Clinicians are more likely to schedule a telehealth follow-up if they have immediate access to patient data.
Clinicians with access to a shared inpatient-outpatient EHR were more likely to schedule a telehealth follow-up appointment or conduct laboratory monitoring, rather than an in-person visit, according to a study published in the American Journal of Managed Care.
Additionally, enhanced interoperability and patient data exchange can boost follow-up care efficiency.
“For the growing number of patients with chronic conditions, care transitions, such as those after hospital discharge, require coordination among multiple clinicians practicing in different settings,” the researchers explained.
Seamless data exchange and interoperability are important for making that level of care coordination and follow-up care happen, but for many outpatient clinicians that’s not always the case. Outpatient clinicians do not always have real-time access to patient data from recent hospitalizations.
Researchers studied over 240,000 hospital discharges in patients with diabetes to examine the rates of outpatient follow-up visits, telemedicine, laboratory tests, and readmissions – which provide real-time access to all patient data across both types of care settings – impacted the type of follow-up care following hospital discharge.
Clinicians with a shared inpatient-outpatient EHR were significantly more likely to schedule both telehealth and outpatient laboratory tests, rather than in-person visits. Clinicians using an outpatient-only EHR scheduled follow-up care at a rate of 22.9 percent. That rate increased to 27 percent after clinicians received access to the shared inpatient-outpatient EHR. But there was little correlation between readmissions or 30-day return emergency department visits.
With researchers finding lower rates of follow-up visits and little association between hospital readmissions, researchers said these findings could shift follow-up care delivery without impacting patient care.
“Although EHR interoperability and HIE functionality have been consistently promoted as policy priorities for improving the quality and efficiency of the American health care system, there is still limited research evidence to inform policy makers about the effects of continuity in provider access to patient information,” wrote the study authors.
The researchers also said the study shows the importance of patient data access across a number of providers between facilities.
“Our findings from patients with diabetes also complement findings of previous studies in the same integrated delivery system, in patients with diabetes and in general patient populations, in which both providers and patients reported that EHR use facilitated care coordination both by providing informational continuity among providers and by supporting direct communication between clinicians and medical staff through electronic messaging tools,” explained the study authors.
While some studies showed in-person visits resulted in better patient outcomes, researchers said there was little evidence of worse outcomes in this study. Furthermore, researchers said patient data access may have decreased unnecessary or duplicate testing.
Although health information exchange is not perfected across health systems, this study shows the importance of patient data exchange.
“Our study finds that movement toward more seamless health information access, even within an already integrated system, can affect the efficiency of follow-up care after hospital discharge without adversely affecting quality,” researchers wrote.
“These shifts may also potentially improve patient convenience through telemedicine follow-up without requiring the transportation and cost of making an in-person visit to health care providers.”
While telehealth is more convenient for patients, it is also beneficial for the current need for social distancing to mitigate the spread of COVID-19.
“Overall, in a setting that implemented a shared EHR with seamless HIE between inpatient and outpatient providers, patient follow-up care after hospital discharge was less likely to include an in-person office visit and instead was managed through exchange of asynchronous secure messages, telephone telemedicine, and outpatient laboratory tests,” concluded the researchers.
Researchers say the new tools, developed using EHR data from the pandemic's first wave, can forecast short- and medium-term risks for patients over the course of their hospitalizations.
Researchers at Mount Sinai in New York see promise in new machine learning models they've developed that can assess – within key windows of time – the risk of certain adverse clinical events in some COVID-19 patients.
WHY IT MATTERS
Research published earlier this month in the Journal of Medical Internet Research describes how the algorithms are enabling better insights into potential risks for a diverse group of COVID-19 patients.
Researchers at Mount Sinai's Icahn School of Medicine and Hasso Plattner Institute for Digital Health gathered electronic health record data from more than 4,000 adult patients admitted to five Mount Sinai Health System hospitals from this spring, during the pandemic's first wave.
Clinicians from the Mount Sinai Covid Informatics Center analyzed characteristics of COVID-19 patients – looking at past medical history, comorbidities, vitals and labs – to help predict the risk of mortality, or critical events such as the need for intubation, within clinically relevant time windows.
By predicting risks for time windows of three, five, seven and 10 days from admission, Mount Sinai researchers say the models offer valuable insights to forecast short and medium-term care decisions for COVID-19 patients over the course of their hospitalizations.
For instance, they note that at the one-week mark – the time period that offered the most accurate prediction of critical events while returning the fewest false positives – conditions such acute kidney injury, fast breathing, high blood sugar and elevated lactate dehydrogenase (indicating tissue damage or disease) were the strongest drivers in predicting critical illness.
Older age, blood level imbalance, and C-reactive protein levels indicating inflammation, were the strongest drivers in predicting mortality.
THE LARGER TREND
Some experts have made the case that artificial intelligence had a somewhat disappointing showing in the early days of the pandemic's spread. And it's true that bias in certain algorithms might have an adverse effect on some healthcare disparities.
But AI and machine learning have a big role to play in diagnosis and decision support as the COVID-19 emergency reaches its newest peak. So far, an array of promising models, many pushed out to clinicians via EHR updates, have emerged to help detect the disease and assess risk on a population level.
Mount Sinai, in particular, has been innovating its research into COVID-19 over the eight months since it was inundated with patients during the pandemic's early peak. It's created an AI model to diagnose COVID-19 in patients with otherwise normal lung scans, for instance. And has also pioneered the use of Apple Watch to study COVID-19 stress and burnout among healthcare workers.
ON THE RECORD
"From the initial outburst of COVID-19 in New York City, we saw that COVID-19 presentation and disease course are heterogeneous, and we have built machine learning models using patient data to predict outcomes," said Benjamin Glicksberg, assistant professor of genetics and genomic sciences at the Icahn School of Medicine at Mount Sinai, in a statement.
"Now in the early stages of a second wave, we are much better prepared than before," he said. "We are currently assessing how these models can aid clinical practitioners in managing care of their patients in practice."
Added Dr. Girish Nadkarni, assistant professor of medicine in the nephrology department at the Icahn School: "More importantly, we have created a method that identifies important health markers that drive likelihood estimates for acute care prognosis and can be used by health institutions across the world to improve care decisions, at both the physician and hospital level, and more effectively manage patients with COVID-19."
As COVID-19 surges and supply lines become critical, health system leaders are working toward real-time visibility and predictive tools for inventory, pricing, lead times and demand trends.
With the next wave of the COVID-19 pandemic beginning to crash down in hospitals around the country, it's more important than ever for health systems to be well attuned to their supply chain needs.
One of the biggest challenges of the first wave this past spring, of course, was the shortage of personal protective equipment, ventilators and sometimes critical medications. Supply chain vulnerabilities were acute – and that's not counting the ongoing cyberattacks targeted at health system supply lines.
Some of these challenges have been ironed out over the past eight months. But as the COVID-19 crisis surges again, CIOs and other IT professionals say robust supply chains are more important than ever.
As Hal Wolf, CEO of HIMSS (parent company of Healthcare IT News) said this past week, a revolution in supply chain management is long overdue.
