Blog from May, 2020

Christopher Jason

The new state-wide health information exchange already has two of Mississippi’s largest health systems in the fold.

The Mississippi Hospital Association (MHA) has established a state-wide health information exchange (HIE) that aims to increase interoperability and enhance the connection between Mississippi hospitals and physicians as they transition toward value-based care.

With three regional hospitals and two of the largest health systems in the state already involved, the HIE is set to launch within the next month. The organization said it expects additional hospitals to join over the summer.  

To get the exchange going, MHA partnered with Care Continuity to utilize its navigation technology and patient advocacy technology to its committed health systems across the state.

“Our partnership with Care Continuity allows all Mississippi providers to deliver care to their patients fully aware of key events impacting them, such as a visit to an emergency department, while also ensuring that all members of the patient care team are working from the same set of information,” Timothy H. Moore, president and CEO of MHA, said in a statement.

“This will help our hospitals address one of the greatest challenges in health care — delivering the right care at the right time.”

First, the HIE will feature inpatient admissions, emergency department visits, and post-acute care transition notifications for providers.

Once the HIE is launched, health systems will eventually be able to access capabilities such as, secure clinical document exchange, provider-to-provider referral management, and support for collaboration within patient-centered care teams and payers. Physicians will also be able to access customizable text or email admission notifications for all connected health systems.

Along with the additional HIE capabilities, the state-wide exchange aims to reduce costs and improve patient care by lowering the chances of duplicative testing and linking providers throughout the state. It also meets the recent Medicaid and Medicare service standards, which awards health systems that can show they are reducing hospital re-admissions and improving care quality.

“Providing the data infrastructure to enable health systems to track patients through their individual journey will ensure patients are receiving quality care in a timely manner,” said Andrew Thorby, CEO, Care Continuity.

Mississippi’s HIE was announced just days after Connecticut launched a state-wide HIE when it inked its first client, Connecticut State Medical Society’s CTHealthLink.

Over the past decade, Connecticut’s government leaders found out the hard way how difficult it is to implement a state-wide HIE.

First, the state attempted to launch the HIE four times prior to this connection, costing the state millions of dollars. More recently, a Connecticut Health Foundation report said the state’s organizers must develop long-term financial plans for sustainability and attract participants before launching the HIE.

Now that the HIE is connected to CTHealthLink, the two organizations aim to improve patient care, enhance interoperability throughout the state, and upgrade Connecticut’s healthcare delivery system.

“Good information is critical for good healthcare; the HIE will help providers get patient information quickly and that improves care, reduces redundant testing, and lowers costs,” Vicki Veltri, executive director of the Office of Health Strategy, said in a statement.

“Individual and public health awareness is front page news – and Connecticut is now officially on the path that 45 other states have already traveled, with a more effective healthcare delivery model to show for it. The Connecticut State Medical Society’s CTHealthlink represents thousands of providers across the state and we welcome them to the HIE.”

The HIE said it aims to introduce the benefits of the new exchange system, while prioritizing patient privacy and security.

“Improving healthcare delivery for Connecticut residents should be a constant goal for health leaders and I’m ecstatic to see this platform up and running,” said Connecticut senator, Mary Daugherty Abrams. “It will reduce costs and improve efficiency, both of which are sorely needed. Especially amid the current COVID-19 crisis, this will undoubtedly improve healthcare across our state.”


The COVID-19 crisis started to consume the United States just as it had been turning the corner on the most severe chapter of the opioid crisis. Opioid prescribing rates and drug overdose rates both remain distressingly high, and some patients on opioids are more vulnerable to impacts from COVID-19. At the same time, for patients with severe chronic pain, opioids are clinically indicated, and provide meaningful relief from a life of constant pain that could otherwise be debilitating. For these individuals, prescribers are often challenged with adhering to CDC guidelines and state laws that limit opioid use while effectively treating pain, and this is especially true for patients who have been treated with higher doses of opioids for extended periods of time.

The EHR Association’s Opioid Crisis Task Force has written a white paper to comment on the role that health information technologies, including EHRs, can play in assisting physicians with responsible opioid tapering.

