available for patients to alter them, but the flip side of that, we also have devices that are very locked down to, say, a survey So it runs the gamut And as the next bullet point there, one app to multifunction, is exactly what I just described running from a survey device to a bedside device And technology is not always the answer So I’ll speak to some of the workflows as well that we ran into where we could not apply an MDM solution We could not apply any kind of technology to it It had to be a different type of workflow And of course, as I mentioned already, the partnerships: IT, information security, and operations That’s–you put all those together, and that is the magic that gave us what we have So one of the points that I wanted to talk about was how we’ve been successful with some of our projects over the years So touching on a few of these items, patient experience, provider tools and nursing tools The interactive patient system, as I said before, we created this system, and at that time– that was before Healthcare Listener, that was before Jamf Reset, Jamf Setup, it was before a lot of stuff So we had to kind of create and build– with the help of Apple, with the help of Jamf folks– what, at that point in time, was a very new system So it was a combination of iPads It was a combination of Apple TVs as well as Macs running Configurator, and at that time, it was pretty cool It got the job done It gave the staff the ability to have an iPad at the bedside Use the flexible configurations that are available We provided 100-plus apps in self-service We pushed web clips to different educational topics as well as links to iBooks, depending on a situation For example, labor and delivery had a need for allowing parents to watch a video before they were allowed to take their baby home So we provided that mechanism to get rid of, at the time, actual VCRs attached to TVs and convert that to an MP4 on the iPad, and they were able to watch it that way, which also saved a lot of room in the patient rooms They didn’t have to wheel in the TV on the cart So not to belabor too much in detail in that, but in order to accomplish that, it was many meetings It was months of development work to figure out how we could best provide that solution, and what came up at that time– and we’ve gone through about three revisions of IPS at this point What we had at that time was an image on the Mac mini using Configurator, with no DEP at the time, and the staff was plugging the iPad into the Mac mini, letting it sit for about a half an hour to reset the device, and then giving it back to the patient As I said, workflow-wise, there is some technology or some situations that technology does not allow to happen, and this was one of them It wasn’t the best solution, but our staff had to take the iPad out of the room when a patient was discharged, plug it in, and then put it back And lesson learned from that is, nurses really need to do nursing stuff, as opposed to doing IT stuff So as the project evolved, the timing of DEP and the timing of some of the other advancements,

self-service in Jamf, allowed us to move to version two, which was more of a dynamic image We were able to take advantage of DEP as well as caching servers on the network It was still a manual reload, plugging it into the device, into the Mac Mini, but that time was reduced down to about two minutes So again, staff still had to move the device back and forth Wasn’t ideal, but it was better than before So with most any project improvements, if you can make it better than before without losing functionality, that’s a win Version three, speaking of a win, when Jamf came up with the Healthcare Listener tool, that was pretty much a game changer So we were able to remove that workflow of the staff having to move the device between the room and the nurse station, and the devices could then just stay in the room At that point, we were able to remove the Mac Minis We essentially had a centrally managed iPad that we could pretty much do what we wanted to based on smart groups, and I’ll talk about that in a little bit But based on smart groups and some other things, configuration profiles, that really made it easy to manage those devices So beyond IPS, because there were iPads in the room, it also allowed us to expand to outside of the hospital So we were presented again with an opportunity to create a situation where our students or students who were in our hospitals for either repeat, like a dialysis situation, or an acute injury where they were there for multiple days or weeks, we were able to work with our clinical staff to figure out how we could allow the patients to reduce social isolation and keep up with classroom work Obviously, the kiddos were more interested in this reduction of social isolation versus keeping up with classroom work, but ultimately, that’s what Classroom Connect evolved into So that little robot there in the picture is a piece of hardware that, through some grants, we were able to acquire and provide to various schools around our catchment area and partner with– they are called intermediate units, to get the devices into the schools in a timely manner and allow us to, using the bedside iPad, do video calls into the students’ classrooms The efficacy was going to be looked into to see what type of impact that had on the patients Unfortunately, the provider that introduced the program did not have the time before they moved on to dig into the research aspect of it, but it was a pretty cool project, and we did learn a lot about working with school districts, working with outside organizations to pull this off Interpretive services So as part of the Affordable Care Act, there were some rules put in place where organizations had to provide interpreter services as opposed to asking the patient to provide those themselves So this was also a new project These were single-purpose devices that provided audio-video interpreters for patients This project also introduced some hurdles as these were non-Geisinger devices So working with where we had settled into being able to use DEP and all of the bells and whistles of Jamf, we could not do that So taking a couple of steps back, we were able to pull this off as well and still provide the services to our patients that they needed This has actually evolved into– and I’ll touch on it a little bit at the end– a very good use case for transitioning between applications and devices So provider tools,

