Christopher Jason

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.


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.”

Heather Landi

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.

Christopher Jason 

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.

Sara Mageit

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.”

Christopher Jason

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 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.


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.

Jessica Kent

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

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.”

Christopher Jason

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.

Eric Johnson

In 2009, the HITECH Act prompted hospitals and medical centers across the country to move patient information from paper health records to electronic versions. Electronic health records (EHRs) introduced a wave of new possibilities—like searching for information instantly, analyzing large trends and preventing data loss.

They also created a need for rigorous standards of privacy and security.

Historically, very few groups outside of health care have had a good reason to collect information about personal health—but the coronavirus changed that.

Suddenly, organizations all over the world are incentivized to understand this virus better, and many are going so far as to do their own research. Local governments are tracing symptoms, offices are asking their employees for temperature checks and companies are checking on customers.

As a survey company, SurveyMonkey has a front-row seat to what might be the second wave of change in the way we think about health care data.

The coronavirus has prompted a flood of demand for data insights

As businesses start to reopen, everyone from retail stores to big corporate offices need to understand whether they can safely go back to their offices and how their community is impacted. They too have started asking questions.

The result is a flood of new data points coming into all kinds of organizations—from health care to government to small businesses to international corporations.

Here are some examples of the types of data that I’m talking about.

  • The Rhode Island Department of Health created an opt-in survey program for patients who have tested positive for the virus to answer questions about how they are feeling. The goal is to track symptoms and understand how the illness progresses.
  • A U.N. organization and partners in South Africa created a self-assessment survey that people without access to a COVID-19 test can take to help self-diagnose. They will use the responses to determine where the country needs to add new facilities, and maybe even new hospitals.
  • A U.S. department store with almost 900 locations is asking employees whether they’ve been diagnosed with coronavirus and what their symptoms are.

Governments, NGOs and companies across the world are doing similar research, and many workplaces will start taking the temperature of every person who enters the building. There are far more health care data points in circulation than before, both publicly and privately.

So what are the implications of this?

First, the clear line between individual protected health information (PHI) and businesses that have nothing to do with health care could get blurrier. Second, we could unlock incredible new breakthroughs.

The importance of prioritizing privacy during the coronavirus

PHI is protected under HIPAA—which means that covered entities and business associates who collect it are liable if they fail to keep the information private and secure. Even if an organization’s intentions are noble, mishandling PHI would be an incredible breach of the trust of its employees or customers.

Violating HIPAA can result in significant fines and criminal penalties and could cost businesses their customers, their employees and their good reputation.

That isn’t to say that these organizations shouldn’t be asking questions or gathering other PHI (like taking temperatures)—in many cases, that may be the responsible thing to do. It just means that teams collecting it need to be careful.

In many cases, businesses already have resources to help people stay compliant from a behavior perspective, including legal teams and security and compliance groups. So whoever is thinking about collecting information that could fall under PHI—marketers, customer support, HR, etc.—will need to consult with those internal experts before they do so and keep them in the loop at every stage.

An area to be especially conscious of is information storage. Groups that collect PHI are also responsible for saving information in a secure place—including digitally—controlling the people who have access to it, and disposing of it securely when it’s no longer needed. HIPAA compliance obligations can often extend to vendors, integrations, and partners.

The urgency of the coronavirus might tempt businesses and other groups to move fast, but it’s equally important to be careful. If organizations plan to collect PHI to protect a community’s best interest, they need to extend that concern to the processes, staff and security of that data and protecting that data appropriately.

The potential benefits of the second wave of health care data

But the flood of new information could also lead to unprecedented insights.

Health care institutions are usually extremely cautious with medical data, including in research, which means less sharing. Many medical studies are restricted to the pool of volunteers within a certain institution or program, which ensures that the data collected is comprehensive and sound, but limits the scale.

This second wave of data involves much more information, coming from all kinds of different sources. Each of these also has its own pre-existing unique data sets. If organizations across regions and industries start collecting and sharing information about coronavirus symptoms and trends, what insights could that unlock?

Some of these changes may even outlast the coronavirus. It’s reasonable to assume that some might pay closer attention to health or continue to collect health-related information in the future. If that’s the case, then organizations should be planning for long-term security policies and sustainable solutions with the interests of their community (customers, employees, partners) front and center.