"We have really under-focused on supply chain," said Wolf, who noted the critical need to track the source of medications and equipment; understand the quality of materials (being able to discern, for instance, that a shipment of N95 masks is really what it says it is); and ensuring supply chains are not interrupted – all while having visibility into price, inventory control and more.
Hospital leaders around the country told Healthcare IT News that the current segmentation of systems has led to shortages right when facilities needed resources most.
Models such as CISOM, developed to improve quality and safety through the integration of supply chain and clinical data in healthcare organizations, can address such inefficiencies. But what are some ways that technology might play a role in making supply chain management a more seamless experience?
Chief information officers and other healthcare leaders who oversee the supply chains weighed in with their own experiences.
"At LifeBridge Health, we have approached the pandemic with a threefold supply strategy: Conserve; source; and, where needed, manufacture," said Tressa Springmann, CIO at LifeBridge Health in Baltimore. "Clearly, as we are now seeing cases rise again, a keen ability to pivot more quickly has surfaced, and a few additional tools would put us into an even better position both now and into the future.
"First, more complete analytics: analytics that tie [predictions of] patient volume and acuity with supply demand would be helpful," she said.
"Second, real-time artificial intelligence that makes visible the entire life cycle – end-to-end if you will – of the global supply chain. This visibility would enable a more effective response to market disruption, risk reduction and position us more effectively for enhanced business continuity."
"The healthcare industry would tremendously benefit from supply chain IT systems being much more seamlessly integrated with electronic medical records and their respective materials data sets integrated side-by-side with clinical data," said Aaron Miri, chief information officer at Dell Medical School and UT Health in Austin, Texas.
"The current state of this system's bifurcation led us down some rabbit holes during the PPE crunch, during the COVID-19 pandemic, and therefore causes data analytics teams to have to jump over hurdles that shouldn't be this difficult," said Miri.
"Further, it's holding back advancement in value-based care bundles and new VBC products that could be put to market, as looking at a patient's complete health often includes materials and respective pricing of materials used during surgery, recovery and ongoing therapy," he said.
Some health system leaders pointed to technologies such as artificial intelligence and machine learning as ways to help augment inventory control.
"We at Stanford Children's Health would like to see our supply chain tool provide real-time visibility and predictive analysis, such as available inventory, preferential pricing, lead times from different suppliers and demand trending," said Garima Srivastava, executive director of enterprise business systems.
"We would also want a system that can be scaled to incorporate new robotic process automation, artificial intelligence and radio frequency identification-based management," Srivastava added. "These are important for us to move towards the digital transformation and automate lots of manual work, which our supply chain department currently does. It will speed up some processes and will reduce manual errors."
Using RFID in particular, Srivastava pointed out, "we will be able to track high-cost items and can manage our inventory better."
"We would love to see predictive forecasting and scenario planning, powered by machine learning and AI capabilities, integrated into our demand planning and supply modeling tools," agreed B.J. Moore, CIO at Providence in Renton, Washington.
"Think about the ability to predict consumption of PPE items based on real-time COVID modeling, patient admissions, and/or case data, and not on historical consumption alone," he mused.
St. Jude Children's Research Hospital CIO Keith Perry also prioritized location awareness. He said he'd like "to have the ability to track an item throughout the supply chain, including (and most important) the 'last mile,' until it physically arrives at the final delivery destination.
"Unlocking or exposing supply-chain data as appropriate for the person who is ordering equipment" would help with efficiency at St. Jude, Perry continued. "That person is the ultimate customer of any supply-chain process."
Bill Donato, vice president of supply chain at the Hospital for Special Surgery in New York City, noted the importance of visibility.
"One of the critical tools to manage the current and future healthcare supply chain is our ability to monitor in 'real time' the status of our critical suppliers' products from their manufacturing plants through their distribution networks," he said. "Additional transparency of our suppliers' sales and operating plans would allow us to anticipate and more effectively manage disruptions to our supply chain."
Leaders pointed out that the changes implemented in response to COVID-19 would have lasting positive effects.
"The most pressing need currently which has been highlighted by the supply chain challenges presented by the pandemic is the need for an affordable, efficient and comprehensive, enterprise-wide inventory management system," said Larry Fogarty, vice president of supply chain management at Memphis-based Methodist Le Bonheur Healthcare.
"This would create coordinated visibility into the availability, stocking profiles and near-expired product monitoring for supply areas across the organization. It would also go a long way in anticipating supply chain exposures, rather than simply reacting to them – a must in the post pandemic world," Fogarty continued.
"Finally, a coordinated system-wide inventory-management system would facilitate timely, inter-facility transfers to best allocate products where and when needed," Fogarty said.
"As the COVID-19 pandemic continues to disrupt the supply chain, globally and at our five-hospital health system, I would love to see a warehouse-management-support system that could better manage, move and track inventory."
Brian Murray, assistant vice president for supply chain procurement at NorthShore University HealthSystem, said, "Business intelligence software that automatically produces executive-level reporting and can help better forecast our need for gowns, gloves, N95s, isolation masks, thermometers and other PPE would be great.
"We are currently opening an offsite warehouse for our system and need a software program that will help us respond to and support COVID-19 needs," he said.
Tanya Townsend, CIO for LCMC Health in New Orleans, said that her system is already taking steps to improve resource management.
"We are embarking on a new enterprise resource planning implementation which will include new Supply Chain functionality. I look forward to having more complete visibility to trace products and how that impacts patient care," said Townsend.
"I'm also excited about a more automated end-to-end process for managing inventory and procuring products," Townsend continued.
Similarly, Suzzanne Thomson Quintero, chief supply chain officer at Orlando Health, said the system has taken advantage of existing capabilities.
"Orlando Health is fortunate to have its own 90,000 sq. foot distribution center. This distribution hub uses a warehouse management system to forecast product needs for our 15 hospitals," Quintero explained.
"We recently enhanced the system to provide meaningful reporting to our hospital operators. In addition, we are introducing artificial intelligence into our purchasing operations to help purchase the right product, at the right price, from the right vendor," she said.
"Also, we are actively exploring robotic process automation to further streamline our operations and meet the needs of our community."
"Advanced inventory-demand planning, modeling and reporting would be a critical functionality to have in our tool kit to drive value in the supply chain, both long-term and during these unprecedented times," said Bill Moir, vice president of supply chain operations at Advocate Aurora Health in Wisconsin and Illinois.
"AAH is committed to enhancing our supply chain to ensure it is a strategic differentiator for our organization," said Moir. "Investments in our infrastructure, like enterprise resource planning, will ensure a strong standardized foundation that we can continue to build upon and innovate from for years to come."
The integration of customized EHR templates is one way EHR optimization to reduce clinician burden for allergists.
Further EHR optimization, the integration of EHR scribes, and implementation of clinical decision support (CDS) and computerized physician order entry (CPOE) systems could boost patient care and reduce clinician burden for allergists, according to an article published in Current Allergy and Asthma Reports.
The constant evolution of health IT in the allergy field has impacted allergist workflow. Like most other clinicians, allergists have seen an increase in after-hours workload doing non-clinical jobs such as EHR documentation.
