Blog

Mike Doyle


Traditionally, the healthcare industry has moved slowly when embracing new technology innovations.

However, over the past few months, it has been forced to rapidly advance to confront the challenges posed by COVID-19. One area that has received increased attention is real-world data (RWD), specifically, the ways in which RWD can be used in clinical research to quickly reveal insights about treatments, outcomes, and risk factors for COVID-19.

As much of these data are already available in the form of electronic health records (EHRs), it enables us to illuminate clinically relevant trends and learnings that can be applied in real-time.

The Biggest Obstacle

If you’ve been following the news over the last few months, one thing is abundantly clear: Things are changing daily as COVID-19 spreads around the world. As a result, frontline care providers are learning how to treat patients in real time and they need new information and additional guidance now.

Unfortunately, the speed at which we need to move is a direct juxtaposition to traditional research methods, which can take months or even years to complete. While randomized clinical trials remain the gold standard for ensuring drug safety and efficacy, they are not designed to provide real-time information to inform treatment for patients with COVID-19.

This virus is a constantly moving target, with a growing data set and a myriad of variables to consider. If we only rely on traditional research methods to improve our understanding of COVID-19, it’s essentially like entering a boxing match blindfolded for those on the front lines. By analyzing RWD from patients who have tested positive, including their treatment patterns and associated outcomes, we can begin to piece together some early learnings.

Gaining insight

By analyzing trends in COVID-19 data, we’ve been able to glean information on what treatments might be making an impact—and which are not. For instance, one analysis showed a lack of efficacy of hydroxychloroquine among hospitalized COVID-19 patients, despite early statements supporting this treatment.

This desire for increased insights isn’t just on the frontlines—the FDA has been vocal about its desire to understand treatment outcomes in COVID-19 patients.

They’re actively working with organizations across the industry to gather actionable information. Another industry initiative that is working to put patient data to use is the COVID-19 Evidence Accelerator, launched by Friends of Cancer Research and the Reagan-Udall Foundation for the FDA. Collectively, these programs are working to fill the gaps in our understanding of COVID-19 so we can better triage at-risk patients and treat them more quickly.

Future applications

Patient data can also be instrumental in ensuring that clinical trials continue on as planned. Due to the pandemic, a number of trials have been put on hold. However, RWD can be used to fill these gaps down the line so that ongoing clinical research isn’t slowed.

We are now seeing the acceptance of RWD increasing across various verticals in healthcare. Using EHR data of real patients, we’ve been able to identify risk factors and treatment outcomes trends. Having this information readily available to everyone—from frontline workers to the FDA—will be instrumental in treating COVID-19.





Researchers in North Carolina have optimized the EHR to implement EHR templates and EHR triggers to improve the quality of breast cancer care.


Christopher Jason


EHR enhancements, such as EHR templates and EHR triggers, are encouraging tools for promoting an understanding of clinical pathways to improve cancer care in the eastern region of North Carolina, according to a study published in Journal of Clinical Pathways.

The eastern region of North Carolina is a rural region of the state, where individuals are at an increased risk for more health issues, including cancer. According to the study, those individuals have lower survival rates than those who live in urban areas, and breast cancer is no exception.

“Patients with breast cancer residing in ENC [eastern North Carolina] are more likely to have delays in delivery of adjuvant chemotherapy and suffer from higher rates of breast cancer-specific mortality when compared with the rest of the state,” the authors explained. “A regional hospital system that serves this rural constituency is uniquely positioned to address these disparate outcomes.”

Researchers at Brody School of Medicine at East Carolina University wanted to ensure that newly diagnosed ENC patients with breast cancer received timely, evidence-based, and efficient care from their respective health systems by EHR optimization.

The researchers aimed to use the EHR as a tool guiding providers to follow certain clinical pathways.

Researchers integrated evidence-based clinical pathways for breast cancer care into the EHR at Vidant Cancer Care in Greenville, NC. The team also provided a means for rapid analysis of quality metrics.

Researchers collaborated with an EHR Advisory Group at numerous meetings to develop critical pathways. The stakeholders established 75 corresponding elements to individual treatment decisions and these critical pathways were then implemented into the EHR through separate approaches.

“First, standardized VBCC [Virtual Breast Cancer Conference] templates comprised of clinical pathway elements were developed and made live within the EHR,” the writers explained. “These templates were purposefully designed to enable rapid data collection and real-time analysis of variance from minimum quality standards.”

“Each element included in the templates was designed to be analyzable as a discrete variable via use of checkboxes and drop-down menus or as a qualitative variable via use of free-response text boxes,” they continued. “This design allows for rapid extraction of data elements via EHR queries. In addition, specific EHR triggers were developed to encourage compliance with clinical pathways and VBCC recommendations.”

Researchers analyzed 435 new breast cancer cases for two years prior to the implementation to gain a baseline. After three months, researchers will run an EHR query to analyze the results. This three-month re-evaluation will continue routinely at stakeholder meetings.

Early data hasn’t been particularly revealing, but researchers said there is upside to these EHR enhancements.

“Baseline data analysis revealed subpar compliance with multiple elements,” the authors wrote. “Gemba walks demonstrated that the standardized VBCC template is user-friendly. EHR triggers are currently in the beta testing phase. While VBCC participation by physicians at nonflagship hospitals has not been robust, EHR enhancements are a promising tool for promoting adherence to evidence-based clinical pathways, thereby improving the quality of breast cancer care in ENC.”

In particular, researchers said the EHR triggers will be an asset to this study once the triggers depart from beta testing phase.