The world is experiencing a flood of new health information, and there are risks, responsibilities, and opportunities that come with that.

Jessica Kent

Howard University College of Medicine is partnering with AARP to improve chronic disease management using artificial intelligence and data analytics.

Howard University College of Medicine’s 1867 Health Innovations Project and AARP Innovation Labs will leverage artificial intelligence and data analytics to boost chronic disease management in medically underserved communities.

The partnership will examine age-tech solutions to expand healthcare access for people with chronic conditions, and will focus on developing new models of care.

AARP and Howard University will conduct two clinical pilot projects to improve diabetes management and medication adherence. The first is a proactive voice-technology that uses facial recognition to remind individuals to take their medication.

The second project will launch a digital online health community that connects individuals to others with similar health challenges. The collaboration will aim to develop additional pilot projects to address health conditions such as hypertension, cardiovascular disease, genetic disorders, cancer, and neurodegenerative diseases.

AARP Innovation Labs will provide Howard University researchers with cutting-edge technologies and resources like design thinking training to improve the health of adults 50 and older.

The technology solutions will include mobile apps, sensors, virtual and augmented reality, artificial intelligence, wearables, facial and voice recognition, and data analytics. The team at Howard University will combine the technology with research and care models to assess short- and long-term effectiveness, while facilitating the adoption of disruptive technologies in chronic disease management and underserved communities.

“The partnership combines the strengths of two great organizations, while enhancing tech and innovation initiatives for the most vulnerable,” said Dr. Hugh Mighty, dean of Howard University’s College of Medicine and vice president of clinical affairs.

Researchers noted that in the current pandemic, partnerships and projects like these are especially critical. COVID-19 has disproportionately impacted older adults and underserved populations: A recent analysis from Avalere revealed that in the top 25 US counties with the highest prevalence of COVID-19, the majority of adults aged 65 and older are at high risk for severe illness if they contract the virus.

“The CDC has identified specific populations of individuals who are at higher risk for severe illness from COVID-19, including adults aged 65 and older and people of all ages with certain underlying health conditions,” Avalere researchers stated.

Additionally, a study conducted by researchers at the MIT Sloan School of Management found that COVID-19 death rates in the US are correlated with patients’ age, race, gender, and other social determinants of health data.

The results showed that African Americans and older people are more likely to die from the virus than Caucasians and people under the age of 65.

“Identifying these relationships is key to helping leaders understand both what’s causing the correlation and also how to formulate policies that address it,” said Christopher R. Knittel, the George P. Shultz Professor of Applied Economics at MIT Sloan.

“Why, for instance, are African Americans more likely to die from the virus than other races? Our study controls for patients’ income, weight, diabetic status, and whether or not they’re smokers. So, whatever is causing this correlation, it’s none of those things. We must examine other possibilities, such as systemic racism that impacts African Americans’ quality of insurance, hospitals, and healthcare, or other underlying health conditions that are not in the model.”

With the projects jointly launched by Howard University and AARP, researchers expect to help protect underserved and older populations from severe illness caused by COVID-19.

“Now more than ever, our most vulnerable communities need critical support to stay connected and educated through innovative measures,” said Nigel Smith, Director, AARP Innovation Labs.

“We’re proud to collaborate with Howard University and focus on solutions to help underserved populations better manage their chronic conditions and live healthier lives, throughout the COVID-19 pandemic and beyond.”

The partnering organizations will conduct the pilot projects through Howard University’s 1867 Health Innovations Project, which launched this past April. The project seeks to collaborate with innovators, entrepreneurs, researchers, and corporate partners to address complex health problems facing underserved communities in Washington, DC and beyond.

Through the development and use of digital health solutions, the 1867 will initially focus on virtual healthcare innovations that allow for greater medical care access and health outcomes, specifically in the areas of artificial intelligence, data analytics, voice recognition, and others.

With this new partnership, Howard University and AARP will work to expand and build healthcare solutions for vulnerable patient populations.

“It is important that all communities have access to innovative digital solutions,” said Michael Crawford, Howard University’s associate dean for strategy, outreach, and innovation. “The AARP partnership allows us to test, scale, and accelerate the use of tech solutions for 50+ medically underserved.”