Clinical EHR documentation was initially designed to record clinical information as provider notes in real-time during a consultation, assessment, or treatment, to share patient data between health providers.
While the transition from paper to EHR documentation has allowed for more accessible and legible notes, it is a primary cause of clinician burden due to information overload and larger amounts of text that is not always relevant to patient care.
“Allergists need to find ways to lower this burden in order to continue to provide exceptional evidence-based medical care while minimizing physician burnout,” wrote Annette F. Carlisle, Saul M. Greenbaum, and Mike S. Tankersley, three faculty members at University of Tennessee Health Science Center.
To enhance EHR documentation, AI voice-recognition scribes have started to replace human scribes in the workplace. The authors noted long-term cost savings, decreased training time, and constant availability as benefits of the technology.
While a well-designed EHR scribe possesses the ability to decrease clinician burnout and technology costs, it cannot replicate all benefits that a human scribe brings to a medical office.
Human scribes can adapt to the process of training, certifying, and managing medical scribes, described the authors. Also, some health systems may have different documentation styles or expectations that cannot be followed by a digital scribe.
Next, digital scribes are not capable of interacting with the provider, other members of the care team, and patients. Because the digital scribe cannot be more than a silent transcriptionist, a health system may have to hire an assistant to fulfill the other tasks of the human scribe.
While the decision of human scribe versus digital scribe is up to the provider, some providers are moving forward with digital scribes to reduce clinician burden.
Along with improving EHR documentation, the three healthcare professionals recommend the implementation of CDS and CPOE systems.
CDS tools enable prescribers to access real-time patient data, ideally resulting in enhanced patient safety, improved compliance rates, and increased medication accuracy. CDS also alerts prescribers to potential errors and adverse drug events.
According to the authors, CPOE integrated reduces medication errors by more than 55 percent. With both CPOE and CDS, medication errors decreased by 83 percent.
Another way to decrease burden is to enhance EHR usability through EHR optimization.
The authors recommended customized EHR templates that clinicians can easily utilize to view patient medical history. For an allergist, the customized interface would include a history of illnesses, such as asthma, dermatitis, rhinitis, urticarial, food, or venom reactions.
Other allergy-based templates and EHR optimizations include recording allergy skin testing, immunotherapy dose customization, integrating the asthma control test, and incorporation of extract ordering.
Additional templates also include the ability to integrate a template for e-prescribing, office visits, patient portal messaging, and other methods of communication.
Easy access to view and utilize this information would boost patient care and decrease clinician burden.
“The practicing allergist can implement various additional strategies in their office workflow to maximize and synthesize good medicine and good business,” concluded the authors. “Optimal use of office staff, electronic health records, and various workflow efficiencies has been shown to improve job satisfaction and reduce physician burnout.”
Study will assess care model that seeks to motivate primary care patients who are dependent on opioids and also have depression
Opioid use and depression frequently occur simultaneously and reinforce each other. Motivating individuals with opioid use disorder and depression to seek and continue treatments has been an unmet challenge for the healthcare system. The Indiana University School of Medicine and Regenstrief Institute faculty have been awarded $3.9 million over four years to collaborate with Kaiser Permanente Washington Health Research Institute scientists on a trial to optimize treatment for opioid use disorder.
The researchers will test whether a scalable, telehealth-delivered collaborative care model can motivate primary care patients who are dependent on opioids and also have depression to increase engagement in evidence-based treatments for pain and opioid-use disorder, while simultaneously improving depression symptoms.
The trial, MI-CARE (short for More Individualized Care: Assessment and Recovery through Engagement), is supported by the National Institute of Health’s (NIH) National Institute of Mental Health, through the Helping to End Addiction Long-term, or NIH HEAL Initiative, to address the national opioid crisis.
“A patient coming into the doctor’s office with a heart problem typically doesn’t have to be motivated to follow a treatment regimen, but for mental health issues, in part because of stigma associated with these disorders, patients often need support to become engaged and motivated to adhere to medications and other recommendations from their primary care physician,” explained Regenstrief Institute Research Scientist and IU School of Medicine Chancellor’s Professor of Medicine Kurt Kroenke, M.D., co-principal investigator for the Indiana site, in a statement. “In studies that we have conducted and in real world situations during the COVID-19 pandemic, telehealth has shown real potential in supporting patients and families. The MI-CARE trial will evaluate telehealth’s value, coupled with collaborative care, in the fight against opioid use.”
The Indiana site of the randomized, controlled MI-CARE trial will evaluate 400 individuals with opioid dependence and depression. Half will receive usual care from their primary care physicians. The other 200 will be contacted by phone by a behavioral health care nurse and offered the opportunity to receive a nurse-supported telehealth program in collaboration with their primary care team. This will typically include evidence-based medications for opioid use disorder such as buprenorphine or long-acting naltrexone along with treatment aimed at improving their depression.
Outcomes for both the treatment and usual care groups will be determined from the patients’ electronic medical records, which will include clinical, laboratory and other information.
Among its goals, the MI-CARE trial is designed to determine if the promises of telehealth and coordinated care can help primary care physicians provide the care that opioid users with depression so clearly need.
Following Nebraska’s social determinants of health data implementation, six additional states jumped on board.
Nebraska Health Information Initiative (NEHII), Nebraska’s statewide health information exchange (HIE), announced it’s expanding its behavioral health data platform, which includes social determinants of health (SDOH) data, to six additional states, including Iowa, Kansas, Minnesota, Missouri, North Dakota, and South Dakota.
The HIE will connect those rural states to the Unite Us platform. This social services network aims to connect health and social care providers to enhance care coordination and delivery across the six states.
“NEHII is thrilled to be expanding our partnership with Unite Us into six new states, to enable better support and health outcomes for all Americans,” said Jaime Bland, president and CEO of NEHII.
According to a common statistic, SDOH impacts roughly 80 percent of an individual’s health goes beyond clinical care and is impacted by SDOH.
Identifying and integrating SDOH data into the EHR can help find answers to a state or region’s most critical issues. However, most health systems face interoperability issues when implementing SDOH data into their respective EHR systems.
Through this partnership, citizens from all seven states can access nutrition services, employment and benefits, and housing. The platform is accessible to both healthcare and social services providers, and they can view healthcare data and outcomes data on the platform.
“We know patients don't seek care in a single institution, let alone a single state, especially along our borders,” continued Bland. “Statewide infrastructures for health and social care are more crucial than ever as COVID-19 continues to devastate the nation. We're eager to help additional states combine their clinical and social care data in one secure location to provide patients and providers a more comprehensive view of their longitudinal health record.”
Using one streamlined workflow, NEHII intends to address SDOH to avoid duplicative care, boost workflows, track results, and develop long-term, sustainable care models. Looking forward, NEHII said it hopes it can add additional HIEs, health systems, and Medicaid departments to the platform.
“Our ultimate goal is to help all Americans lead healthier lives, and this extended partnership with NEHII enables providers to better address whole-person needs, including nonmedical issues and social determinants of health,” said Taylor Justice, president of Unite Us.
This six-state expansion comes after HIE and network launched Unite Nebraska in June. The pair expect all networks to go live by August 2022.
