Brittany Partridge started her career at Ascension, transitioning hospitals from paper to digital. Now, she’s the Virtual Care Technical Lead at University of California San Diego Health (UC San Diego Health). In the last two years, she has rolled out virtual care to every department in the hospital and spearheaded the integration of language services into their platform. We sat down to talk with Brittany about implementation, change management, accessibility, and her new book (coming out in October).

Cloudbreak: How did you get into healthcare?

Brittany: I went to school in upstate New York. I was actually attending for horseback riding, but I was also in the ROTC program. One of my co-cadets suggested I look into firefighting. I became a firefighter, and I really liked it, so I went through some Emergency Medical Services (EMS) courses and became an Emergency Medical Technicians (EMT). I thought “I’m going to do this once I graduate.” But in the middle of college, I moved back to California and I got an internship with the Emergency Medical Services Authority. I was the youngest person there, so they just assumed that I knew everything about computers – which at that time I did not. They asked me to create a database for the state’s disaster resources. I realized I really liked the intersection between medical and technical. So, I went to a grad certificate program at University of Texas in Austin for Health Information Technology.

Cloudbreak: So now you’re at UCSD. What does a typical day look like?

Brittany: I’m a little all over the place, but the main trend is virtual care. Anything that touches telemedicine. Also, clinical communication. I did a lot of work there too.

A typical day could be going into a clinic, checking on how their workflow is going, answering any questions, and discovering any areas of friction that I might be able to address through design changes. Then the rest of the day might be in design sessions, implementation meetings and spending time doing the build in our Electronic Health Record. Throughout the pandemic we were just trying to survive, making sure everyone had the tech they needed to function, but we’re starting to come out of that now.

Cloudbreak: Leading telehealth the last two years has probably been a whirlwind. What was that like?

Brittany: I joined UC San Diego Health maybe four months before the pandemic really hit. We had a two-year plan to get everyone up on virtual care. All of a sudden, we had to turn that into a two-day plan and just go. I remember sitting in the command center, thinking “Well we can’t turn it on the way I planned at all.” We ran zoom trainings for over 1,000 providers in one weekend.

I really appreciated that our teams set aside what they were doing and came together. No one said, “Oh I can’t do that job”. We had senior ops team members answering help desk phones, we had directors going down to clinics and dropping off iPhones. I love times like that, even though it’s often the hardest times in healthcare, they are also the times when your team shines.

Cloudbreak: I know in the past you’ve talked about accessibility and Diversity, Equity, and Inclusion like when you were on the panel of our recent webinar. Where do you see crucial gaps in today’s technology?

Brittany: A lot of discussion around diversity and accessibility is racially focused. That’s definitely important, but the way different races use technology isn’t always intrinsically different, apart from if there are language needs. Where diversity really comes into play for me is how people use technology differently. People of different ages use technology differently. That’s diversity. If you can’t move your finger across the screen because of a disability, that’s diversity. If you don’t have access to wifi, that’s diversity. We need to expand the conversation.

Once you have that conversation, you need to apply it during the design process. Accessibility can’t be an afterthought. When we rolled out our virtual care technology, we didn’t have interpreters integrated right away because we were scrambling to launch solutions as fast as possible. We had to push really hard and collaborate closely with Cloudbreak to customize our solution.

The fact that accessibility is missing from the design plan, that it’s an afterthought, is an area we really need to work on.

Cloudbreak: Over the course of pandemic, integration became hugely important to what we do. We started looking at our competitors as potential partners because language access was missing, like you said, from every platform that had already been designed. What specific considerations did you have to make when integrating language access?

Brittany: What you said about partnership is huge. Prior to the pandemic, getting vendors to work together was a struggle. The response was typically “Well, how do we recreate that feature on our platform” instead of collaborating between technologies that already existed and had been done well. But with the pandemic we had to provide this service for our patients NOW, and everyone understood that.

The biggest consideration was just getting it done at first, honestly. We just needed a button that added an interpreter to the video visit. Once we secured that, we started asking questions like “Can we include that patient’s primary documented language, and request a specific interpreter rather than going through the operator?” Since then, we’ve expanded the functionality of the integration.

Cloudbreak: So what’s next for language access and technology in your hospital?

Brittany: I’m really excited that we’re expanding our Martti implementation. All of our nurses carry iPhones and we just had a meeting to get the Martti app installed on those. For us, that’s a huge win. We’ve already put Martti everywhere, integrated into our telehealth, standalone Martti carts, bedside tablets… but in some of the surgical areas bedside iPads aren’t always accessible. So now every nurse will have an Interpreter  on-hand.

For the future, I’d love to see us focusing on open notes for patients. We release these notes rapidly, and they’re written in medical English. If you don’t speak English, they are really difficult to understand. So I think getting those notes translated into preferred languages would be great.

Cloudbreak: We assume everyone is familiar with technology, but the digital divide is very real. Do you find yourself having to consider and build in non-digital options as part of your accessibility efforts?

