Researchers from the School of Public Health, University of Texas Health Science Center at Houston and Harris County Public Health leveraged the Greater Houston Healthconnect (GHH) health information exchange to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes.
The team of public health researchers and HIE executives published their findings in PLOS One, a peer-reviewed open access scientific journal. They stress that HIEs offer a relatively quick and efficient means to acquire large data sets to identify potential risk factors of emerging diseases. “Additionally, HIEs offer researchers access to a wide array of lifestyle, clinical, laboratory, and demographic characteristics to conduct exploratory and confirmatory studies so public health officials can intervene and improve population health,” they wrote.
GHH, a regional HIE founded in 2010, links more than 1,500 venues of care in greater Houston, South and East Texas, and Western Louisiana. GHH is connected to more than 95 percent of hospitals and healthcare systems in the greater Houston area and the majority of practicing physicians, representing over 15 million unique patients, making it one of the largest HIEs in the United States.
GHH has multiple interfaces with each participating provider’s EHR system. The first is an Admission, Discharge, Transfer (ADT) interface that feeds messages in real-time to populate its master patient index (MPI). The second is a two-way interface that enables the exchange of clinical information unique to the participant’s EHR. The third set of interfaces feeds discrete clinical data from laboratory, pathology, radiology, and other ancillary systems in real-time. Transcribed reports including progress notes, history and physicals, discharge summaries, and other text-based documents are also included. These interfaces in addition to GHH’s diagnostic imaging exchange service allow for the real-time monitoring of patient encounters and the collection of their clinical and demographic data, documents, and diagnostic images.
The research team noted that understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up
The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic's onset to June 12th, 2020. They gathered demographic, lifestyle, laboratory, and clinical data from patient's encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities.
Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, more than 26 percent were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older, male and had a history of tobacco use. History of tobacco use remained significantly associated with COVID-19 fatality after adjusting for age, gender, and race/ethnicity.
The researchers noted that the project demonstrates the value of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across several healthcare providers’ EHR systems, and follow the cohort over time. “These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death,” they wrote.