“We anticipate that our EHR triggers will successfully improve compliance because similar triggers have been demonstrated to be effective mechanisms for identifying deviations from quality standards in cancer care,” the writers explained. “We intentionally limited the number of triggers to two in an effort to prevent “click fatigue,” which is associated with increased patient safety hazards and physician burnout.” 

“Once beta testing is complete and the triggers go live, we will solicit feedback from providers about the perceived benefits of the EHR triggers relative to the additional burden on their workflow.”




Christopher A. Brown


A global health crisis can lead to global cooperation, if we work together to create sustainable change

The COVID-19 Pandemic has exposed a chink in the armor of the US healthcare system. It has become clear that our healthcare network is woefully fragmented, with the lack of cooperation between organizations underscored by the absence of data interoperability putting both the general public and care practitioners at a disadvantage. While the free sharing of data between patients, caregivers, and providers is not a panacea for all current and future health challenges, interoperability can certainly help us to flatten the curve.

COVID-19 is the very definition of a population health crisis. To truly understand this disease, we need to analyze it and see its effects from every angle: responses to drugs, mortality rates, comorbidities, patient responses to intubation and other treatments, and what happens after they come off ventilators and return to the general population.

Models are being developed that can leverage this information to produce actionable insights and stratify patients for risk, but we need data to use these tools effectively. Although COVID-19 is like nothing we have seen before, we can seek to refine information that has already been collected on the spread of infectious disease within and across populations. Some technology leaders, along with innovative healthcare partners are working to optimize and normalize this data for validation with the goal of revealing signals and trends which can result in better outcomes for patients.

The current options for data collection have one thing in common: they require a patient to show up. We ask them to log on and fill out a questionnaire, or to physically present themselves before a doctor. While such practices serve well enough for triaging of patients, we must look for ways to leverage the data that already exists, without relying on continually adding new data to the equation. This pandemic has uncovered the importance of true preemptive population health, rather than the reactionary “calling in sick” health.

Locking up the data
An individual’s healthcare records are commonly delivered across multiple settings. Throughout a patient’s journey, their medical records may lead from a private physician’s office to an imaging center, hospital, outpatient center, and back to the original physician, each step producing its own records. For quality care, accessible information must accompany the patient every step of the way. If all these twists and turns exist within just one patient’s medical journey, how much more so of a whole population? And how can we combat the spread of diseases among the population if this data is inaccessible and disorganized?

The infrastructure of our care system is fragmented. Imagine city planners designing New York City’s transit system without communicating – the roads, the subway, the train all built independently of one another would lead to chaotic intersections and more than a few deaths. So why do we provide healthcare to 328 million Americans based on data gathered in such an irrational way?

Other industries have long shown the way in creating a common and mostly secure platform for data access and sharing. Our advancing technology in healthcare now has the potential to transform our healthcare system into one that continuously learns and improves, using predictive analytics and decision support tools. However, without access to the necessary data, these tools will be useless.

Free sharing of data promotes interoperability
The barriers that exist when it comes to sharing data are not trivial. Issues relating to privacy, legality, ethics, economics, and politics must all be considered. While we do not have all the solutions to these obstacles, priorities must be determined, and the public health considered alongside these challenges.

The key to improving patient outcomes and managing population health is interoperability, the transfer of information seamlessly between multiple sources. Leveraging healthcare’s full potential requires the free (and secure) sharing of data with the technologies able to analyze it effectively.

For example, if a patient regularly sees a cardiologist, but between appointments is admitted to the ER, the cardiologist should automatically have this information available. Interoperability of data will allow us to avoid unnecessary duplication of services, reduce costs, and provide safer and more compassionate care. Interoperability will not only help individual patients but the collating and sharing of robust health records will support more accurate tracking and prevention efforts for a range of public health threats.

The free exchange of data affords providers lifesaving and cost-effective insights, enabling them to make beneficial care decisions. Improving patient outcomes and reducing cost is not just about having the data but putting that data in the right hands to provide actionable insights.

Looking to the future
The World Health Organization’s eHealth Resolution includes the aim “to foster exchange of data and information for promotion of health, health systems, and training of health-care workers.” Effective exchange of health information is vital to improving the capabilities of hospitals and the health of populations.

When the dust settles, health systems will be reeling from the physical, emotional and financial burden caused by COVID-19. Instead of a well-deserved break, staff will be inundated with a second wave of patients, this time from a backlog of innumerable medical procedures that were put on hold throughout this pandemic. This demand will hit providers hard, but it will also provide an opportunity to utilize data to stratify patients at-risk for specific diseases or downstream complications. We need to prioritize these patients, so hospitals can do the right work on the right people without wasting precious resources.

Failure to learn from this pandemic will mean we miss an opportunity for real advancement in medical practice. The tools which will be most important in the future are those that can analyze existing population data and provide answers without relying on a constant stream of new data. The future is in sight, but without better access to the health records currently held in silos, we cannot optimize these algorithms effectively. Sharing data freely is the key to curbing this pandemic and mitigating the effects of any future outbreaks.



Kat Jercich


Hospitals are having a hard time reporting data to public health agencies, according to a new JAMIA study, which finds patchwork data sharing, "often occurring via fax or phone."


Hospitals may encounter administrative or logistical hurdles when reporting data to public health agencies – which, in turn, can hinder essential information tracking in times of infectious disease outbreaks. 

In a study published in the Journal of the American Medical Informatics Association, Harvard Business School researchers used data from the 2018 American Hospital Association Annual Survey and IT supplement to examine the barriers hospitals faced when trying to meet meaningful use requirements.

