Within a few hectic months, healthcare providers around the world have faced unprecedented challenges in infrastructure and patient care due to the COVID-19 outbreak. The novel coronavirus was first identified in December 2019 in Wuhan, China, but has since spread to over 150 countries . Despite initial efforts to contain the spread of infectious illness, the World Health Organization (WHO) declared a pandemic on March 11, 2020 . Soon afterward, the United States proclaimed a national emergency in response to the evolving crisis . As of today, it’s apparent that the pandemic is testing the limits of healthcare infrastructure on a global, national, and local level.
A steady increase in infections and deaths has forced healthcare organizations to adapt and pivot to electronic health records (EHR) and Telehealth (aka Telemedicine) to meet clinical demands. In a technical guidance policy recently released by the WHO to help strengthen health systems, Telemedicine was highlighted as an essential clinical service and clinical decision support . The modifications implemented thus far by healthcare providers such as UC San Diego Health include EHR based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology .
Ramping up the technological infrastructure to ensure safe and efficient testing measures as well as real-time and reliable communications is a daunting task. Success, in a short amount of time, requires the medical community’s innovative collaboration and perseverance on a scale that has never before been seen. Few understand the scope of this hurdle better than Health Informaticians like Joel ArunSursas. Health informatics utilizes information technology to organize and analyze health records to improve healthcare outcomes .
In this article, Joel ArunSursas reviews how EHR and Telemedicine capabilities optimize the clinical management of the COVID-19 pandemic.
EHR Based Rapid Screening Processes
EHR is a digital version of a patient’s medical chart and works in conjunction with various Telemedicine resources . In principle, EHRs enable doctors and medical support teams to access patients’ medical information wherever and whenever they require care . The tech is capable of real-time transmission tracking, mass information distribution, hosting digital meetings for day-to-day operations as well as Telemedicine platforms .
Shortages in reliable COVID-19 test kits inspired healthcare providers and their IT teams to develop an EHR based accelerated screening process . The system consists of telephone calls, direct email, and EHR messages to reduce in-person communication. Coupled with standardized templates consisting of pre-approved screening questions, physicians can confidently diagnose patients and identify which individuals warrant additional testing.
Due to obvious time constraints, health facilities lacked the luxury of quality control for the new screening process. Still, the end-product is the result of prioritizing the needs of the healthcare workforce who administer patient care. Even in desperate scenarios, it’s possible to define scope, timelines, budgets, and deploy EHR resources and standardize processes rapidly.
As of April 10, the WHO reported approximately 900,000 confirmed cases of the virus . Certain countries, such as Germany and South Korea that adopted mass testing procedures in the early days of the outbreak, have maintained a better grasp on the virus . Whereas in America, testing facilities were limited and struggled to scale.
But as hospitals and third-party laboratories ramp up their testing resources, tech is playing an instrumental role. Pre-registration via telephone or an online portal allows patients to schedule an appointment at a designated testing site, thus reducing in-person interaction and potential exposure. Drive through coronavirus testing, although not available everywhere, has been an effective method to test patients who are suspect of infection while adhering to the social distancing guidelines provided by the WHO and CDC .
Clinical Decision Support
Clinical decision support systems (CDSS) are computer-based programs that analyze data within EHRs to provide prompts and reminders to assist health care providers in implementing evidence-based clinical guidelines at the point of care . Over the last three months, EHR vendors have augmented their existing systems to give users access to relevant data and information to cope with the crisis . Recent amendments and additions to systems include screening criteria, educational resources on test kits, protective equipment protocols, as well as approximate test result turnaround time. There has also been a demand to require and document the testing criteria met by the patient.
Athenahealth, a health IT vendor, is continuously updating software to align with CDC best practice recommendations . Its interactive decision tool within a clinical mobile app is of particular note. In less than 60 seconds, clinicians can access the CDC’s authoritative guidance to help diagnose and treat COVID-19 patients .
Custom reporting and analysis tools that are easily accessible by key personnel can help streamline patient care management. Relevant report topics and real-time data include testing capacity, isolation procedures, number of tested patients, test results, ICU vacancy, inventory (e.g., number of ventilator units), as well as the volume of Telehealth services.
The company Epic maintains a clinical records system utilized by a significant portion of American health organizations and encourages providers to share pertinent information via its interoperability network. Clinicians can use Epic's suite of analytical tools to evaluate and compare data across different communities . The collaborative analysis may provide insight into effective treatment methods and help identify potential virus hotspots.
The United States government temporarily eased its Telehealth requirements, and medical institutions have seized the opportunity via remote triaging.
Patient portals allow individuals to schedule appointments, send secure messages to the care team, view and download test results, and connect with their primary care physician through video conferencing.
EHR and associated technologies can help mitigate the substantial strain on health systems worldwide . Once integrated, it can maintain the quality of healthcare, even improve it in certain circumstances, reduce the number of in-person visits, and subsequently reduce transmission and infection rates.
About Joel ArunSursas:
Joel ArunSursas is a Medical Doctor and Health Informatician motivated to solve administrative problems in healthcare. His determination to work tirelessly to bridge the gap between doctors and engineers is resulting in medical technology solutions that improve patient outcomes, enhance monitoring, and protect patient privacy. Dr. Joel ArunSursas is an effective communicator who facilitates the achievement of team goals.