During a hastily called March 26 meeting of the Health Information Technology Advisory Committee (HITAC) of the Office of the National Coordinator for Health IT, members sought to identify steps ONC could take to be most helpful to healthcare provider organizations in the short-term COVID-19 emergency.
Speaking with urgency, the chief information officers and chief medical information officers on the committee pressed several key points.
Brett Oliver, M.D., the CMIO for Baptist Health in Louisville, Ky., said other steps ONC could address would be nice, but noted that “My one, two and three right now is PPE. If we don’t get a better more reliable supply of PPE to our front-line workers, we are going to see an absolute tragedy. To send these folks into these situations in ICUs without the proper equipment is sad and feels almost criminal,” he said. “Whatever we could do to find materials tracking available resources, essential repository, perhaps a national 3D printing resource. My supply chain folks at our organization, what they are having to do to find available PPE for our folks is just ridiculous. We are getting hijacked by the government. We had a $1 million shipment of masks coming from a supplier in China only to have the supply taken over by the government and redistributed. I understand there are national priorities, but we have to have a way we can successfully order these things, know where they are and track them. We literally have a car escorting a truck from a Southern state where we put in an order and gotten some things because we are afraid someone is going to take it from us.”
Oliver said he can’t emphasize enough how important the PPE issue is for the health of our healthcare systems. “If you notice, once China adopted severe PPE requirements, when they started putting on gowns, bunny suits, hats and double gloves, they had zero healthcare workers infected. We have got to start moving to that,” he stressed. “We have to understand what is happening at the local level with our suppliers. It is just a black box right now. All these suggestions are great, but if I don’t get masks, gowns, gloves, and sterile wipes, I am hosed.”
Aaron Miri, CIO for the Dell Medical School and UT Health Austin, added that sharing information about how health systems are responding to the PPE shortage would be helpful, including 3D printing and cleaning and reusing equipment.
Miri said rapid action can work, demonstrated by HHS changing rules around telehealth and how quickly providers and patients in Austin have adopted it. He then raised several issues. “There is a new ICD-10 code for COVID-19 published by the World Health Organization. There are a number of electronic health record vendors out there that are reluctant to add this code anytime soon. A lot of EHR vendors have put a pause on any updates; therefore, we cannot code use this new ICD-10 code. I think we need to look at that and see if we can do anything to support the vendor community to get it out there so we, the providers, can utilize that.”
Miri also mentioned that there is a need to better share information about what providers are seeing on the front lines. “There are data elements we are seeing around loss of smell that are early indicators of coronavirus infection,” he said, adding that people are currently sharing these on Twitter. “We need to do a better job of highlighting those real-time aspects we are learning in the field.”
Arien Malec senior vice president for research and development, clinical and administrative networks for Change Healthcare, echoed Miri’s statement about the importance of rolling out terminology to support disease surveillance. “If we don't have universal rollout of terminology, I am not sure anything else we are talking about matters, because we can’t do job number one, which is disease surveillance and risk management,” he said.
“It concerns me that we don’t have ubiquitous adoption and rollout of updated LOINC terminology for testing and updated SNOMED CT and ICD10 terminology and making sure that the already deployed CDC Biosense 2 network is being informed by the appropriate data with the appropriate terminology,” Malec continued. “It seems to me there is a role for ONC in its coordination function. We have a huge amount of data sitting in EHRs that could be used for looking at disease surveillance and additional risk factors, and that data is not as accessible as it could be. There is a huge amount of data flowing through Commonwell and a number of HIEs are up and running. We should be able to turn and deploy that information flow to improve disease surveillance and improve identification of risk factors and improve remediation.”
Malec added that there is a need for urgent coordination of standards development in high-priority areas. “To give one example, there is a team looking at making access to ICU status available via FHIR-based APIs to provide additional information for intake and response to direct people to available beds. ONC has a role to play in prioritizing standards development in terms of the needs of communities most effected.”
Abby Sears, CEO of the nonprofit consortium OCHIN, which provides health IT services to community health centers across the country, suggested that ONC and CMS delay implementation dates for its recently released final rules on interoperability. “Our part of the delivery system does not have adaptive capacity,” she said. They are serving the most vulnerable patients and switching to virtual care as much as they can, she said, but they do not have capacity to implement the interoperability rules during the crisis. “Without delays in the rule, they are not going to make the timelines.”
UT Austin’s Miri made another suggestion: “Look at the forms out there for contact tracing,” he said. “The CDC form is fantastic, with numerous fields, but if you look at the CDC form, the local public health contact tracing form and the state’s, they are all different. Can we normalize that and get down to a set of data elements that make sense so that everybody can adopt them? We are in the process of rolling out an app on iOS and Android and we had to decide just to go with the national form.”
The HITAC will continue to meet to narrow down the list of items it will recommend that ONC seek to tackle in the short term.