One significant challenge, researchers found, was the ability of agencies to receive the data hospitals were mandated to send. 

"More than four in 10 U.S. hospitals report that public health agencies are unable to receive electronic data," researchers wrote. 

"This finding may reflect the fact that substantial federal funding has been devoted to hospital information technology adoption, including the ability to send data electronically, without a concomitant investment in the ability of public health agencies to receive and act upon this data."

WHY IT MATTERS

The Centers for Medicare and Medicaid Services requires hospitals to send data to city or state health departments. These requirements, researchers noted, were implemented in part to allow agencies to respond efficiently to epidemics and pandemics. 

Still, they write, reporting gaps exist, and the novel coronavirus outbreak has made those inefficiencies clear. 

"Despite billions of dollars in federal investment in digitizing the U.S. healthcare system, aggregating information such as test results and potential cases was done in a patchwork way, with data sharing often occurring via fax or phone," researchers wrote.  

"Had electronic data sharing been in place, hospitals could have quickly transmitted COVD-19 testing results and syndromic surveillance data to public health agencies to supplement their testing and provide greater clarity on disease prevalence and incidence," they continued. 

Most of the 3,512 hospitals surveyed, the research team found, reported at least one barrier to sharing electronic data with health agencies, with public health agencies' capability being the most common hurdle. Interface-related issues, such as costs or complexity, were the next most common issues. 

Other problems cited included challenges extracting the data from electronic health records, different vocabulary standards, hospital capacity and lack of information about which public health agency should receive the information.

"One state had no hospitals reporting public health agency inability to receive electronic data while several states had the majority of hospitals reporting that barrier," researchers explained.  

"Differential funding levels priorities for public health agencies at the state and local level may explain some of this geographic variation," they continued.

Researchers also noted that some public health agencies may have only been able to receive data from certain EHR systems, which could explain the variation in answers even within the same state.

THE LARGER TREND

Researchers have noted the importance of data interoperability in containing the effects of COVID-19 around the country.

Earlier this month, a Duke-Margolis Center for Health Policy research team recommended better commercial lab reporting, improved access to clinical data and more reliance on the National Syndromic Surveillance program to manage the continued spread of COVID-19. 

And although CMS has offered some flexibility for implementing interoperability requirements, experts say the crisis has only highlighted the need for efficient information sharing – including with patients.

"The COVID-19 pandemic gripping the nation underscores the importance of these regulations in enabling greater data exchange and providing patients with their information," said Ben Moscovitch, Pew's project director for health information technology, in April.

ON THE RECORD

"Many areas reporting barriers to public health receipt of electronic data are also projected to be overwhelmed by COVID-19 patients, indicating that it is not just low density or rural areas who lack critical IT infrastructure for electronic disease surveillance," said researchers in the JAMIA study.

"Policymakers should prioritize investment in public health IT infrastructure along with broader health system information technology for both long-term COVID-19 monitoring as well as future pandemic preparedness," they continued.





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.”





HIMSS EHRA Blog


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.”




Brandi Vincent


The pandemic-driven outcomes could demonstrate what strategic interagency efforts around emerging technology can catalyze in rapid timeframes.


Three federal agencies have teamed up to collectively leverage and accelerate 3D printing and other advanced manufacturing technologies in the fight against COVID-19.

The Food and Drug Administration, Veterans Affairs Department and National Institutes of Health recently signed a Memorandum of Understanding to formalize a unified effort through which they’ll solicit designs for, produce and test 3D-printed personal protective equipment and other medical supplies to support America’s response to the worldwide health emergency. 

Through the work, the agencies are also engaging in a public-private partnership with the non-profit accelerator America Makes, which will act as a sort of matchmaker between the health care facilities that need the agency-approved, to-be-printed goods and manufacturing industry insiders with the capabilities to produce them. 

“This initiative is rapidly evolving,” Dr. Beth Ripley, chair of the Veteran’s Health Administration's  3D Printing Advisory Committee and enterprise lead of VHA’s 3D Printing Network told Nextgov Monday. She now also serves as VA’s representative for the new MOU-driven effort.

As Ripley’s title suggests, federal agencies have been harnessing 3D printing to serve their missions in a variety of efforts over the last few years. But the global spread of the novel coronavirus ushered in new equipment shortages and growing strains on America’s medical supply chain—and subsequently introduced a fresh use for 3D printing, which can rapidly accelerate the speed between the first concept of a product, and the time it takes to produce it into reality. FDA, NIH and VA already possess the resources necessary to quickly test and share 3D-printed designs of face masks, shields and other supplies that medical personnel now need, so they likely came together to help accelerate that delivery.

Ripley shared details on the process laid out in the memorandum. It begins with NIH’s 3D Print Exchange, which is an existing tool used to share and find models that are clinically relevant and readily compatible with 3D printers. People with 3D designs of materials relevant to COVID-19 that they aim to share can submit them to NIH online. Then VA evaluates and tests the submitted designs. 

“The VA 3D Printing Network prints the parts and assesses their safety and clinical efficacy in collaboration with VA’s frontline medical providers,” Ripley explained.

As part of its duties highlighted in the memorandum, VA, through its Innovation Ecosystem, also swiftly launched an external website that interested individuals and health care entities can access to submit designs, find solutions, or support the testing involved. As the designs prove to be safe and effective in VA’s assessment, FDA then participates in the review process, provides guidance and ultimately makes the final designs easily accessible online. 

Finally, America Makes acts as a streamlined, solitary voice that connects those with significant 3D-printing capabilities to health care facilities with urgent needs for the supplies approved in the agencies’ process.