I said I would touch on that a bit So as part of the non-iPad, but more iPhone projects that we had, there were projects that were put in place both for our providers as well as our nurses to give them ways to use a secure text messaging tool– and in our case, it’s TigerConnect– and also access to our electronic medical record– and in our case, it’s Epic So using the tool apps Haiku and Canto to give the physicians the ability to do lookups into the medical record from a device in their pocket, and then other clinical apps like UpToDate or other reference apps So those iPhones were essentially put in place They do not have a voice plan on them, but because of the better radios that were in the iPhones over the iPods at the time, folks didn’t want it to go in that direction So these provider tools are now available, and in most cases, these are available in a BYOD model So the providers don’t have to take their own extra phone– or their own phone and an extra phone around with them The nursing tools are on in-house iPhones So again, most all of the same tools In the EMR case, it’s an app called Rover, as well as other reference apps, but the feedback that I’ve heard from our nurses and nurse informaticians is that the TigerConnect, the secure messaging, has been a game changer for them, allowing them to better interact with other staff, reach out to the appropriate roles that are available, find the right on-call people very quickly So that is in place now That has rolled out to, I believe, almost all of our campuses as of today So much of the talk that I just went through, I touched on in another presentation that I had done prior to HIMSS, and that presentation, “iPad at the Bedside” was done on March 10th, and as you can see, right around that time, COVID hit, and during that presentation, my parting thought was increased agility and the ability to flex as new things were pushed our way in IT and in health care So on March 15th, as you can see there with the tweet that I put out there, had to provision 50 iPads at that time to get them out for our providers as we started to get the message that isolation for COVID– changes in workflows for COVID were happening So the future was now, and because of that, we were able– because we had Jamf in place, and it was a mature MDM for us, we were able to leverage all the good stuff: the extension attributes, the smart and static device groups, the configuration profiles, and the customized backgrounds, and Jamf Reset So what that allowed us to do was to quickly spin up approximately eight– well, eight inpatient and outpatient configurations, and I said to start And that was to start So touching on a few of those So in the past– I guess we’re up to six months now since March– what we had accomplished was, in addition to IPS, we had not rolled it out to all of our campuses So we were able to rapidly configure temporary IPS iPads and get them delivered logistically out to our campuses We were also able to put together a program that we call Because We Care It was a program mainly because of the isolation protocols that were in place for COVID patients We needed to be able to quickly set up communication between a patient and their family if it was a end-of-life scenario

So we were able to utilize the iPads that we had kind of in reserve to get that project up and running and out to all the different hospitals Thankfully, we only had to use that a handful of times, but it was a project that we were very proud of, because those are very sensitive situations, and any connection that we can give to patients and their families was key The majority of our time was spent with telehealth At Geisinger, we have a remarkable center for telehealth that has ramped up exponentially since March and provided the ability for, at that time, our patients who were no longer able to leave their homes due to a stay-at-home order from our governor in Pennsylvania We needed to– we in IT, we in telehealth world, had to come up with a method to spin up telehealth sessions as quickly as possible Luckily for us, we already had an application in-house, so there wasn’t a great learning curve We just had to work and partner between IT and the operations to educate and train thousands of providers, nursing staff, therapists, and all the patients that wanted to use this platform So what we were able to do was provision an iPad for a provider with our specific telehealth app and the configuration profiles that it needed, and they were able to then take it home, or if they were able to come into the office, use the iPad as their device to communicate with the patients A very interesting project, UHEI consult As you can see here, there was a lot of creativity that was going on So in addition to the isolation protocols that were in place, some of our rooms were converted to negative pressure rooms to keep the airflow from escaping as doors were open, but because of that, there needed to be a better way to monitor, and as you can see in the picture on the right there, rooms that had wooden doors with no windows on them, there needed to be a way to monitor patients So again, quickly provisioning iPads and decommissioned iPhones, we were able to create kind of a monitoring station there, as you can see on the left with the iPhones, so that our nursing staff could monitor the patients at the bedside I touched on language interpretation That was another configuration, that was desired to be pushed out as well So that paper that’s on the right there was created by our nursing staff Because we had so many iPads hitting the nursing areas, they needed kind of a cheat sheet So on the right-hand side, you can see that we have different wallpapers, and then they were able to interpret what those wallpapers meant So a few slides of what we’ve done or what we accomplished So March 27th, we had unboxed, charged, updated, because they were a little bit out of date One-touch-configed, sanitized, and reboxed, because we did not want to be the spreader of COVID within the organization 1,000-plus iPads That team was essentially my team of two as well as a half a dozen other folks’ time over the course of a week to get 1,000 of those devices ready to go and out the door So we were busy back then More of the same And as you can see here, we were also asked to get specific devices out to tents that were doing screenings So we had specific config devices that we had to get to our various campuses So a few more configurations that we ran into Traffic reduction in high-risk locations So our providers asked us to come up with solutions so that we could reduce their traffic in dialysis centers or hematology, oncology treatment areas So we flipped the script and put iPads in those locations

that the physicians’ remote connected to and were able to do that Remote check-ins in skilled nursing facilities, So those are non-Geisinger areas that we were able to get devices out to and, again, remotely connect to using our telehealth application And then reducing personal protective equipment That was key at the beginning, and we were able to work through those configurations as well So lots of configurations And then I say, “Dare we ask what’s next?” And what’s next is all of this stuff because we set the bar so high and we’re successful in doing what we did My team and the operations teams have been asked, “What else can you do for us if there’s a wave two, or if there’s another pandemic?” So as you can see here, these are some of the new things that are on our list And with that, I’m gonna turn it back over to Kelly That is essentially our last six months plus six years in a nutshell, with how we are integrating the iDevices into health care Thank you, James, for sharing your history, experience, and innovation using Jamf Thank you for joining us today We encourage you to check out the other health-care sessions during JNUC or check us out on Thank you, everyone