What is Opioid Tapering?

Opioid tapering represents the process of gradually reducing opioid dosages according to a tapering plan, while monitoring for and mitigating side effects and meeting the patient’s pain management needs through non-opioid therapies. When indicated, tapering involves dose reductions of anywhere from 5% to 20% every four weeks. Opioids should not be tapered rapidly or discontinued suddenly due to the risks of significant opioid withdrawal. Opioids may be tapered down until complete discontinuation, or reduced to a safe maintenance level.

How Can Health IT Help Providers with Appropriate Opioid Tapering? 

The EHRA white paper notes that each organization should first have an opioid stewardship program firmly in place, and that it makes optimized use of the EHR. EHRA previously developed an EHR implementation guide for existing CDC Guideline for opioid use, suggesting ways to implement all 12 CDC recommendations. 

Once a program is established, additional electronic tools can be leveraged to assist providers with opioid tapering, including:

  • Morphine Milligram Equivalent (MME) calculations
  • Generation of tapering schedules and special instructions attached to medications
  • Clinical decision support that promotes non-opioid and non-pharmacologic therapy alternatives
  • Specialized physician notes to track tapering progress
  • Screening Assessments for withdrawal symptoms
  • Evidence-based order sets to manage side effects, and initiate substance use disorder treatment or address other major decompensations if indicated
  • Ongoing education for the patient, their family and their caregivers

What’s Next?

With the opioid crisis still unresolved and the COVID-19 pandemic making patients more vulnerable to opioid misuse, the need is urgent for the digitization of the opioid tapering plan, and organizations can act now to create, develop, and implement this solution. In the future, there are many exciting new frontiers in EHR development that can advance this process and can help providers to balance safer, evidence based, and equitable use of opioids with patient-centric care plans. 

Christopher Jason 

Implementing travel history into the EHR and enhancing patient data exchange is crucial to limiting the spread of COVID-19

Effective patient data exchange can help trigger an effective response to COVID-19, according to a manuscript written by medical professionals in the Journal of Informatics in Health and Biomedicine.

Tracing the origins of the coronavirus is crucial to flattening the curve, as the notoriously contagious disease crosses state lines and hits the most populated area of the country the hardest. Luckily, there is EHR data that is readily available for researchers to utilize.

“COVID-19 data flowing across geographic borders are extremely useful to public health professionals for many purposes such as accelerating the pharmaceutical development pipeline, and for making vital decisions about intensive care unit rooms, where to build temporary hospitals, or where to boost supplies of personal protection equipment, ventilators, or diagnostic tests,” wrote the authors

“Sharing data enables quicker dissemination and validation of pharmaceutical innovations, as well as improved knowledge of what prevention and mitigation measures work,” they continued. “Even if physical borders around the globe are closed, it is crucial that data continues to transparently flow across borders to enable a data economy to thrive which will promote global public health through global cooperation and solidarity.”

The five contributing authors join other researchers in pointing to travel history information and its utility in the EHR.

Travel history can lead to detailed patient data, prompt further testing, and spark protective measures for individuals who come into contact with an infected patient.

“Transportation data have been used to simulate the spread of a disease and estimate the effect of local and intercontinental travel restrictions,” the authors explained. “Air, sea, and land transport networks continue to expand in reach, speed of travel, and volume of passengers carried, providing a vector for infectious disease spread.”

EHRs can also integrate with travel history to customize immediate diagnosis for returning travelers, similar to how cardiovascular risk calculators can show the patient a customized list of potential lifestyle changes.

“Prescriptive analytics on outbreak data through algorithms or models can simulate possible outcomes and help answer: ‘what should we do’ when the outbreak constitutes a public health emergency of local or international concern,” they continued.

COVID-19 dashboards, such as the one developed by the Nebraska Health Information Initiative (NEHII) and its partners, can connect providers to enhance interoperability and help facilitate COVID-19 data at a fast and effective rate.