The partnership came together fast, moving from the original collaboration concept to actual existence in less than a week. And it’s already producing results. 

"In just six days, VA tested two face shields and designed and tested one face mask,” Ripley said. “We have already made significant progress in a short time."



Matthew Michela


Driven by business interests, many healthcare organizations continue to use the pretext of patient privacy all too easily, to keep data locked away. It's time to review what this generation of patients really want.


When I started working in healthcare, I was speaking and writing about the lack of interoperability and its effect on cost and quality. Now, three decades later, despite advances in science and technology, unfortunately, most of the barriers to interoperability are essentially still in place. The financial incentives and business practices preventing interoperability are so entrenched that it’s taken a perfect confluence of forces to make cracks into heavily fortified data silos. Finally, market forces combining the entry of new big tech companies, a meteoric rise of consumerism in healthcare, and regulatory vigor are setting the foundation for change.

New Regulations Pave the Way
The Federal Health IT Strategic Plan released by the Office of the National Coordinator (ONC) is a broad plan that seeks to address these structural problems. First, we’d like to applaud the ONC for its extremely well thought out and comprehensive plan. It succinctly captures the wide range of challenges and the major components that need to be addressed in order to break down those barriers.  The plan also provides a clear structure and guidance on these issues.

The plan, however, would benefit from a measure of prioritization of the objectives and strategies, or guidance on which should receive more emphasis in the immediate future. Among the 13 objectives identified in the plan, several would generate a more immediate impact and would accelerate progress and momentum of the other objectives if they received more immediate attention.

Patient Ownership of Data Controls Everything Else
The plan specifically calls out, and correctly so, the paramount importance of patients’ right to control their health, and how this must include the right to access and control their health information.

For decades, national policy on healthcare data privacy has been based upon the determination that healthcare data is especially sensitive, vitally important, directly impactful, and needs to be more secure than even our financial data. As such, it has been protected, held highly confidential and locked away as a fundamental condition of its collection. The protection of patient data has worked its way into every aspect of healthcare from the design of all technology, research, direct patient care, and even the design of physical facilities.

While the goal of keeping patient data confidential has been largely achieved, an unintended consequence of this protective effort has led to a lack of medical data availability — contributing to misdiagnoses, medical errors, suboptimal outcomes, and even patient death. A Johns Hopkins Study estimated that more than 250,000 people die each year due to medical errors, which is the third leading cause of death. Tragically, many of these deaths are preventable and the lack of relevant clinical data at the point of care is universally recognized by clinicians as a major reason medical errors occur.

The Challenge of Democratizing Data
Driven by business interests, many healthcare organizations continue to use the pretext of patient privacy all too easily, conveniently, and frequently to keep data locked away in order to preserve their own financial self-interest and market share.

Meanwhile, over the past 20 years, other industries from banking to navigation apps have allowed consumers to make their own choices about how private they want their data to be, in return for other tradeoffs in their lives. This generation of citizens openly shares its physical location with third parties to more conveniently navigate the roads and avoid delay. Consumers share their biometrics with fitness companies so they can be guided more effectively in exercise. They share their purchases and spending habits so they can more efficiently search for the product that best fits their need. They share videos of their home interiors and exteriors so they can watch their pets during the day or ensure the safety of delivered packages. They share their banking and financial information so they can improve their credit scores. And so on…

ONC has the capability to emphasize this point in both its policy-making and its ability to influence industry dialogue and perceptions. It’s critical to revisit our cultural perspective on the importance of the government, in combination with physicians and big industry, as the entities determining the rules for healthcare data privacy for citizens. This is an important step in helping clear the road for achievement of the ONC’s heath IT goals. As an example, even getting to a single national identifier would allow the ONC to better establish standards and procedures to share data and dramatically accelerate the achievement of the identified objectives. Subsequently, technology companies of all sizes can make decisions on where to invest development dollars.

This generation of citizens has demonstrated their capability, interest, and capacity to understand complex issues and make decisions for their own lives. It’s time to get them engaged on this topic. We may just find that historical assumptions that are generating so much complexity are no longer valid.




Jessica Kent


Organizations are using real-world data to gather evidence on utilization, population health, and the impact of interventions during COVID-19.

As the COVID-19 pandemic continues to disrupt the status quo, the healthcare industry is turning to real-world data to better understand, monitor, and prepare for whatever the virus may bring.

From patient surveys and EHR information, to studies on past outbreaks and hospital capacity, leaders are harnessing the power of real-world data to observe patterns and make critical decisions.

Defined by the FDA as information derived from sources other than traditional clinical trials, real-world data can provide valuable insights into patient health status or care delivery.

With big data playing a major role in the COVID-19 pandemic, this kind of information will prove extremely valuable in the fight against the outbreak.

What real-world data are organizations collecting to better understand COVID-19, and how is the industry using this information to combat the virus?

EXAMINING UTILIZATION RATES, HOSPITAL CAPACITY

The rapid spread of coronavirus has left many hospitals facing unprecedented strains on resources, with limited capacity to care for critically ill patients.

To help researchers, healthcare leaders, and the public identify places with low capacity, some organizations are monitoring data on hospitals’ utilization and capacity rates.

Definitive Healthcare recently partnered with Esri to launch an interactive data platform that allows users to track US hospital bed capacity, as well as potential geographic areas of risk. The resource displays the location and number of licensed beds, staffed beds, ICU beds, and total bed utilization rates across the country.

Some institutions have also leveraged real-world data to design modeling tools that can help hospitals and health systems plan for critical care surges. A team from Penn Medicine developed a tool that would predict surges in clinical demand, as well as best- and worst-case scenarios of COVID-19-induced strain on hospital capacity.

