American health care has been in the fight of its life to address the pandemic caused by the coronavirus disease 2019 (COVID-19). As a country, we have had to quickly ramp up ways to contain, diagnose and treat this virus in unprecedented ways. While things have seemed grim as the dimensions of the scope and severity of the virus became known, there is good news: we’ve rapidly been able to leverage health information technology (health IT) in the fight. Here are some examples.
Telehealth. Use of telehealth has skyrocketed in the scramble to combat COVID-19. To be sure, virtual visits have been on the rise for several years; but now in the face of the COVID-19 pandemic, policymakers quickly jumped on the potential of telehealth to provide care, protect patients and health personnel and limit community spread of the virus. This was facilitated by many relaxed regulatory restrictions. For example, Medicare announced waivers and policy changes related to telehealth payments while restrictions for multistate physician licensure (a major barrier) have been temporarily lifted. The Federal Communications Commission relaxed broadband rules to give health systems and broadband providers more opportunities to improve connectivity and expand telehealth and mobile health capabilities. The Drug Enforcement Administration eased restrictions on controlled substance prescribing for telehealth.
Virtual visits come in all sizes and shapes. They can be just telephonic or in-person sessions through Zoom, Skype or specialized applications. Allscripts, for example, provides telehealth capabilities within their FollowMyHealth patient engagement platform, which enables providers to give direct patient-to-provider telehealth services. eClinicalWorks has a televisit capability within its Healow platform, which provides secure and fully virtual visits integrated into the eClinicalWorks electronic health record (EHR), leveraging existing equipment and webcams by both providers and patients.
Telehealth leader American Well has made its virtual care platform available in Epic’s App Orchard. The American Well Telehealth (Clinical) app enables providers to embed video visits into their existing clinical workflows and launch an American Well?powered video consultation from the patient chart with one click. A physician can use a patient’s electronic health record (EHR) to access clinical information during the virtual visit to triage for testing and treatment and arrange for interventions. Similarly, Amwell’s telehealth solution is embedded within Cerner Millennium, enabling providers to launch video consultations directly within Millennium using single sign-on and eliminate the need for dual screens.
EHR platforms can pair with various kinds of applications (apps), wearables and other technologies to provide clinical information (such as heart rate and glucose levels) that will better inform the interaction between patient and provider, as well as improve satisfaction and outcomes.
There also are innovations in remote monitoring that are being brought to bear — both to prevent exposure to the virus as well as provide needed care. For example, Israel’s largest hospital is deploying an EarlySense monitor under mattresses of COVID-19 patients isolated in hospital rooms and their homes. The EarlySense sensor measures a patient’s respiration and heart rates and motion. It has an artificial intelligence (AI)-based algorithm that alerts the care team when a patient is deteriorating or about to crash, typically 6 to 8 hours before that happens. This gives the care team the opportunity to assess the patient and arrange for higher-level care, such as transfer to the intensive care unit (ICU).
Patient portals. Patient portals also aren’t new. In fact, their use is one way to meet the Advancing Care Information requirement under the federal Merit-based Incentive Payment System. Using patient portals linked to certified EHR technologies is one of the easier ways to provide patient access to their health data. According to research by Kaiser Permanente, access to a patient portal can increase engagement in outpatient visits, potentially addressing unmet clinical needs, and reduce downstream health events that lead to emergency and hospital care, particularly among patients with multiple complex conditions. Despite a number of successes, such as patient use of Epic’s MyChart and Kaiser Permanente’s success with its portal, uptake across the industry has been sparse — roughly a third of patients use portals even though 90% of provider organizations offer them.
That is changing rapidly in response to the COVID-19 crisis. Health systems are encouraging patients to use existing portals; consequently, patients are migrating to portals to schedule virtual visits and COVID-19 tests. They are exchanging secure messages with their providers about their symptoms and places to go for care. All this can have a huge bearing on treatment efficacy, utilization and patient outcomes and satisfaction, aside from limiting the spread of the virus and mitigating hospital overload.
