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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.”