Researchers used publicly available epidemiological data on COVID-19 and clinical outcomes data from multiple Penn hospitals to build the model.

“With close collaboration between the clinical and operational leaders of our health system and data science team, we were able to rapidly explore a range of scenarios based on published data from other regions of the world,” Penn researchers said.

RAND Corporation, a nonprofit research institution, recently created a similar model. Researchers developed an interactive tool that allows decisionmakers to estimate current care capacity and explore strategies for increasing it.

As part of the project, the group reviewed literature on past outbreaks and COVID-19 experiences, conducted surveys of frontline clinicians, and held virtual roundtables with emergency care providers.

“These critical care capacity estimates can inform cross-regional critical care resource sharing—from regions with less demand to those with more demand,” the RAND research team said.

“We encourage hospital leaders and regional and state officials to use this tool to examine critical care capacity creation strategies using assumptions based on data from their communities.”

IDENTIFYING HIGH-RISK PATIENT POPULATIONS

Healthcare leaders and investigators are also gathering and analyzing real-world data to determine who is most at risk during the COVID-19 pandemic.

At Medical Home Network (MHN), a Medicaid accountable care organization, care managers are identifying vulnerable individuals by finding out which patients are experiencing social isolation. MHN asks patients if they live alone, if they are homeless, and whether they have people who will help them if they get sick.

Additionally, the organization is leveraging AI and machine learning to identify which patients have a high risk of admission for COVID-19, or for unrelated complications from respiratory issues.

“After we cross those two lists of patients – those patients who are at risk for being admitted for respiratory failure or COVID-19, and those patients who are socially isolated – we know who to reach out to first,” Art Jones, MD, chief medical officer of MHN, told HealthITAnalytics.com.

Other institutions are collecting patient data to better understand COVID-19 risk factors. Researchers on the Healthy Nevada Project, a population health study combining genetic, clinical, and environmental data, is now incorporating COVID-19 data from consented participants.

In a 13-question online survey, study participants offered information about possible exposure or risks of COVID-19, including recent travel, attendance at large public events, and whether they are experiencing symptoms of the virus.

“The data that our participants have provided us, in less than a week, has allowed us to discover risk factors within communities and take action to live longer, healthier lives,” said Joseph Grzymski, PhD, an associate research professor at the Desert Research Institute (DRI), Chief Science Officer for Renown Health, and principal investigator of the Healthy Nevada Project.

State-level organizations are also utilizing real-world data to demonstrate the impact of COVID-19 on certain communities. The Illinois Department of Public Health (IDPH) is releasing COVID-19 cases by zip code, allowing people to see how the virus is affecting different areas of the state.

The information can help leaders recognize which geographic locations may need stricter interventions or more critical care resources.

TRACKING INTERVENTION SUCCESS, INFORMING NEXT STEPS

As the number of confirmed COVID-19 cases continues to climb, states across the country are adopting stringent intervention methods to curb the spread. Social distancing measures have become commonplace in US communities, and researchers have started to examine the potential impact of these approaches.

At the University of Texas Health Science Center at Houston (UTHealth), a group used an AI tool to discover that stricter, immediate interventions are needed to reduce the spread of coronavirus in the greater Houston area.

The researchers developed the model based on COVID-19 cases in China and Italy, and applied that model to 150 countries around the world. When the virus spread to the US, researchers first used the model at the state level and then the major metropolitan areas in Texas, including Houston.

“Although there are a lot of numbers and a lot of details, we saw two consistent patterns: earlier intervention was better, and more stringent intervention was better than less stringent,” said Eric Boerwinkle, PhD, dean and M. David Low Chair in Public Health at UTHealth School of Public Health.

Stanford University researchers took a broader approach. Investigators developed a data-driven tool that evaluates the possible outcomes of interventions like social distancing and quarantine. Rather than trying to map the exact dynamics of a particular location, the model shows possible trajectories under different hypothetical scenarios.

“We wanted to start a larger conversation about how our long-term response might look,” said Erin Mordecai, Stanford biologist. “We’re concerned about the potential for the disease to rapidly spread once we lift control measures.”

The modeling framework allows for different types, intensities, and durations of interventions to be implemented, and shows how these interventions impact the spread of the virus over time.

“In the future, we are considering additional interventions and scenarios including contact tracing with efficacy dependent on the testing capacity, fatality and hospitalization rates dependent on the age structure of a population, and fatality rates further dependent on hospital capacities,” Stanford researchers said.

As the COVID-19 situation continues to unfold, real-world data will increasingly help healthcare leaders make critical decisions to mitigate the impact of the virus. Tracking, controlling, and understanding coronavirus will largely depend on the industry’s ability to learn from past and current real-world information.



Brandi Vincent


The pandemic-driven outcomes could demonstrate what strategic interagency efforts around emerging technology can catalyze in rapid timeframes.


Three federal agencies have teamed up to collectively leverage and accelerate 3D printing and other advanced manufacturing technologies in the fight against COVID-19.

The Food and Drug Administration, Veterans Affairs Department and National Institutes of Health recently signed a Memorandum of Understanding to formalize a unified effort through which they’ll solicit designs for, produce and test 3D-printed personal protective equipment and other medical supplies to support America’s response to the worldwide health emergency. 

Through the work, the agencies are also engaging in a public-private partnership with the non-profit accelerator America Makes, which will act as a sort of matchmaker between the health care facilities that need the agency-approved, to-be-printed goods and manufacturing industry insiders with the capabilities to produce them. 