A recent JAMA Network Open study offered a key example of how providers can use SDOH data integrated into the EHR for purposes beyond social services referral.
Researchers developed an SDOH screening tool, measuring common SDOH factors and deployed it with nearly 5,000 high-risk US Department of Veterans Affairs (VA) patients. The SDOH screener integrated into the EHR and researchers used it for risk analysis to predict hospitalization.
Overall, SDOH integration helped estimate hospitalization at both 90 and 180 days. Researchers directly correlated the results to the integration of resilience, marriage status, smoking status, health literacy, medication insecurity, and health-related locus control.
Following the study, researchers recommended integrating specific SDOH data into the EHR, including marital status, health-related locus control, smoking status, health literacy, resilience, and medication insecurity.
Health information exchanges across the country are boosting interoperability by connecting at the state, regional, and national levels.
Adequate and seamless health information exchange is an evergreen problem in healthcare, the adverse consequences of which are well-documented.
But according to The Office of the National Coordinator for Health Information Technology (ONC) —and nearly everyone else in healthcare—electronic health information exchange (HIE) allows providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety, and cost of patient care.
HIEs are looking at different ways to boost interoperability between more health organizations. To achieve these goals, health IT developers are broadening the digital footprint at state, regional, and national levels.
DEVELOPING A STATEWIDE HIE
It took Connecticut numerous tries to establish its HIE, Robert H. Aseltine, PhD, chair of the advisory board for CTHealthLink, said it was a no-brainer for CTHealthLink to sign on with the statewide HIE, which will take on the name CONNIE.
Statewide HIEs reduce costs and improve care by eliminating the chances of duplicative testing. These statewide networks also link several providers without establishing a connection with each facility and identify health trends.
“With the state putting so many resources and so much effort and planning into this, it would be very difficult to decline,” he explained in an interview with EHRIntelligence.
“Once the state decided this was the direction they were going in, we were very pleased they chose a mechanism that allows for partnerships. This will allow us to be extremely successful in serving community-based providers and the types of physicians who may not have access to this type of technology based on their practice arrangements.”
The HIE leans on a network-of-networks concept. It aims to bridge existing health system networks together with independent hospitals and providers to enhance interoperability within the state.
With its first partner in the fold, the HIE can add more partners and develop long-term financial plans for sustainability.
“We really are the only functioning HIE in the state of Connecticut,” Aseltine said of CTHealthLink. “There have been other efforts to bridge certain facilities and outpatient practices, but not a full-fledged HIE.”
Aseltine also noted the HIE would be working on expanding these partnerships with other national exchanges in a way that provides a powerful demonstration of the scale they can achieve together.
“This echoes how important health data exchange is for physicians across the state of Connecticut,” Layne Gakos, JD, General Counsel of Connecticut State Medical Society, said to EHRIntelligence.
“We're excited to be where we are right now and to be the first one that's up and running. It's taken a lot of work. But it's been rewarding, and we believe it's going to be rewarding moving forward as the state moves forward in developing its HIE.”
BUILDING REGIONAL RELATIONSHIPS
A common issue with interoperability is that there are too many boundaries, making it localized. Some experts contend that HIEs should ease those boundaries to boost interoperability across the state —or even across state lines— for a more regional approach.
A regional HIE is currently growing in the western part of the country. Colorado Regional Health Information Organization (CORHIO) knew it needed to grow to reach a regional population and develop significant insights on larger populations and geographies.
CORHIO tapped a neighboring HIE, Arizona’s Health Current, to achieve this goal.
The two HIEs connect roughly 1,320 healthcare organizations, and the collaboration would significantly boost interoperability between those organizations in Colorado and Arizona.
The two HIEs then needed to use common technologies and standards to create common services and products.
“The goal of all of this is to build out the infrastructure that we've been building for the last 10 years, and then take them to the next level,” said Morgan Honea, CEO of CORHIO.
The two HIEs will ultimately want a technical integration on a single data management platform to achieve these goals, where they migrate their respective technologies into a standard solution. But for right now, CORHIO and Health Current need to quickly integrate key data points to utilize as use cases.
“There are parallel paths that we can go down,” Honea said. “Some are more immediate opportunities, and some are going to be long term planning and integration strategies that we're going to have to go through. But without a doubt, one of the primary objectives of this is to create technology commonalities.”
While the two data exchanges are still in talks, they prioritize developing a model through entity structure and representative governance to encourage other HIEs to join the movement.
“That's what we're going to be paying close attention to over the next six months with our legal counsel and with the support of some of our peers,” Honea added.
“We are trying to develop a model that would be encouraging of other HIE's to join and be comfortable in a model that is fair and equitable in terms of governance, operations, and autonomy. But it focuses on leveraging economies of scale and technology commonalities. That is absolutely a top priority of this effort.”
CORHIO is aiming towards the ultimate goal of a nationwide model to further increase interoperability.
Leveraging existing health IT infrastructure is an essential component of the federal plan to achieve nationwide interoperability and successfully develop a learning health system.
The eHealth Exchange is a leading example of this plan.
More than 50 percent of the nation’s HIEs connect to the eHealth Exchange network. Additionally, 75 percent of all US hospitals, 61 regional or state HIEs, 70,000 medical groups, and over 8,000 pharmacies link to the nationwide exchange. In total, eHealth Exchange accounts for over 120 million patient records.
The eHealth Exchange was formed over a decade ago by the ONC and adopted a federated exchange approach. Policymakers opted to take an open-market and decentralized approach, rather than a required gateway, which would support further innovation.
The eHealth Exchange utilizes the InterSystems platform integrated with eHealth Exchange’s FHIR healthcare directory based on the hub model.
The hub will make it significantly easier for organizations to connect, using a “connect once” model to reach any other member in the network. This method will facilitate streamlined access to patient records at lowered costs.
The new approach will also help organizations prepare for regulatory changes, such as the interoperability rule and the Trust Exchange Framework and Common Agreement (TEFCA).
In late 2019, eHealth Exchange implemented Carequality into the health information network to support additional exchange methods and to provide a standard gateway for all participants.
Carequality helps members reduce information exchange expenses, accelerate the implementation of innovative capabilities, and further expand their national footprint.
With additional large HIEs now connected to the network, the eHealth Exchange can adopt a more centralized health information network approach by providing a common gateway for all participants.
As participants continue to transition to the gateway approach, early adopters of the new architecture expand their focus to complete implementation of the Carequality Interoperability Framework.
The Carequality framework is already in use by more than 600,000 physicians and is home to over 36 million patient records.
While HIE and interoperability problems run rampant throughout the healthcare industry, local HIEs are aiming to alleviate that burden by making strong connections at state, regional, and national levels.
Health systems are saving money after implementing CDS alerts into their respective EHR systems.
EHR-based clinical decision support (CDS) interventions have an overall positive economic impact on health systems, according to a study published in the US National Library of Medicine.
While researchers noted a lack of extensive cost components in their analysis, researchers acknowledged CDS interventions had a positive economic impact on health systems, such as reducing healthcare waste.
