Mayo Clinic’s John Halamka on HIT Innovation to Fight COVID-19

April 1, 2020
The president of Mayo Clinic Platform, and co-chair of the recently launched COVID-19 Coalition, speaks out on health IT innovation around the pandemic

With the aim to leverage real-time data to gain actionable insights that will ultimately help flatten the coronavirus pandemic’s curve, last week a collection of healthcare organizations announced the creation of a new COVID-19 Coalition. The partnership brings together healthcare organizations, technology firms, nonprofits, academia, and startups to bring their collective expertise, capabilities, data and insights related to the public health crisis.

“With communication and coordination between coalition members, we can save lives through real-time learning to preserve healthcare delivery and protect populations,” according to the new group’s website. “With top experts and industry leaders sharing plans and resources—and working collaboratively—we can deploy resources more effectively and offer better situational awareness to those at the front lines.” Notably, nobody will be paid for coalition work, without exception.

The group is co-chaired by Jay Schnitzer, M.D., chief medical and technology officer at MITRE Corp., and John Halamka, M.D., president of Mayo Clinic Platform. Recently. Halamka spoke to Healthcare Innovation Managing Editor Rajiv Leventhal about the coalition’s near-term plans, the promise of technology innovations to help fight the crisis, and more. Below are excerpts of that discussion.

What is the Coalition asking for right now, first and foremost?

In this time of COVID, communication, collaboration and coordination are most important. We put together this broad coalition of healthcare systems and [others in the] private industry to work on a whole variety of issues. One issue is that China has had early access with the use of convalescent plasma [collected from COVID patients]. So if you have a disease and you survive it, you develop antibodies for that disease and therefore your plasma is a cure. Wouldn’t it be wonderful to take the convalescent plasma of someone who survived, give it to someone who is seriously ill to help their immune response and get them through it?

A national effort involves Mayo Clinic, Johns Hopkins, Michigan State University, [and others], as well as a variety of private companies helping with logistics, to coordinate the collection and measurement of convalescent plasma to make sure its effective, and then distribute that across the country. This could be one of our best opportunities for a short-term cure.

Another [area] is coordinating the availability of test capacity. There are many companies working on novel tests, rapid testing or even in-home testing, so we have come together as a coalition, bringing together innovators, logistics companies, and labs to rapidly expand testing capacity in the next few months. And we’re thinking about how we could even extend it to the home.

What innovation is happening at Mayo Clinic around COVID-19 that’s worth mentioning?

We [believe] in turning a challenging situation into a productive path forward that will lead us to a better place, even post-COVID.  On that theme, let’s start with telehealth, which means a lot of things, such as remote patient monitoring and video visits, to name a few. The challenge has been regulatory restraint; we couldn’t offer telehealth services across state lines without having appropriate medical licensure in that state. In the COVID world, we have suspended the requirement for state level licensure. As you do more telehealth, you need more time to figure out which platforms and devices you will use, and how you will get the data to flow. So we now have waivers that say OCR won’t [impose] HIPAA enforcement and sanction as you go through the telemedicine transformation.

Mayo Clinic has the Center for Connected Care, where in 72 hours we moved the clinic from an on-premise facility to a virtual visit facility. Another significant project we have been working on for months, pre-COVID, is [thinking about] how to deliver higher-acuity services in a home setting. Clearly, the notion of a home hospital becomes important in a COVID era, in a slightly different way. How do you decant hospitals of non-COVID patients—for example, patients who have CHF or COPD—to the home so you can free up the beds and the capacity to run ventilators and other things in the hospital setting? We are moving forward with the policies, and technology [around that], and are working in collaboration with multiple companies to move the home hospital forward.

Another area is figuring out how we will we take the data from the past and use it to inform cures and the future while protecting privacy. In a COVID world, how do we mine experiences that have happened across medical literature and medical records to understand what the likely drug targets are? What are the likely populations that will need a given therapy? How will we help with vaccine development? So we have partnered with a company nference in Boston, and you will see a number of published articles upcoming on how we can better target cures for COVID all based on using machine learning and natural language processing with our partner.

How far along is the industry in being able to collect key COVID-19 data that will lead to actionable insights? Or is it still far too early?

Audacious Inquiry, a [health IT company], is leading a national effort, of which Mayo is a part of, to create a minimal COVID data set for the country. The challenge is that the U.S. has its national standard—the United States Core Data for Interoperability (USCDI) —which is the core health data set for interoperability, and that’s problem lists, medications, allergies and lab data. But what else do you need to know in a COVID world? Data standards are being worked on that will help us with a whole variety of things such as, do we even know how many ventilators we have? Where are they being used and not used? What ICU beds are available? There is the aggregation of data, and we’re doing that today with the USCDI data set, but there is also building the capacity to understand situation awareness for [crises] like COVID to enable national response.

[Editor’s note]: In a March 25 letter sent to the Trump administration, Audacious Inquiry noted that not having “real-time situational awareness of the location and availability of essential but scarce healthcare resources, is a national health security vulnerability.”

As such, the company’s strategy involves adapting an existing FHIR resource (i.e. a modern method to expose data, including bed and resource data, from a hospital EHR) that carries bed type and bed status information, and promoting standard adoption of this resource alongside the other FHIR resources currently supported in hospital EHRs. Once complete, data can be readily imported into local, state, and national bed availability toolsets, the company stated. The organization contends that a viable technical specification can be developed within weeks, and that deployment can begin in less than 60 days to hospitals and health systems in priority regions.

In what other areas do you see health IT and informatics playing a role in battling the epidemic?

Let’s presume you are social distancing and let’s [pretend] that you went to Home Depot yesterday. Do you have any idea if there were any COVID-positive people who visited Home Depot yesterday? Of course not. So another informatics issue is contact tracking. Imagine I turn on my phone, and with my consent, I track where I have been over the past 24 hours, and then I contribute that to a national resource. This is de-identified; you don’t care who I am. Similar to how Waze helps us figure out traffic patterns because there are multiple people contributing their driving paths, people will contribute their walking paths, and when they test positive, they contribute the fact that this was a positive path as of a given date and time. You could then have a sense of if you encountered a safe place or an unsafe place on your path.

This is possible [to deploy], but it will require real coordination. The open-source software exists, and it’s a question of how it will be used. It’s an open-source consumer product, so you will decide if you want to do it. It’s all under your control and totally anonymous so that no one knows who was positive and who went where; all you know is that you crossed the path of someone who was positive. It [presents] a fascinating informatics challenge: protecting privacy while at the same time sharing geo-location for the purposes of understanding contact tracking.

There are other informatics challenges, too, of course. I have been talking to many companies that are building situational awareness dashboards. While knowing the number of positives in a city is straightforward, as you get that from public health folks, how about understanding how many hospital beds and pulmonologists are available at this moment? And what ventilators are available this moment? We don’t have that [ability]. For some of this, you work on a proxy for that kind of data. We also have these new ONC and CMS requirements to exchange ADT [admission, discharge, transfer] data, and if you were able to understand for all the healthcare facilities in a region—how many admits, discharges and transfers they had—you could use that to understand a little bit about what their capacity is right now.

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