“This initiative is rapidly evolving,” Dr. Beth Ripley, chair of the Veteran’s Health Administration's  3D Printing Advisory Committee and enterprise lead of VHA’s 3D Printing Network told Nextgov Monday. She now also serves as VA’s representative for the new MOU-driven effort.

As Ripley’s title suggests, federal agencies have been harnessing 3D printing to serve their missions in a variety of efforts over the last few years. But the global spread of the novel coronavirus ushered in new equipment shortages and growing strains on America’s medical supply chain—and subsequently introduced a fresh use for 3D printing, which can rapidly accelerate the speed between the first concept of a product, and the time it takes to produce it into reality. FDA, NIH and VA already possess the resources necessary to quickly test and share 3D-printed designs of face masks, shields and other supplies that medical personnel now need, so they likely came together to help accelerate that delivery.

Ripley shared details on the process laid out in the memorandum. It begins with NIH’s 3D Print Exchange, which is an existing tool used to share and find models that are clinically relevant and readily compatible with 3D printers. People with 3D designs of materials relevant to COVID-19 that they aim to share can submit them to NIH online. Then VA evaluates and tests the submitted designs. 

“The VA 3D Printing Network prints the parts and assesses their safety and clinical efficacy in collaboration with VA’s frontline medical providers,” Ripley explained.

As part of its duties highlighted in the memorandum, VA, through its Innovation Ecosystem, also swiftly launched an external website that interested individuals and health care entities can access to submit designs, find solutions, or support the testing involved. As the designs prove to be safe and effective in VA’s assessment, FDA then participates in the review process, provides guidance and ultimately makes the final designs easily accessible online. 

Finally, America Makes acts as a streamlined, solitary voice that connects those with significant 3D-printing capabilities to health care facilities with urgent needs for the supplies approved in the agencies’ process.

The partnership came together fast, moving from the original collaboration concept to actual existence in less than a week. And it’s already producing results. 

"In just six days, VA tested two face shields and designed and tested one face mask,” Ripley said. “We have already made significant progress in a short time."



Mike Miliard 


The CIO of Arizona's Health Current describes the health information exchange's efforts to serve its participants during the COVID-19 crisis – and discusses its ongoing efforts to boost data quality and consistency across the state.

Phoenix-based Health Current, Arizona's statewide health information exchange, serves more than 500 organizations: ACOs, behavioral health and community providers, emergency medical services, rural health clinics, hospitals and health systems, payers, labs, LTPAC organizations, and state and local health agencies.

For some time now, the HIE has been engaged with a major initiative focused on data governance and data-quality improvement, working to integrate more clinical and behavioral data across its network. Having seen 700% growth over the past three years, with its participants becoming ever more diverse, Health Current has been grappling with big challenges related to the sprawl and diversity of coding terminologies and data content across its stakeholders.

Since 2017, it has worked across its community of data suppliers and end users to work toward more commonality and uniformity in how data is relayed. That approach has been helpful in recent weeks as Health Current has had to pivot to focus on marshalling healthcare-data resources across Arizona in response to the COVID-19 crisis.

The HIE is working to ensure its data centers and IT infrastructure are solid and backed by multiple redundancies, even as its team members are observing social distancing by working remotely. The aim is to ensure all participants have easy access to critical data without any drop in service levels.

Health Current is enabling widespread access to longitudinal patient medical histories and data from patient encounters during the pandemic via its secure online portal, and with tens of thousands of alerts sent to clinicians and other healthcare staff. It's also offering expanded services for members to help monitor vulnerable populations, and prioritizing recruitment of new participants to expand its range of customers.

Healthcare IT News spoke recently with Keith Parker, Chief Information Officer at Health Current, to see how the HIE is serving as a critical public health infrastructure.

Q. How has Health Current pivoted in recent weeks, in light of the COVID-19 pandemic, to better serve the healthcare organizations across Arizona that rely on the HIE?

A. We're reaching out to our stakeholders and communicating with them about how best to use our data and the infrastructure we've put in place here in Arizona: everything from data-mining our database for our state or other authorized individuals to use for hot-spotting, to using our alert mechanisms, so when different labs or different high-risk patients come across, we can make sure that their care teams and their providers are aware of it as well.

Q. What is the size and scope of Health Current?

A. We don't really frame it in the context of the number of providers, but instead look at it through market-segment penetration. So we have about 98% of our acute care facilities connected and sending information bidirectionally – sending and receiving information.

Q. So the HIE is serving as a pretty critical information backbone to kind of help coordinate response to this crisis statewide.

A. We do have an infrastructure that is a pretty critical backbone for the state, as far as alerting and getting data to distribute across our healthcare community. And we send out, from a broad message perspective, well north of 20 million messages a month. But from a raw perspective, one encounter could equal several different message types that are going back and forth.

Q. That's just on a typical day?

A. That's typical.

Q. So you expect this to ramp up as the crisis continues to unfold.

A. Yes, and we've got the infrastructure in place. We've been doing north of 10 million alerts for the past almost year now.

Q. Talk about the importance of data quality.

A. We're on a journey to improving the data quality here in Arizona from a systems approach: How do we actually put in place mechanisms that engage our stakeholders, as well as the infrastructure that we have currently, to ensure that we have quality across the data continuum.

And what I mean by that is the data has to be input directly from the data source to us: The connection has to be built correctly – and to be built correctly as far as the types of data – and from a validation perspective: Is it actually syntactically correct, coming across? Is it complete and is correct?

We started down this path a little over a year ago, and I've got to tell you, it still feels like we're just at the beginning of that journey. There's just so much work to do to be able to clean up the data, make sure it's accurate, make sure that it's coming across on a regular basis.

