Digital Health Companies, Providers Evolving Partnerships to Fight COVID-19
Across the U.S. these days, in the face of a growing healthcare crisis, patient care organizations and digital health companies are teaming up to offer solutions that support different ways clinical workflows could be automated and virtualized. Some of these include real-time virus tracking, online symptom diagnosis, virtually delivering care, patient outreach, and identifying high-risk patients.
In Washington State, the Seattle area was one of the first hit with COVID-19 cases in the U.S., leading TransformativeMed—a company focused on electronic health record (EHR) usability—to offer its COVID-19/Core Work Manager (CORES) app to Seattle-area hospitals and medical centers free of charge during the COVID-19 outbreak.
TransformativeMed originally started as a project within the University of Washington Medical Center, and today is providing all hospitals who use the Cerner Millennium EHR free access to its EHR-embedded Core COVID-19 App—regardless of location. Erik van Eaton, M.D., a board-certified surgeon and faculty member at University of Washington, says the tool essentially acts like a dashboard, instantly displaying a list of patients who have been tested for COVID-19, as well as showing inpatient and outpatient status, pending test results, the patients’ current location, and their precautions. It also has the ability to flag patients who need confirmatory testing, and caregivers can “pin” comments about patients’ COVID-19 status and history, which are then used to contact outpatients to inform them of test results, van Eaton explains. “All those facts all displayed on the screen and can be updated in real time. You don’t have to open a patient’s chart,” he says.
Van Eaton notes the dashboard operates differently than an EHR as the latter system has mostly pre-fabricated patient lists with just basic elements included, and while developers and their customers can sometimes work together to better customize the technology, “it’s hard to get the EHR system, as built, to adapt quickly,” he says.
The primary users of the dashboard, says van Eaton, are infection control and infectious disease clinical service professionals. And at each of the health system’s facilities, a “COVID-19 triage doctor” is deployed—either an infectious disease doctor, internist, or hospitalist—who is in charge of the ebb and flow of the COVID-19 patients for a 12-hour shift, and who also oversees the dashboard, van Eaton explains.
In the same region, Physicians of Southwest Washington, a 550-physician independent physician association based in Olympia, Wash., already had been working with a vendor called Innovacer on a population health platform to support its value-based care arrangements before the state became the first epicenter of the crisis in the U.S. While the collaboration with big EHR vendors is central to many hospitals’ response efforts, smaller niche vendors and community health partners are working on rapid response as well.
“Within just a few days, Innovacer was able to produce some COVID-19 dashboards that allow us to identify those patients at highest risk of COVID-19 among our population,” says Tamra Ruymann, chief of digital health at Physicians of Southwest Washington. “Our care management team has really focused in on that high-risk set of patients and has started doing outreach to the highest risk—those with four or more co-morbidities. We are contacting them and asking what services they need. We want to keep them in the home, so they don’t have to go out and get prescriptions filled, for instance.”
Ensuring workers are healthy at UCSF
Meanwhile, in California, UCSF Health is working with healthcare technology company Conversa Health to leverage its COVID-19 Employee HealthScreener tool that helps the health system screen its employees daily to ensure that anyone who might be infected will not come into contact with patients.
In mid-March, San Francisco healthcare organizations received a city mandate to start screening employees before they entered the hospital, recalls Aaron Neinstein, M.D., director of clinical informatics at the UCSF Center for Digital Health Innovation. At first, he explains, there were long lines of employees, sometimes in cold and rainy weather, waiting to get into work, but in just one week, a rapid cycle development team was created between the health system and vendor to launch the screening tool, which is an interactive branching questionnaire that ask users questions about risk factors related to COVID-19. These factors of course change as more knowledge about the virus is gained, Neinstein notes.
“We needed a low-friction tool; one with no sign-up required or app to download. We also [needed] the ability to iterate on the logic and clinical care pathways, since guidelines and risk factors change on a near daily basis,” he says. The result is the screening tool that asks about risk factors and symptoms. Then the output either “passes” the employee on his or her smartphone—similar to an airline boarding pass—allowing the person to get through the front door at work, or it recommends the employee go to the health clinic for further testing and care, Neinstein explains.
“Within a week, we went from idea to prototype to pilot launch,” Neinstein says. “Now we are looking at expanding the deployment to other UCSF locations. Today, thousands of people are using the tool each day to get into work. The screening time at the door went from 40 seconds per employee down to 8 seconds. When you have hundreds or thousands of people showing up for a shift at 7 a.m., that time saved adds up,” he says.
Other ways tech is helping
In another example, Cook County Health, the safety net provider for Chicago and suburban Cook County, was in the process of working with messaging solution vendor Luma Health on new ways to use text messaging with patients when COVID-19 cases began appearing in Chicago. “There were a few approaches our organization was looking at in terms of the way we reach out to our patients, which is why we had targeted Luma to begin with,” explains Adam Weber, director of clinical ancillary applications at Cook County Health. “When the pandemic hit, we realized we had to do it right away. There is not time for a four to six-week project. We have to get this going tomorrow.”
Cook County Health partnered with Luma Health to design messages for different targeted groups of its patient population. “For people who have regular appointments, we could reach out to 8,000 to 10,000 patients and let them know at once not to come to the hospital or clinic, and that we would be reaching out to them and doing telehealth visits with them at their normally scheduled time,” Weber says, adding the organization has seen a 94 percent success rate with the SMS version, and was also able to reach patients via e-mail or phone calls.
Meanwhile, at Hardin Memorial Hospital in Elizabethtown, Ky., healthcare workers are deploying hands-free technology from healthcare communications company Vocera that can be used under isolation gowns, hazmat suits, and personal protection equipment (PPE) to facilitate real-time communication and collaboration between professionals, even if they are isolated in ICUs and caring for patients, or forced into quarantine and working remotely.
Deanna Parker, R.N., assistant vice president of the emergency department at Hardin Memorial, notes that in the midst of trying to conserve PPE, without the Vocera device, all the equipment would have to be taken off just for a clinician or nurse to reach his or her smartphone. “There’s always a risk with taking on and off your PPE because you can have contamination. With [this tool], physicians have the ability to call right into a room, and ask for the nurse in room 12 [for example], who may be already in room 12 providing care to a patient. And that nurse does not have to leave the room, does not have to take off his or her PPE, and has the ability to answer the call hands-free. They just have to accept the call.”
