In an April 9 AMIA presentation, executives describing the role clinical informatics is playing in the rapid switch to virtual care as well as public health data sharing and the creation of dashboards and registries. A common theme was that the rapid spin-up of solutions was possible because of years of work creating the informatics framework and developing standards.
Ted Palen, Ph.D., M.D., M.S.P.H., senior clinician investigator for health research at Colorado Permanente Medical Group, said years of experience with telehealth made the ramp-up in Colorado possible. “We were able to go from 10 percent virtual encounters to between 70 and 90 percent virtual, in all specialties, all departments in a two-day period. I have to say the reason we were so successful was the list of our endeavors in virtual care the over the last two decades.”
Kaiser Permanente has been doing e-mail between physicians and patients for almost two decades, and text-based chats with doctors for four years. It has a long history of conducting video visits and has been doing e-consults between primary care doctors and specialists for 15 years. “Because we had that infrastructure in place, and were doing research studies and pilots, we were able to pivot to give this a more prominent role in delivering care. We had the tools available and ready to go,” Palen noted. Medical informatics teams had to build the tools in the EHR to support documentation of patients with COVID-19. “That was all new,” he said. They created smart documentation order sets and patient instructions embedded in the EHR to guide the documentation of triaging patients and helping direct how to care for these patients.
Deepti Pandita, M.D., chief health information officer at Hennepin Healthcare in Minneapolis, has led efforts to set up inpatient telehealth and remote monitoring solutions to avoid unnecessary contacts and reduce use of personal protective equipment. “We had some template for outpatient telehealth,” she said, “but in the inpatient setting, that was uncharted territory.” They found a solution for video communication into patient rooms and set up video or audio communications with all the members of a patient’s care team, including interpreters (35 percent of their patient population does not speak English). All monitors, pumps and ventilator data is projected onto a virtual display board. “Time and money present hurdles, too,” she said. “As tele-ICU technology can be expensive and take weeks to be delivered and installed, you have to think outside the box and look at low-tech solutions.”
Hennepin also set up dashboards and analytics to track beds, staffing and equipment needs and predict demand. “Every answer touches clinical informatics in some way or another,” Pandita said. They look at demand, capacity, quality metrics, ventilator capacity, how many tests have been ordered, and what percentage of staff has gone through PPE competency testing. A COVID-19 Executive Dashboard allows “every care team member and employee with access to have the same source of truth.”
The research community is responding rapidly as well. Paul Fu Jr., M.D., M.P.H., chief medical information officer at City of Hope, a nonprofit clinical research center, hospital and graduate medical school located in Duarte, Calif., described the rapid creation of a new community called the COVID-19 & Cancer Consortium to assess the impact of COVID-19 on patients with cancer. “We want to collect prospective data and organize it to scale and develop insights as rapidly as possible,” he said. In just a few weeks, more than 50 institutions across 26 states signed up to participate by sharing outcomes data; many of them are NCI-designated Comprehensive Cancer Centers.
Shaun Grannis, M.D., director of the Center for Biomedical Informatics at the Regenstrief Institute in Indianapolis, described the importance of having a strong statewide health information exchange, such as the Indiana Health Information Exchange (IHIE).
IHIE, one of country’s largest and longest-running HIEs, integrates a variety of data from across the state for a variety of services, including public health. It has several ongoing initiatives with the CDC and connects to more than 100 hospital systems and 50,000 physicians. For many years it has been sending notifiable disease and syndromic surveillance data to public health departments. Now the state is leveraging those pre-existing capabilities, Grannis said. The Regenstrief LOINC team had created codes for lab testing. All testers and health systems route through HIE as an aggregation point. “I would argue that every state could be doing automated electronic lab reporting. The fact that we could turn COVID-19 lab reporting on in less than a day is a tribute to the work that has been done and a culmination of all our data efforts.”
He said if you want to see what interoperability can do, look at HIEs such as this one. “The primary success is not technological, Grannis said. “It is the fabric of trust and collaboration we have been able to build. That has allowed us to have perhaps the best situational awareness on coronavirus in the country.”