CDS tools enable prescribers to access real-time patient data, ideally resulting in enhanced patient safety and medication accuracy. CDS alerts can also prevent errors and additional adverse drug events from happening. Implementing CDS alerts into EHRs aims to reduce costs based on these typical health system challenges.
In a literature review of 27 studies, researchers aimed to evaluate the economic impact of CDS interventions based on EHRs. Researchers also identified and categorized CDS best practices.
Of the 27 studies, 22 studies noted a positive economic impact following CDS implementation. The implementation of CDS tools lowered costs on laboratory testing, antibiotic prescriptions, transfusion practice, and decreased duplicate order entries.
However, researchers also found previously undiscovered CDS malfunctions, order facilitators, and maintenance costs that could lead to added costs for a health system.
“While high upfront and maintenance costs of CDS systems are a worldwide implementation barrier, most studies do not consider implementation cost,” explained the study authors. “Finally, four included economic evaluation studies report mixed monetary outcome results and thus highlight the importance of further high-quality economic evaluations for these CDS systems.”
While researchers found several studies to show the economic impact, the study authors said evaluating this impact and its future value remains a significant challenge for researchers. The 22 studies reporting cost savings did not highlight how CDS solutions maintained or developed costs.
“Therefore, we could not draw a sound correlation between vendor-purchased or home-grown systems’ costs to their economic benefit,” explained the study authors. “Nonetheless, this study reveals several use cases with coherent CDS tools that have proven to be cost-saving and could be eligible for other healthcare providers, clinic managers, and researchers for implementation or further exploration.”
Researchers questioned the increasing number of CDS interventions based on point-of-care alerts, how much algorithm-based systems and numerous interventions would impact health system costs.
Health systems will have to consider the number of alerts, time expenses, and process-cost analysis to better understand the entire CDS economic impact, said researchers. Even implementing comparative metrics to assess the cost per useful alert could be a better way to look at these numbers.
“In a simple model, the authors introduce this measure to analyze how different parameters affect the cost of implementing EHR based CDS alerts for genomic precision medicine,” wrote researchers. “However, for future economic evaluations of EHR based CDS interventions, a more specific approach for individual application areas or focus on medical risk factors is needed to draw meaningful conclusions from cost and outcome comparisons.”
On the other hand, researchers said computerized physician order entry (CPOE) systems with automated lists and order sets could increase costs, thus, decreasing the value of CDS alerts.
“For example, the rate of unnecessary laboratory tests can increase when healthcare professionals tend to accept the whole order set rather than de-selecting single order items,” the study authors said. “This can be explained by alert fatigue, which must not directly be related to the order set, in combination with the ‘button clicking syndrome’, which explains the inducement of moving along inattentively.”
Extensive research is needed to come to a concrete conclusion, but researchers found CDS interventions have a positive economic impact.
“Predominantly point-of-care alerts concerning unnecessary laboratory testing, efficient transfusion practice, or reduction of antibiotic prescription emerged as application areas with already promising potential for high-cost savings,” concluded study authors.
“Nonetheless, most studies lack consideration of coherent cost components as well as comparative metrics. Therefore, the economic dimension of EHR based CDS interventions needs to be further explored.”
Gathering and integrating social determinants of health (SDOH) data are becoming more common, but the study of social informatics could help ease the integration process.
Social informatics could be the answer to some of healthcare’s social determinants of health (SDOH) data problems, according to an article published in the Journal of the American Medical Informatics Association (JAMIA).
The rise of value-based reimbursement has led the medical field to increasingly recognize the importance of meeting not only patients’ clinical needs, but also their social needs. As social services and SDOH programming crop up in practices and hospitals nationwide, providers need the SDOH data itself to determine how to best refer patients to services.
But current health IT and data processing systems aren’t quite equipped to do that. Interoperability and integration from multiple data sources hamstring efforts to understand the full scope of SDOH and create appropriate social services recommendations to patients.
The burgeoning field of social informatics may be the answer to that, as well as federal calls for better use of SDOH data, like those from the Office of the National Coordinator for Health Information Technology (ONC).
“This new domain—which we term social informatics—studies the application of information technologies to capture and apply social data in conjunction with health data to improve clinical care and advance individual and population health,” explained the study authors.
“Social informatics uses SDOH-relevant data from informatics resources, such as EHRs, claims data, and mHealth data, to inform research, enhance patient care, and facilitate rapidly growing activities at the intersection of SDOH and medical care.”
According to the study authors, who hail from the University of California, San Francisco, social informatics complements the pre-existing subfields of health informatics, such as clinical informatics, translational bioinformatics, clinical research informatics, and public health informatics.
Researchers suggested the study of social informatics could address common SDOH integration issues, which range from data sources, interoperability, methodologies, and ethics.
DATA SOURCES AND INTEROPERABILITY
Although clinicians can gather social data during patient visits, social data is also accessible through local and national government datasets and community-based organizations.
But EHRs do not make social data easily accessible and integration is a common issue. With more social data becoming increasingly available, researchers said there would be new opportunities to incorporate data into the EHR and integrate social care interventions that identify risks.
In order to meet that moment, informaticists need to be agile and keep up with changes in social circumstances, like a patient’s home address.
“Linking only to home address may also omit relevant information in the case that a patient lives and works in different neighborhoods,” explained the researchers. “Thus, there is a need for new approaches to representing geography-based measures in EHRs beyond interoperability solutions that have primarily been designed to connect patient-level data that exist in 2 places.”
Furthermore, most health systems typically face massive interoperability issues when implementing SDOH into their respective EHRs, and new interoperability platforms need further development, said the researchers.
Outside of those two challenges, social informatics can address and further expand methodologies. Incorporating social data into the EHR can enhance clinical decision making.
“As one example, structured data elements that capture patients’ transportation needs can facilitate patient-level interventions related to providing transportation assistance,” explained researchers. “These clinical decision–related applications distinguish social informatics from public health informatics, which is less focused on clinical care delivery at the individual level.”
However, EHRs don’t currently provide clinical decision support in the context of a unique patient’s SDOH.
For example, researchers could develop an EHR alert to prevent a clinician from prescribing refrigerated medications for a patient residing in a homeless shelter.
While there are clinical decision support (CDS) tools, there are no social care CDS tools.
Social informatics also will need to assure the ethical acquisition, use, and exchange of social data and guard against unintended consequences of creating, storing, and applying social data. Studying social informatics could address how long social data remains within the EHR and that the information is secure.
Overall, social informatics is a crucial subhead of health informatics. But for proper integration, it will demand new data sources, interoperability, policies, practice tools, regulations, and a commitment to security.
“We hope that communities of practice and research will help to both establish and nurture this rapidly evolving field,” wrote the study authors.
The study authors recommend social informatics expert groups could become a mainstay at the American Medical Informatics Association, the American College of Physicians, or other medical organizations. Also, the ONC could further expand social informatics research to increase its awareness.
Researchers also noted the National Library of Medicine’s (NLM’s) 10-year Strategic Plan, highlighting the importance of implementing social factors into research and developing SDOH data standards.
“To more comprehensively support social informatics, the NLM could expand their SDOH approach to other objectives—particularly those related to informatics applications and knowledge delivery infrastructure— in order to explicitly surface and address the unique needs of social and medical care integration activities,” explained researchers.