Secure messaging via portals also is used to triage those having been exposed to the virus and requiring treatment. For example, Alphabet’s Verily launched a website on which California residents can complete a short survey regarding their current condition and, if they meet certain criteria, could be referred to a nearby mobile COVID-19 testing site. Labs run the samples and Verily sends the results to patients.
Electronic health records. EHRs are ubiquitous in hospital and ambulatory settings. They have many functionalities that are being brought to bear in the COVID 19 crisis.
- Electronic prescribing. EHRs are the main way to prescribe medications in the United States. Electronic prescribing (ePrescribing) currently is key for patients who need prescriptions and refills not related to the virus. ePrescribing’s problem list and medication history functions can help inform virtual visits. As we start to turn the corner on the emergency, ePrescribing will be essential for prescribing new treatments and vaccines as they become available.
- Ordering of tests. Many EHR vendors and users have integrated the ordering of tests and equipment into the EHR workflow. Intermountain Healthcare in Utah has configured its EHRs so clinicians can more easily order COVID-19 tests and necessary equipment.
- Providing clinical guidance. Decision support capabilities are already within EHRs to provide clinical guidance. It’s just a matter of configuring them, populating them with appropriate content, and updating content and workflow as they evolve for COVID-19. Many EHR vendors have created COVID-specific workflows, screening tools, order sets and care paths, and are distributing them to their clients.
- Identifying those at risk. EHRs can be leveraged to identify at-risk patients based on certain metrics. For example, data analytics within Epic’s suite of products can be used to create and run reports that indicate how patients are being affected within a community. One possibility is a search that might map positive COVID-19 patients by ZIP code to reveal potential hot spots. Boston’s Brigham and Women’s Hospital is leveraging information from its EHR to trace patient and staff contacts for follow-up if they have been in contact with providers who test positive for the virus.
Screening. EHR vendors are enhancing tools to help providers screen patients. Cerner’s Soarian Clinicals is an example. Its Provider Documentation and Inpatient Nursing Assessment model provides communicable disease screening questions as well as alerts and patient-level icons. In another example, MEDITECH is providing additional system configuration instructions and guidance for screening patients suspected of COVID 19 infection.
Mobile apps. Mobile apps are becoming central to health care in general and to the fight against COVID-19 in particular. They attempt to address all aspects of diagnosis and treatment. Athenahealth’s epocrates mobile app for clinicians now features an interactive decision tool based on the latest CDC guidance. In under 60 seconds, a clinician can access the CDC’s updated guidance relevant to a patient’s situation directly from a mobile device. MobileSmith Health’s COVID Response Mobile Apps enable hospitals to communicate with the community, hospital employees and volunteers. The Sentinel Fever Tracker is a new app to help health systems, hospitals, government agencies and employers monitor the temperatures of people under self-quarantine due to possible exposure to the virus. Hospitals are using real-time locator apps and wireless real-time location system technology to keep track of people and equipment, which is essential in the current hectic and fluid environment surrounding COVID-19. Apple has teamed up with the White House Coronavirus Task Force and federal agencies to stand up a mobile app and web site for COVID-19 screening and resources.
Data analytics. Health IT vendors are continually expanding their products to include more and sophisticated data analytics capabilities. Use of such data analytics as AI, machine learning and predictive modeling have been on the rise before the pandemic. Now they are essential to fighting the virus and its spread. Hospitals and public health officials are leveraging data analytics tools embedded in EHRs to identify outbreak clusters and epidemiological patterns. Data analytics companies are rolling out new modules to enable clients to track where patients who test positive for COVID-19 have been within the health system and which staff members have interacted with these patients. Optimal scheduling of precious resources such as ICU beds can benefit from advanced analytics and technologies. Health IT vendors are using AI to identify gaps in the supply chain and which workers will need hardware and software to work remotely. AI algorithms can identify abnormal chest X-rays of COVID-19 patients, providing “instant triage” that could speed diagnosis and improve resource management.
The COVID-19 epidemic will forever change the face of health care and how we work, and health IT will continue to play a key role in fighting it and any future pandemics.