Brittany: My role at UC San Diego Health is very technology implementation focused, so I don’t work that broadly with non-digital solutions in my professional role That being said, I do often have to consider workflows for the different types of technology users might have (phone vs cell phone etc), or the types of connectivity they have. I volunteer with Remote Area Medical which is a volunteer group that goes into areas that might not have the same access to care. They provide free healthcare, free dental, etc. With those efforts, we think a lot about “How do we get information into the communities that need it?” Many of the people receiving treatment might have walked 10 miles to get it, or they might not have a computer, or they might not have a smartphone. We provide telehealth, but we have to think about how to get devices and Wi-Fi to those patients, because it’s not something they natively have.

Cloudbreak: Accessibility for the patient is hugely important. But another stumbling block for tech is provider onboarding. What does that process look like for you?

Brittany: I just finished writing a couple of chapters for a book called Mobile Medicine: Overcoming People, Culture, and Governance and one of my main chapters was essentially this topic. Don’t come at implementation and onboarding from an outsider’s perspective. Before COVID, I was always attached to a team, going on rounds with them, shadowing in the clinics, just really becoming a part of their every day. That way we don’t miss steps in the workflow like a verbal communication – if I hadn’t been with the team I might not have known about that verbal communication. Providers might tell you they do one thing, but they actually do twelve. Knowing where they come from and everything that they do helps build that trust.

Also, train a bunch of different ways. Being able to have zoom classes, and videos, and tip sheets…because everyone learns a little bit differently. Make sure that you include clinicians in the whole process including kick off meetings, testing, more testing, all of that. Don’t just pull them in at the end and say, “Okay here’s your new technology.”

Cloudbreak: Tell me more about this book! It sounds great.

Brittany: One of my mentors is Sherri Douville. We met at a conference in Texas, maybe five years ago. She’s the CEO of Medigram, which is a mobile clinical communication solution. Sherri really pushes me to try new things in my career. When she started writing the book, she invited me to come on to help manage the process. I got steadily more involved. Now I’ve written a chapter and co-authored a few others.

My chapter is focused on change management throughout the entire implementation life cycle. It starts with my lessons learned when I was new to the field and working to transition a system from paper to digital and works through practical applications of those lessons. I co-wrote a chapter on robotics and how wearables work in the healthcare system. The final chapter I co-wrote covers moving through the HIMSS MRAM Stages – what things you need to consider as you move through the stages.

Cloudbreak: Workflow is so important to consider when implementing new technology, and failure in implementation is why new technology often doesn’t work. What do you think is the most important thing to consider when you’re looking at a workflow or trying to change it?

Brittany: I usually just try to document workflow  exactly as is first to make sure we don’t miss any steps when designing new solutions, and then look for any duplication like “Are they charting this four different times somewhere?” I also ask, “How does this new technology affect the workflow in a positive manner?” There are a lot of ways that tech gets introduced into healthcare systems, and you must make sure to ask what the driver is. Is it going to help our clinicians, is it going to help our patients, is it going to make things easier? Or are we just doing it because we want to use this new tech? That’s always a bit of a tough conversation.

Cloudbreak: Technology does not intrinsically make things easier just because it’s technology.

Brittany: Exactly. And especially if it doesn’t integrate with the system we already have, and it creates duplication. I think because I round with our teams, and spend so much time with our clinicians I really feel for them, when technology is a burden rather than a boost, and I feel it’s my role to advocate on their behalf.

Cloudbreak: You had to take your two-year plan and launch it in two days. Now that your project is stabilizing and starting to iterate, what does your new two-year plan look like?

Brittany: My goal is to really optimize virtual care. We have a wide range of workflows. One example hyperacute telemedicine,, which is for things like telestroke and supporting for emergency departments that aren’t part of our system. We also have inpatient telemedicine, and the traditional ambulatory video visit workflows. My short term plan is to reassess those workflow, and leverage new updates and solutions that have come out to improve them.

I’m also thinking about how we can leverage virtual care in remote patient monitoring situations. We’re still in the early stages of remote patient monitoring here. I’ve seen the impact a mature remote patient monitoring program can have on patients, especially on readmission rates and empowering patients to manage their conditions. I really want us to get there as a health system.

Cloudbreak: We’re going to see a year of everyone re-doing the work they did during the pandemic in a more permanent and sustainable fashion. But because of that initial panic, the door for technology has been opened, and a lot of systems are much more open to new solutions.

Brittany: Definitely. Now that we’re hopefully emerging from the pandemic, we can start thinking about how we can expand and optimize the technology that was rapidly rolled out to meet COVID demands. I feel like this past year has also really opened our eyes to partnerships, and having health systems at similar baselines makes that more of a reality. One example of this in the UC System is that we are looking to stand up a Virtual Care Collaborative, where UCs cross-cover each other in the virtual space, starting with providing care to our students. I’m really looking forward to that.

Cloudbreak: We’ve had a lot to overcome in the last few years. What keeps you motivated and committed to your work?

Brittany: I have a great team. You can reach out to anybody at any time across everyone at UC San Diego IS, and they really make it work. And honestly being able to continue to provide care for our patients was my biggest win. We went almost completely virtual at one point during the pandemic. Knowing that my technology was helping deliver patients the care they needed when there wasn’t another alternative really motivated me.