The researchers recommend NLM expand its objective of enhanced informatics research training and data science to integrate social data into EHRs.
“Creating this new subfield of informatics is necessary to drive research that informs how to approach the unique interoperability, execution, and ethical challenges involved in incorporating social information into health care,” concluded the study authors.
“Social informatics will be a new tool in the toolbox for better integrating social and medical care in ways that can improve individual and population health and health equity.”
During the pandemic, data sharing has proven to be a challenge. Here's how Healthfirst's HIE helped NYC hospitals
During the height of the COVID-19 pandemic, as normal hospital workflows were disrupted, providers often struggled to get the critical patient information they needed.
This was particularly true in New York City, which was hard-hit by the pandemic in April and May, where a data-sharing platform proved to be a valuable tool for health systems including NYU Langone Health, Mount Sinai and Northwell Health.
Insurer Healthfirst operates a private health information exchange (HIE) with data points on its 1.4 million members in NYC and Long Island.
Hospitals have leveraged that HIE to better identify care gaps and improve care for patients while in the midst of an unprecedented outbreak, according to Jay Schechtman, M.D., Healthfirst's chief clinical officer. For instance, physicians often don't have basic information such as whether patients filled their prescriptions. But that can be key to keeping patients out of the hospital.
"During COVID, if patients don’t fill their medicine they can then have an exacerbation of their condition, such as cardiac disease, which would send them to the hospital," he said.
Hospitals are able to get that pharmacy fill data and medication adherence information through Healthfirst's HIE.
MediSys Health Network operates Jamaica Hospital Medical Center and Flushing Hospital Medical Center, both located in Queens in NYC, which had been the epicenter of the pandemic.
The hospitals were inundated with critically ill patients, said Pauline Marks, executive director of TJH Medical Services, PC, the physician group of the MediSys Health Network.
"It was great comfort to know that the exchange of information was uninterrupted. Healthfirst was fully supportive and aware of the status and follow-up of our 160,000 members," Marks said.
Through the HIE, Healthfirst sends 35,000 patient care summaries, including claims and care gap data, each month to hospitals in its provider network and federally qualified health centers.
Like most providers in its network, Healthfirst works with MediSys Health Network through a value-based arrangement. That financial model and the collaboration with Healthfirst proved to be valuable from a financial perspective as well.
"Since more then 50% of our organization's revenue come from our value based arrangement with Healthfirst, we benefited from a cash flow perspective," Marks said.
In New York, state officials suspended certain administrative requirements for hospitals, such as inpatient notifications to health plans, to help hospitals shift resources to treat COVID-19 patients. That could've also caused some big problems, though.
"Without this HIE, we would have been completely blind as to what happened with our members," Schechtman said, noting that the HIE data enables the health plan to follow-up with members to ensure they stay healthy after being discharged from the hospital.
Nearly 1 million of Healthfirst’s members are covered solely by Medicaid, making this data-sharing platform even more critical.
As disadvantaged populations have been disproportionately impacted by the COVID-19 pandemic, having data on Medicaid members enabled Healthfirst to have a real-time view on how the pandemic was affecting that population.
"It allowed us to model out what was happening to our population and to look at certain ZIP codes, areas like Elmhurst and Corona, which are very ethically diverse neighborhoods that were very hard hit," he said. "We used that data to then work with New York City to push out messaging around COVID-19 testing."
Public health officials have acknowledged that the COVID-19 pandemic has exposed a lot of inefficiencies in the healthcare system—with one of the largest being data sharing and access.
Data access is critical both for patients who are navigating care for COVID-19 as well as for the army of contact tracers trying to track the spread of the virus, Centers for Medicare & Medicaid Services Administrator Seema Verma said during a virtual event in July.
For instance, the patients who were in quarantine on cruise ships during the early days of the pandemic would have been in a better position if they had access to their electronic health records and medical data, which would provide details on other medical conditions or medications they take, Verma said.
Schechtman also believes that the COVID-19 pandemic has proven the need for greater interoperability in healthcare.
"You can’t do anything unless you have the right information at the right time to the right people and it has to be actionable information. If we didn’t do the investment in this, we would be struggling right now," he said.
Researchers and government leaders in the St. Louis area will be able to access demographic information and local COVID-19 data in one workflow.
The St. Louis Regional Data Alliance has launched the St. Louis Regional Data Exchange, an online portal that bonds more than 400 regional public data sets incorporating local COVID-19 and demographic data, according to an article published in the University of Missouri – St. Louis Daily.
The University of Missouri – St. Louis (USML) Community Innovation and Action Center will store the data exchange. The university also runs the St. Louis Regional Data Alliance.
“This has been a long time in the making,” Paul Sorenson, director of the St. Louis Regional Data Alliance and interim co-director of the Community Innovation and Action Center, said to the UMSL Daily. “We’re excited to get it off the ground.”
With the database up and running, users have access to demographic data, real estate and land records, information about health and social services, tax information, boundary data, environmental information, COVID-19 data, and more.
The portal gathers the data sets from St. Louis, St. Charles, and Jefferson Counties in Missouri, along with St. Clair and Madison counties in Illinois. It also includes public data from the Metropolitan Saint Louis Transit Agency and East-West Gateway Council of Governments.
“This is a rare collaborative effort across different local governments,” Sorenson continued. “Although the exchange features data that they already share, now it’s easy to find in one place, and we’ve had great buy-in and participation from the institutions we featured on the site. They will continue to publish their own websites, but they’re happy to have their data all in one place.”
Several years ago, leaders at East-West Gateway and Saint Louis University attempted to develop a regional data exchange, called OneSTL. However, creating the data exchange did not go as planned.
“The time wasn’t right, so it didn’t quite get off the ground,” Sorenson said. “When we started the RDA two years ago and decided we wanted to create a portal, we worked very closely with the designers of the original St. Louis Regional Data Exchange to learn what happened and continue to build on it.”
Sorenson said the coalition plans to add additional data from local governments, universities, and nonprofit organizations into the portal.
The group intends to unite the St. Louis Data Commons and the St. Louis Regional Data Exchange, which would allow researchers and government leaders to access increased amounts of data and learn more about local COVID-19 data, social determinants of health, and racial equity. Sorenson said this could launch in the fall.
“It can set the stage for important conversations about what to do next,” Sorenson said. “The data portal is a big bag of data; it used to be scattered all over the floor, and you couldn’t find anything and that wasn’t great.
“Now it’s in one place, organized. But what we want to do next is connect the dots in a more meaningful way. We’re really working now on creating those regional data assets that connect property data across different counties or COVID data from different healthcare systems.”
“The Regional Data Exchange gives us a fantastic foundation to continue to build upon.”
The spread of COVID-19 has spurred the need for increased regional data.
Regenstrief Institute in Indiana and its partners developed a COVID-19 tracking and response EHR data dashboard to provide the state with a more in-depth view of the pandemic within its border.
The dashboard gathers existing patient data throughout Indiana to enhance patient care. Using this data, Indiana’s government is able to learn more about the potential hot spots and surges across the Hoosier state.