“A common way to disseminate data about infections like COVID-19 is through data visualizations and simulated disease models,” the authors wrote. “These data products enable the public, policy makers, and scientists to quickly understand the global spread of COVID-19 at the population level, enabling forecasting at the local level.”

“These examples of data and data product flow across geographic borders are extremely useful to public health professionals for many purposes such as accelerating the pharmaceutical development pipeline, for triaging clinician resources to a locale, and for making decisions about intensive care unit rooms, where to build temporary hospitals (e.g., Boston Hope Medical Center15), or where to boost supplies of personal protection equipment, ventilators, or diagnostic tests,” they continued.

The pandemic has caused health systems to focus on additional challenges outside of data exchange, such as decreasing PPE, expanding ICU capacity, and the impact of reductions in elective procedures.  

“Providing data analytical tools for organizations that cannot share data or have limited analytical resources can also be helpful to help with virus response, better-coordinated care, reporting, and organizational operations,” the authors said.

The ability to utilize EHR data and exchange patient data at a higher rate than usual is vital to lessening the spread of the coronavirus.

“Global data on disease trajectories and the effectiveness and economic impact of different social distancing measures are essential to facilitate effective local responses to pandemics,” wrote the authors. “Policymakers have used these data to inform their decisions regarding travel bans, quarantines, and economic stimulus. To facilitate the dissemination of knowledge regarding COVID-19 during the outbreak, publishers are prioritizing review of and offering free, open access to relevant research findings.”

“Sharing COVID-19 data freely and globally boosts the data economy, enabling quicker dissemination and validation of pharmaceutical innovations, as well as improving knowledge of what prevention and mitigation measures work,” the authors concluded. “Even if physical borders around the globe are closed, it is crucial that data related to COVID-19 continue to transparently flow across borders to enable a data economy to thrive which will promote global public health through global cooperation and solidarity.”

Christopher Jason

Researchers were able to develop an EHR tool that successfully diagnosed a previously undiagnosed dementia patient.

A tool implemented into the EHR can be utilized to address the issue of missed or late diagnoses of dementia and can flag the patient record for a future follow up, according to a study published in the Journal of the American Geriatrics Society.

One of the top concerns of America’s aging population is the misdiagnosis or under-recognition of dementia.

Using this tool, clinicians can give patients an early diagnosis of dementia, which would allow for earlier, timelier patient care. However, roughly half of the patients with dementia are left undiagnosed.

So far, little work has been done to translate findings from models of future risk of dementia into EHR systems that could be used in primary care settings to detect undiagnosed cases.

Researchers from University of California, San Francisco; the University of Washington, Seattle; and the Kaiser Permanente Washington (KPWA) Health Research Institute, conducted a study on patients age 65 and older at Kaiser Permanente Washington health system to examine the impact and accuracy of the EHR-based tool.

Researchers selected 31 markers that were observed in the EHR linked to a higher likelihood of dementia. The tool, called the EHR Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR), used the markers to identify patients who may have been under or misdiagnosed.

The 31 markers are highlighted by demographic data and dementia-related symptoms. The markers are based on age, sex, psychosis, use of antidepressant prescriptions, emergency department visits, and health conditions such as cerebrovascular disease and diabetes.

Researchers sifted through the EHRs of the individuals who had been classified as having no dementia, recognized dementia, or unrecognized dementia during their study visit.

To diagnose patients with dementia, providers would have noted individuals to have memory complaints, prescribed dementia medication within the last two years, or given a positive dementia diagnosis.

Of the 4,330 patients and 16,665 visits observed, 1,015 visits resulted in a positive dementia diagnosis. Out of those positive diagnoses, 49 percent were not previously diagnosed with dementia in their EHRs.

The study showed that those who had eRADAR scores in the top 5 percent were more than 5 times more likely than the rest of the patients to have undiagnosed dementia. Due to that result, researchers said it would be vital to screen patients with high eRADAR scores.

Researchers then analyzed the 31 markers to identify the important predictors of undiagnosed dementia. Those predictors helped develop the eRADAR model, which provides a score that increases with the likelihood that an individual has dementia.