Q. How do you approach that work?

A. We take an approach that's more collaborative. We have a data governance council. A lot of our ideas go to them. We put in place standards that go through our data governance council that we then take to our board, which is a representation of Arizona's market: payers, hospitals, providers, behavioral health, physical health. And then we move forward with it.

So from a data-governance perspective, that collaborative approach that promotes getting in the weeds, we actually have started running data-quality reports back on a subset of our facilities to say, "In these segments, this is what we're seeing." We've identified that we're missing specific maps, because not everything meets national terminology. And some of the areas that we've had to do this in his round of facility naming conventions, because what they name their facilities is not going to be in any national terminology book.

Q. And what about in a situation like the pandemic, which is so fast-evolving, with new CPT codes, new ICD-10 codes, new terminologies in general?

A. That's where having the foundation in place is valuable. We already know what those codes are, so we're just going in and validating that we're receiving those codes that we can data-mine against those codes. So when you take a look at it, it's the CPT codes, it's the LOINC codes for the labs, it's the CDC guidelines for symptoms or other areas that they're looking at.

So we've pretty quickly developed what that compendium looks like, and then we could go in and validate. But part of what we've done is, when we bring in our large data sources right now, those 98% of our hospitals, our acute care facilities that are sending us information includes labs. We've already got the foundation in place to be able to move that information back and forth. So it's just a matter of us going in and validating: This is the appropriate coding that we're looking for.

And then we can connect with the data sources and say, yes, that's how they're settling in as well. When it comes down to the national coding elements, it actually makes it a little easier because from a LOINC perspective, they follow those guidelines.

And if they don't, we can identify it. Then we can talk to them as far as how they actually code it. And then we have the appropriate data maps in place to be able to bring the data across as usable data. So the foundation really lends itself to us being able to stand up pretty quickly, to be able to say, as the testing is being distributed, we can then already have mechanisms that we're wrapping up or putting in place to be able to alert on those tests.

Having the right pipes in place is key – having those pipes support national standards, and having the appropriate mapping in place so we can make that data usable, and then doing spot checks (Is it actually working?), and validating against it. So from that perspective, it makes it a lot easier when something like this does arise to be able to work with our stakeholder and say, "How can we support you better?"

Q. Do you get the sense that the stakeholders, generally speaking, are appreciative of the role you're playing here and are using you to the fullest potential?

A. I would say here in Arizona, yes. So, we've got a pretty collaborative state when it comes to working together and sharing the information. We try to hit 90% or better on the data quality coming across. But the different data types is going to lead to natural variation that's going to be in the data coming across.

And our data sources work hand in hand with us to make sure the data quality is there. And then the end users: how is the data actually going to be used? A lot of our data goes out to those care teams, those care navigators that are supporting the rest of the care teams, the providers, the hospitals, the outpatient facilities on how to better manage those patients. The 10 million alerts that we send out are because most of our complex patients are on multiple provider panels.

Q. In recent years, as interoperability and data exchange imperatives have evolved, many HIEs have similarly innovated the services they provide. Talk a bit about how Health Current has changed its own business model in recent years.

A. Like evidence-based medicine, we pursue an evidence-based strategy. When we started sending out alerts we were at maybe 10,000, we thought we're doing pretty good. But when we reached out to our stakeholders and actually had deep conversations as part of what they really needed with the individuals who are using the alerts, we went from less than 100,000 to over 10 million a month.

We saw individuals starting to update their panels, stay more in touch, so it's really listening to our stakeholders. We do that. We take that same approach when it comes to data use from, say, pop health or analytic platforms. So we've spent a lot of time and efforts on developing different queries that we hit against our system to be able to support specific measures.

So if Organization A is using a given analytics platform, instead of just giving them CCDs, we give them the specific national codesets that they're looking for for those. Along with specified demographics, it's a lot cleaner. It goes into their system a lot easier. We do the normalization on our end, so it just feeds right into their environment.

We also work on it probably hitting their system in a few cases where we can support them with the alerts, to where it can support a care pathway. So they're using IP or solutions out there to be able to say, "I've got a diabetic; he presents in this way; this is the recommended pathway for the care team," they need that information to hit the system.

And we provide a mechanism when it's done to be able to hit their system like that. And we try to do it from a real-time perspective, so that information comes across. We immediately set it off to their system. The coding is then in place for them to be able to run whatever algorithm is downstream with their partners, with their care teams, as well.

So it's really listening to our stakeholders and understanding the direction they're going. It's also looking at it from an integrative perspective. We've the approach to where we're not shying away from 42 CFR information, if we bring in substance abuse information and make it available in accordance with SAMHSA, with national direction on that as well.

So it's really listening. As our environment's going to integrated facilities, integrated care, it's making sure that we have a data infrastructure or a direction that we're moving in that can support that as well. So it really goes from HIE to data management. So from the exchange to how do we actually manage data across market segments, and aligning both state and federal guidelines.

Q. We've seen often how in times of natural disaster, whether it's wildfires or hurricanes, HIEs really serve as key infrastructure: a "public utility … as critical as having roads, as having fire hydrants, as having an electricity backbone," as another HIE director once told me. Is that how Health Current sees itself as the COVID-19 crisis unfolds?

A. We see ourselves as a partner here in Arizona to make sure that we're providing the best care possible. So we see ourselves definitely as a piece of that puzzle. But only a piece of the puzzle. In hurricanes, when records were lost, well, you've got at least the start of a longitudinal record inside the HIE that you can begin using. And as the data elements become more complete and the quality improves, that only gets better over time. But yes, we definitely see ourselves as an integral part of the healthcare system and providing better care.