With the majority of Indiana’s health systems and laboratories connected, it allows state officials to make predictions about the spread of the coronavirus and identify patterns.
Digital innovation is becoming increasingly critical to clinical practice, not just as a workforce management tool, but as a foundation to change the way care is delivered. Healthcare IT News spoke to senior nursing informatics officer for Abu Dhabi Health Services, Hana Abu Sharib and professor in health and human services informatics at the University of Eastern Finland, Dr Kaija Saranto, to find out exactly how nurses and midwives are leading the digital transition.
Nurses and midwives have played a key role in leading the digital and informatics arena to improve patient care, particularly in the COVID environment where the quality of digital care delivery has come to the forefront of healthcare and been under more scrutiny than ever. In September, they will be speaking at the HIMSS & Health 2.0 European Digital Event, in the ‘Nurses 2.0’ session, where they will expand on some of these key issues in greater detail.
“During the pandemic, nurse informatics teams were involved in training for different EMR applications and devices for nurse shifting cross settings (ED-OPD-Inpatient) based on operational needs. They were also very actively involved in building the input forms for nursing and addressing the patient surge during the crisis. From a data perspective, they were validating the reports and dashboard,” explains Abu Sharib.
Saranto adds: “Recording has been more crucial, and a variety of mobile applications have been tested and partly implemented to control the outbreak of the virus. I assume that both nurses and midwives have worked under a heavy pressure to guarantee safety and continuity of care.”
With the recent growth of digitalisation, nurses and midwives are continuing to lead the digital transition and using informatics to improve patient care.
Saranto said: “The most important or effective key to success is education. I believe that there still is a lot of nurses who do not have proper knowledge and skills to use health information technology tools. Nursing and midwifery programmes have integrated health informatics into their curricula, but it concerns newcomers in the field and the 40 plus age groups are left behind. Thus, in-service training is badly needed.”
Nurses and midwives recognise the importance of this transition and the value of health informatics education and training, as Abu Sharib commented: "RN level and the nursing informatics speciality roles are adopted by many nurses and they are addressed for many clinical documentation requirements or technology adoption as they have advanced knowledge in that field. Nurse informatics is now classified under nursing as one of the specialities acknowledged by senior management.”
In Finland, technology is helping to bring healthcare to the homes of the ageing population, and nursing has subsequently been pushed to the forefront of this community-based care. Finland recently adopted a national information system called Kanta, which includes electronic prescriptions, a patient data repository and an online system which allows patients to view their health information.
Saranto explains: “The situation in Finland is partly easy, but also complicated when we already have 100% EHR coverage in the country. Thus, moving from electronic to electronic systems creates a lot of challenges around how to convince staff that the new system is better. So, the old way was a step-by-step or phased implementation, and now we have moved to big-bang implementations."
The importance of nurse involvement was also highlighted by Saranto, as a way to optimise cooperation between health professionals: “Whatever the model, I think nurses and midwives should be involved right from the beginning and I would like to stress the importance of cooperation between all expert groups.
“Too often nurses and midwives are invited too late to participate in projects. This often leads to misunderstanding and neglects the relation of information flow and work processes. I believe that participation in the HIT projects will also facilitate health informatics (HI) skills, as the need for education becomes real and is attached to your daily practice.”
When discussing the future of innovation and informatics, Saranto said: “Multidisciplinary education is not an innovation, but it is far too seldom used as a model for basic or advanced HI education, although we have encouraging outcomes.
“I have always found IT as a tool to support practice. I hope that those coming to the healthcare arena also have at least minimal knowledge and skills from the context.
“Often in multidisciplinary groups, concepts and terms can cause severe misunderstanding. For example, when planning interfaces. I believe that this could lead to more efficient implementations and satisfied users.”
Abu Sharib concludes: “My hopes are to build the capacity on nurse informatics designated roles in the nursing workforce, and the improvement of nursing informatics use in the innovation of nursing practice based on process enhancement and improving patient outcome.”
An increase in interoperability and access to patient data triggered an ePrescribing increase in 2019.
The introduction of ePrescribing in 2003 brought a more convenient, cheaper, and safer prescribing alternative for doctors, pharmacies, and patients.
“With electronic prescribing, or ‘e-Prescribing,’ health care providers can enter prescription information into a computer device – like a tablet, laptop, or desktop computer – and securely transmit the prescription to pharmacies using a special software program and connectivity to a transmission network,” according to The Office of the National Coordinator for Health Information Technology (ONC).
Once a pharmacy receives a request for a prescription, it can start filling the medication immediately.
Momentum began for ePrescribing when it was introduced in the Medicare Modernization Act (MMA) in 2003. It then became more prevalent, and it garnered more publicity when a July 2006 Institute of Medicine report said it reduced medical errors, which helped build further awareness of ePrescribing’s role in increasing patient safety.
According to CMS, adopting the standards to streamline ePrescribing is an essential government item to accelerate the adoption of EHRs and build a national health IT infrastructure in the US.
In short, an increase of ePrescribing aims to allow for improved workflow, increased patient safety, and more drug price transparency in the future.
In 2019, healthcare professionals saw the benefits of greater access to patient data information, according to a Surescripts 2019 National Progress Report. As a result of this access, ePrescribing rates increased between 2017 and 2019, alongside improved workflows, increased drug transparency, and increased automation.
EPRESCRIBING ADOPTION, USE TAKES OFF IN PROVIDER OFFICES
ePrescribing rates climbed from 1.49 billion in 2017, to 1.64 billion in 2018, to 1.79 billion in 2019. That brings the total rate of ePrescribing up from 66 percent of all prescriptions in 2017 to 80 percent of all drug prescriptions in 2019.
Clinicians used ePrescribing for both non-controlled and controlled substances at a higher rate in 2019 than the prior two years.
ePrescriptions for non-controlled substances are up from 76 percent in 2017 to 86 percent in 2019.
“With the COVID-19 pandemic impacting patients and providers across the globe, a trusted nationwide health information network has never been more critical,” Tom Skelton, chief executive officer of Surescripts, said in a statement.
USING EPRESCRIBING TO CURB THE OPIOID CRISIS
In response to the country’s opioid crisis, paper opioid prescribing rates have declined recently.
Opioid overdose rates have quadrupled between 1999 and 2015, meaning the opioid epidemic has shown no signs of slowing down.
What’s more, tracking appropriate opioid prescriptions — one of the primary drivers of the opioid epidemic — can be challenging.
In 2019, 13 states enacted e-prescribing requirements, meaning more than half of all states now require ePrescribing for opioids, all controlled substances, or all prescriptions. Also, more opioid prescriptions were written electronically, which helped protect patients against prescription fraud and abuse.
Since 2017, the number of ePrescriptions written for opioids increased 36 percent, from 33.2 million to 67.7 million.
Furthermore, the introduction and usage of Electronic Prescribing of Controlled Substance (EPCS) technology intended to help providers integrate opioid prescription information into EHRs, which can boost patient safety and help prevent diversion and fraud. ECPS technology can also streamline clinician workflow and reduce patient burden.
A 2019 study conducted by ONC found the number of clinicians that utilize EPCS increase 29 percentage points from 2015 to 2017 with the help of EPCS technology.
