In response to COVID-19, a 1,000-bed facility with telehealth services was established within a week in Boston, thanks to a partnership between local, state and private entities. 

The facility, called Boston Hope, is split into two 500-bed halves: one for COVID-19 patients, who otherwise might overload local hospitals, and one for the unsheltered population, a group at high risk of infection. The project, which began construction in early April, was a joint effort between the city of Boston, the state of Massachusetts and the Boston-based nonprofit Partners HealthCare. The latter entity operates the facility, which is housed within the Boston Convention and Exhibition Center. 

Brian Golden, director of the Boston Planning and Development Agency, said that even though the city is “one of the medical Meccas of the globe,” officials projected that a metropolitan area of approximately 5 million people would run into a hospital capacity problem given that the region is a COVID-19 hot zone. 

He suggested that other local areas with projected increases in infections should, if possible, follow Boston’s lead sooner rather than later. 

“Once you understand who’s paying and who’s doing and what kind of facility you need to develop, move very expeditiously because you don’t have time,” Golden said. “If you have a COVID problem, sooner or later you’re going to have a COVID problem … that will overwhelm your health-care facilities. So move quickly.” 

Knowing your potential partners and where the money will come from is key to jumpstarting such a project. The brainstorming for Boston Hope occurred during March and into April. The city initially talked with the U.S. Army Corps of Engineers (USACE) to learn about potential building and funding options. 

Later, with the help of the Massachusetts Emergency Management Agency, Boston learned that the “vast majority of the spending” for the facility could be covered by the Federal Emergency Management Agency if the city decided to carry out a plan without USACE. The build-out for Boston Hope amounted to about $12 million, Golden said. 

In regard to COVID-19 patients, Boston Hope is primarily intended for those who have already been treated by medical professionals — in other words, well enough to leave a hospital, but not well enough to go home. The facility houses only 10 beds for acute or critical care. 

Other than this limitation, Boston Hope has the full works when it comes to technology, Golden said. 

“If you walked in there today, I think you’d be very impressed by what that hospital looks like,” he said. “It has all the sophisticated technology and capabilities of any major American medical center.”

Industry analyst Craig Settles told Government Technology in an email that Boston Hope’s telehealth capabilities go beyond mere video chats and basic health monitoring. The facility is able to facilitate a continuum of care through the Internet. Professionals at Boston Hope can “observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record and/or report” in a way that leads to the full recovery of patients. 

“Be clear that Boston Hope would not have happened as easily or as quickly … if the feds and probably the state of Massachusetts had not removed the ridiculous restrictions on telehealth or digital health care,” Settles said. “With any similar type endeavor in any part of the country, state and federal governments have to jettison the antiquated rules that impede technologies’ progress while maintaining regulations that ensure security, safety and privacy.”

As Golden put it, “It’s not just about sheetrock and framing with two-by-fours.” Boston Hope required active leadership from Boston Mayor Marty Walsh, who received daily construction reports and listened to what both local hospitals and human service advocates had to say. Golden also gave a lot of credit to the state of Massachusetts. “States can help municipalities find partners for solutions quicker,” he said. 

“Probably the most amazing thing about [the] Boston Hope project is that you have the local and state governments pulling in the same direction soon after the crisis broke,” Settles said. “The key was that … government entities and Partners HealthCare had several meetings and trial runs.”

Settles also unpacked the idea of a nonprofit like Partners HealthCare coming into the fold. 

“Perception is an issue here,” Settles said. “Everything in our mind about what we think a hospital should be has been dictated by tradition, expediency, cost, and marinated in the belief that only a corporate hospital can deliver health care well. A project like Boston Hope is possible once we step outside of our perceptions. Just never confuse competency with expediency.”

In an interview with Settles, John Campbell, a CIO working under Partners HealthCare, said telehealth will be essential to overcoming the threat of COVID-19 in the near and distant future. 

“This virus is not going to be solved for 12 to 18 months,” Campbell said. “So we have to figure out how to continue to take care of patients for that 12 to 18 months, how to keep them safe, how to keep our physicians and our nurses and our other health-care workers safe. So, you know, we need to be able to continue to see patients by telehealth for an extended period. And I think it's going to require the federal and the state government to enact some kind of emergency legislation."