Heather Landi


Health IT leaders at hospitals and health systems are fast-tracking major technology projects—some in a matter of days.

As coronavirus cases rapidly increase in the U.S., healthcare chief information officers (CIOs) and IT executives are facing an unprecedented situation with a demand to ramp up technology tools on multiple fronts.

Hospital CIOs are quickly putting up telehealth infrastructure and telecommuting capabilities for thousands of employees and also developing screening chatbots and tracking tools to help frontline healthcare workers respond to the coronavirus pandemic.

"The leaders out in the field, at clinics, nursing homes, and hospitals, they are working at a pace that is heroic at best. What they are doing is right now is pretty amazing," said Russell Branzell, president and CEO of the College of Healthcare Information Management Executives (CHIME).

"We’ve never experienced anything like this," Geisinger Health System CIO John Kravtiz told FierceHealthcare, noting that IT teams are working at "lightning speed" to support clinicians. "You get things done, you plan on the fly. We're providing resources to solve problems. We have a fabulous IT team here at Geisinger. I can’t believe what we’re doing."

One of the key ways that technology can help in the response to COVID-19 is to reduce exposure from person-to-person contact and to prevent hospitals from being overrun.

Geisinger has developed a chatbot to help triage and screen patients remotely and is setting up video chat capabilities for patients admitted to the hospital to connect with their families at home. The health system also is using existing tools such as e-ICU to manage patients across its campuses.

Across its service area, Geisinger also has set up 13 screening tents outside of its facilities to screen and test patients. "The screening tents are like a MASH unit, there are computers and printers out there and they are fiber-optic connected. It's amazing how fast we were able to turn those things around," Kravitz said.

Branzell, a former healthcare CIO, said IT leaders are quickly shifting from focusing on the day-to-day IT needs inside the hospitals to enabling community-wide integration, including home wireless and internet connectivity. 

"What I'm hearing across the board is that organizations are making this stuff happen in days that could have taken years," he said. 

Virtual visits and telecommute

As Pennsylvania has joined California, New York, and Illinois with putting restrictions in place to curb the spread, health systems in that state are rapidly setting up telecommute capabilities and enabling physicians to do virtual visits from their homes.

The University of Pittsburgh Medical Center (UPMC), which operates 40 hospitals, has pivoted its patient-facing telehealth services to focus on onboarding primary care physicians to address the flood of patients with potential COVID-19 symptoms.

"We're also recognizing that many of our healthcare providers may be potentially quarantined or may be COVID-19 positive and this enables them to deliver telehealth care from their homes. We have been focused on making sure they have appropriate technology at home," Robert Bart, M.D., chief medical information officer at UPMC, told FierceHealthcare.

The health system's IT network is currently supporting 30,000 concurrent connections, with about 18,000 to 20,000 of those remote users, Bart said.

UPMC's urgent care telehealth platform, AnywhereCare, has seen a six-fold increase in visits, from an average of 80 visits a day to 500 visits a day. The health system's ambulatory care telehealth platform saw visit volume in one 48-hour period equal to the telemedicine visits performed in all of 2019, according to Bart.

"On our peak day, we saw about 1,500 visits. That number is climbing and we expect it to go higher," he said.

The health system also is working to deliver telemedicine functionality to all its inpatient units and ICUs.

Bart said UPMC's IT infrastructure is robust and has the capacity to scale up to meet ongoing demand. "We're less concerned with infrastructure and hardware than the durability of the people to deliver the care," he said.

Geisinger is working to onboard 1,000 physicians for virtual care visits by providing devices, cameras and headsets to physicians at their homes, according to Kravitz.

Danville, Pennsylvania-based Geisinger Health System services over 3 million patients in 45 counties in areas of Pennsylvania and southern New Jersey.

The IT department also is working to support radiologists working from home who need significant technology resources including high internet bandwidth, high-resolution monitors, and voice-to-text capabilities to transcribe documentation and get it back into the health systems' electronic health record (EHR), Kravitz said.

The number of Geisinger staff members and physicians working from home has doubled compared to a weather-related emergency such as a snowstorm, from about 6,000 concurrent users to 13,000 users, he said.

Crisis driving innovation

As health systems respond to the pandemic, IT leaders are pushing forward innovative technology solutions. Developers are working on tools using Fast Healthcare Interoperability Resources (FHIR) APIs to share public health data, Branzell noted.

Geisinger has worked with its local health information exchange, Keystone HIE, to develop a "heat map" dashboard that pulls in data from the Department of Health and laboratories and provides real-time data on people reporting symptoms and coronavirus cases by county. Hospital emergency departments find that information valuable to better prepare for potential patients coming in, Kravitz said.

IT leaders are setting up these capabilities while also ensuring that systems are running at peak performance and maintaining strong cyber defenses. "Cybersecurity criminals will look for vulnerabilities and take advantage. The cyber-surveillance cannot stop or we run the risk of being attacked and having major problems on our hands in our crisis situation," Kravitz noted.

UPMC is taking steps to implement telemedicine capabilities on EMS ambulances. "If there is a potentially affected patient, we can bring the physician to the patient to decide whether a patient needs to come into the ED or not. That will be helpful to triage patients in near real-time and potentially allow patients to stay in isolation without the risk of exposure to other individuals," Bart said.

Branzell predicts that the technology advances occurring now won't reverse once the pandemic ends.

"With telemedicine and remote monitoring, this is the new norm and how we provide care going forward is going to fundamentally change," he said.