ONC found that only three percent of Medicare prescribers used EPCS in 2015, 11 percent in 2016, and then 32 percent in 2017. While the total EPCS use is still low, the increase is a step in the right direction.
Policymakers expect the use of EPCS technology to increase under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which they passed in 2018.
The bill would require clinicians to electronically prescribe Medicare Part D prescriptions of opioids and other controlled drugs by the start of 2021.
“The value of EPCS technology – streamlined prescriber workflow, improved medication safety, and reduced drug diversion and fraud – should be available to all clinicians,” ONC doctors Andrew Gettinger, MD, and Thomas A. Mason, MD, said in a statement.
“We are also intrigued by the potential for EPCS technology to make prescriber identification both assured and easier. This can permit a single workflow for prescribing both controlled and non-controlled drugs, which can improve the usability of the current process. To that end, ONC will continue to work with our federal partners and clinical stakeholders to advance the adoption of EPCS technology.”
While the use of ePrescribing is currently ascending, this form of prescribing will allow for more drug price transparency, increased patient safety, and an improved workflow for clinicians in the future.
The team will leverage artificial intelligence to develop tests that can predict a severe illness linked to COVID-19 in children.
NIH is funding a project that will use artificial intelligence to identify children at risk of Multisystem Inflammatory Syndrome in Children (MIS-C), an illness believed to be a severe complication of COVID-19.
Most children exposed to COVID-19 develop only mild symptoms. However, some go on to develop MIS-C, a severe and sometimes fatal inflammation of the organs and tissues, including the heart, lungs, kidneys, eyes, brain, and skin. The new effort will aim to encourage studies of genetic, immune, viral, environmental, and other factors that influence the severity of COVID-19 cases and the chances of developing MIS-C.
NIH will award up to $20 million to successful research proposals over four years.
“We urgently need methods to distinguish children at high risk for MIS-C from those unlikely to experience major ill effects from the virus, so that we can develop early interventions to improve their outcomes, ” said Diana W. Bianchi, MD, director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
The NICHD-led project, called Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence (PreVAIL kIds) is part of NIH’s Rapid Acceleration of Diagnostics (RADx) initiative. The RADx initiative seeks to speed innovation in the development, commercialization, and implementation of technologies for COVID-19 testing.
The effort is a national call for scientists and organizations to bring their innovative ideas for new COVID-19 testing approaches and strategies. Funded projects may also include new applications of existing technologies that make tests easier to use, easier to access, and more accurate.
“We expect that RADxUP will foster continued use of common data sets around the pandemic, and create a model about how this can be done well. The initiative can serve as a data resource that people can use for years going forward,” Lis Nielsen, PhD, director of the Division of Behavioral and Social Research at the National Institute on Aging (NIA), told HealthITAnalytics.com.
PreVAIL kIds will aim to encourage the development of cutting-edge approaches for understanding the underlying factors influencing the spectrum of conditions that may occur in children and youth infected with COVID-19. These range from no symptoms at all to fever and cough, abdominal pain and diarrhea, and inflammation of the coronary arteries. The goal of the initiative is to understand the range of symptoms of COVID-19 and factors leading to MIS-C.
Studies funded through the PreVAIL kIds will evaluate genes and other biomarkers in COVID-19 pediatric cases, as well as examine how the virus interacts with its host and how the immune system responds. Researchers will leverage artificial intelligence and machine learning to sort and categorize the data they acquire to understand the disease patterns they uncover.
The initiative will add to NIH’s many efforts to further combat and understand COVID-19 using innovative tools. The organization recently launched the Medical Imaging and Data Resource Center (MIDRC), which will use artificial intelligence and medical imaging to enhance COVID-19 detection and treatment.
The effort will be led by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), and will work to create new tools that physicians can use for personalized therapies for COVID-19 patients.
“This program is particularly exciting because it will give us new ways to rapidly turn scientific findings into practical imaging tools that benefit COVID-19 patients,” said Bruce J. Tromberg, PhD, NIBIB Director. “It unites leaders in medical imaging and artificial intelligence from academia, professional societies, industry, and government to take on this important challenge.”
The nation’s largest health information exchange has boosted its interoperability by enabling electronic case reporting.
eHealth Exchange, the nation’s largest health information exchange, launched COVID-19 electronic case reporting (eCR) in connection with the Association of Public Health Laboratories (APHL) and OCHIN to increase interoperability between providers and public health agencies.
eCR is the automated production and submission of reportable diseases and conditions from the EHR to public health agencies, according to the Center for Disease Control & Prevention. It also aims to address and reduce reporting burden.
eCR gathers data from APHL, the Council of State and Territorial Epidemiologists (CSTE), and the CDC. Each organization plays a role in facilitating eCR. Precisely, providers use eCR for reporting certain health conditions, as well as the public health agencies and vendors that enable eCR.
“The new electronic case reporting allows network participants to automatically report relevant health information to public health agencies via the eHealth Exchange,” Jay Nakashima, executive director of eHealth Exchange, said in a statement.
“We’ve been working hard with APHL to bring this to life and hope it eases the process for providers and health information networks reporting COVID-19 data and other reportable conditions to their local, state, and federal agencies.”
OCHIN, an Oregon-based nonprofit health information and innovation network that includes over 10,000 clinicians from across the country, is the first eHealth Exchange connection to utilize eCR across its network. According to OCHIN, it tapped eCR through eHealth Exchange due to the eCR requirements for communities that were severely impacted by COVID-19.
“The eHealth Exchange provided OCHIN a single API to securely channel disease notifications to local and state public health authorities all across the U.S.,” Paul Matthews, chief technology officer, and chief information security officer of OCHIN, said in a statement.
“So instead of building and maintaining these separate connections with countless public health authorities across the country, this allowed us to create efficiency in the reporting system and reduced the burden on providers in our network.”
More than 50 percent of the nation’s HIEs are connected to the eHealth Exchange network. Furthermore, 75 percent of all US hospitals, 61 regional or state HIEs, 70,000 medical groups, and over 8,000 pharmacies make up the nationwide exchange. In total, eHealth Exchange accounts for over 120 million patient records.
The eCR service will be provided to all Carequality-connected networks at no cost, to advance public health reporting, cited the organization. The HIE said the eCR platform would automatically generate and transfer COVID-19 case reports, and it will eventually have the capability to support the 50-plus diseases that APHL oversees.
“The eHealth Exchange has paved the way for seamless electronic case reporting via the Association of Public Health Laboratories AIMS platform,” John Loonsk, chief medical informatics officer of APHL, said in a statement.
“The policy and technical underpinnings of the eHealth Exchange allow healthcare organizations to provide critical clinical data to public health while practically reducing their reporting burden.”
New COVID-19 data protocols now call for situation awareness data to flow from the CDC to the US Department of Health and Human Services (HHS). However, situational awareness data differs from eCR data, which still transfers between state and local public health agencies.
While case reporting between state and local public health agencies is a requirement across the country, providers are facing a challenge with individual public health jurisdictions. The process is very localized, where counties do not want to work directly with the state. This means the CDC and the state have to be on the same page to streamline the process.