Patients in this study undergo cognitive screening every two years and are seen at Kaiser health system. This makes it easier for researchers to identify the average number of patients whose dementia goes misdiagnosed or undiagnosed in the average health system, which shows the importance of the EHR tool by targeting the most at-risk patients.

Researchers said the study needs additional research due to its limitations, such as the patients being primarily Caucasian, well-educated, and English-speaking from one health system. They also suggest that more information and research is needed on the eRADAR model to determine the accuracy and impact it would have on other health systems.

This study showed that the eRADAR tool could accurately identify patients who should be screened for dementia. Not only does it detect an earlier diagnosis but that early diagnosis can allow for quicker patient care, which then allows for better financial and long-term care planning.

The researchers also noted that earlier diagnosis could begin a trend of more evidence-based care tools, triggering better symptom management for patients.

Christopher Jean

Researchers at University of California San Diego are conducting EHR optimization to mitigate patient and clinician COVID-19 exposure.

EHR optimization and implementing tools into the EHR are crucial to managing the spread of COVID-19, according to a study published in the Journal of Informatics in Health and Biomedicine.

“While the incidence of COVID-19 continues to rise, healthcare systems are rapidly preparing and adapting to increasing clinical demands,” wrote the authors of the study. “Inherent to the operational management of a pandemic in the era of modern medicine is leveraging the capabilities of the EHR, which can be useful for developing tools to support standard management of patients.” 

“Technology-based tools can effectively support institutions during a pandemic by facilitating the immediate widespread distribution of information, tracking transmission in real time, creating virtual venues for meetings and day-to-day operations, and, perhaps most importantly, offering telemedicine visits for patients,” they continued.

Due to the spread of the virus in Southern California, Researchers at University of California San Diego Health (UCSDH) decided to develop a rapid screening process, hospital-based and ambulatory testing, new orders with clinical decision support, reporting and analytics tools, and enhance its telehealth technology.

UCSDH became a quarantine site in early February, making the area exposed to COVID-19 earlier than most. This triggered an Incident Command Center (ICC) being established at the university hospital for non-stop pandemic monitoring.

With the ICC in place, researchers at the medical center were developing COVID-19-related projects to optimize the EHR and build tools to implement into the EHR.

First, the team needed to build screening tools to be implemented into the EHR due to the influx of patient visits and in-person encounters.

They implemented tools that could be accessed by operators and triage nurses to give patients information on quarantining, where to get a COVID-19 test, and when to visit the emergency department. They developed automatic email notifications to properly triage prior to visiting the facility.

Next, researchers built a travel and symptom screening questionnaire into the registration process that could be handled by the front desk.

Developers also generated ordering tools that included screening criteria, information on specimen acquisition, requirements for personal protective equipment, and guidance for COVID-19 testing turnaround time. The team also implemented lab orders, isolation orders, and options for different types of testing into the EHR.

In order to ease communication between the newly developed seven-person Ambulatory COVID Team (ACT), the team built a secure messaging program. This 24-hour messaging platform could share patient data and it could be accessed over desktop or a mobile app.

While it was important to keep the ACT team on the same page, researchers also constructed a reporting team for the health system to coordinate all clinicians. It highlighted operational and patient monitoring processes, along with patient isolation procedures.

On top of that, a COVID-19 Operational Dashboard was built to constantly update clinicians on the number of patients tested, bed availability, test results, and the number of ventilators available.

Lastly, the enhancement of telehealth technology has been critical to reduce COVID-19 patient and staff exposure. Although the health system already had telehealth infrastructure, it expanded access to all outpatient areas and increased learning videos about how to properly conduct the tool.

Researchers said that within 72 hours, over 300 employees were trained in telehealth technology and over 1,000 video visits were scheduled.

“In the face of the COVID-19 pandemic, healthcare systems can best prepare by following guidelines and recommendations set forth by federal and global institutions,” the authors wrote. “The electronic health record and associated technologies are vital and requisite tools in supporting outbreak management that should be leveraged to their full potential, and we hope that our experiences in developing these tools will be helpful to other health systems facing the same challenges.”