David Raths

Because hospitals were ‘flying blind,’ specialist societies hurried to develop registry tools to help identify patterns in care

When the pandemic struck, clinicians struggled to cope with treating a virus nobody had ever seen before. Medical societies responded by creating or amending data registries to gather and disseminate COVID information as quickly as they could. “In the early stages of the pandemic, we were flying blind,” said Clifford Ko, M.D., director of the division of research and optimal patient care at the American College of Surgeons, which rapidly built a registry tool to share with hospitals. Ko and other society executives recently discussed lessons learned from the scramble to gather COVID data.

The ACS has a long history of developing and maintaining clinical data registries for trauma, cancer, surgical quality improvement for adult and pediatric hospitals, and bariatric surgery.

Ko, who also serves as vice chair and professor of surgery and health services at the University of California, Los Angeles, was speaking during a webinar put on by the Council of Medical Specialty Societies. He said that at the start of the pandemic there were reports of extremely poor surgical outcomes. The mortality rates were from three to five times higher in elective surgery in patients who were known to have COVID or who were not known to have COVID and showed symptoms post-operatively.

“The mortality rates were sky-high and that really scared a lot of folks around the world,” Ko said. Also, there was so much that was unknown. “We were hearing from many of our hospitals they did not know how they were doing with COVID,” he added. They didn’t know what was helpful or not in terms of treatment, and who to test and who not to test, and didn’t have outcomes data.

“We had multiple requests for help with data collection to help them see how they were doing,” Ko said. “To be honest, in the beginning the college’s thinking was that there were going to be a lot of efforts in this area, and that we should stay focused on surgery and rely on others, but hospitals were telling us they needed data now, so we very quickly did two things: We put COVID variables into our current registries and we launched a basic COVID registry for hospitals. We heard these requests in the last week of March, and by second or third week of April we launched this registry.”

The ACS COVID-19 Registry was developed with the input of several experts who are currently treating COVID-19 patients. Included data variables cover demographics, severity predictors, admission information, hospitalization information, therapies used, and discharge information. So far, the registry has data on 10,000 patients from 30 states. The hospital registrars who typically enter data into surgical registries have volunteered to enter this data.

Looking back, Ko said that there are some basic questions specialty societies need to ask about their COVID registries. Are the data good enough or enough for clinical care information and epidemiological information? Is it adequate for research investigations? Is it helping clinicians improve? Are we making gains in the fight against COVID? “I am not sure we are making huge gains, particularly if we agree that the pandemic is ongoing and worsening in many areas,” he said. “We have to ask ourselves if we could be doing something better. First we have to ask ourselves why are we collecting the data and what are the questions we are trying to answer now and what are potential questions we will need to answer in the future?”

ASCO’s COVID Registry

Elizabeth Garrett-Mayer, Ph.D., is director of the Division of Biostatistics and Research Data Governance, Center for Research and Analytics (CENTRA) at the American Society of Clinical Oncology (ASCO). She said that in order to better understand the impact on oncology practices and their patients, ASCO launched a registry of community oncology practices on April 10. “We now have 41 practices in 23 states,” she said, and 175 patients have data submitted. ASCO’s objectives are to analyze distributions of symptoms and severity of COVID-19 among people with cancer; examine the impact of COVID-19 on cancer treatment and outcomes; and document adaptations of cancer care to the pandemic.

“We are very aware that this is dynamic.” Garrett-Mayer stressed. “We recognize that the way we set this up, we would not be able to foresee things coming down the road. We formed a steering group to help us figure out how to move forward and make changes to the data collected.”

“We have tried to be transparent as possible about how we are collecting data,” Garrett-Mayer added. “We are having conversations with the National Cancer Institute and other groups on their registries for cancer patients, and we plan to release reports publicly periodically starting in September. We plan to make the entire data set available to other researchers next year.”

Society of Critical Care Medicine’s VIRUS Registry

Also speaking on the panel was Greg Martin, M.D., professor of pulmonary and critical care at Emory University School of Medicine and president-elect of the Society of Critical Care Medicine (SCCM).

SCCM’s COVID registry is called VIRUS, short for Viral Infection and Respiratory Illness Universal Study. VIRUS is a cross-sectional, observational study and registry of adult and pediatric patients who were admitted to a hospital with COVID-19 confirmed disease or high clinical suspicion. “We have 170 sites from the U.S., but also in the Middle East and Asia, and we are bringing on more sites all the time,” Martin said. There are currently approximately 15,000 patients in the registry. “We are working to facilitate more and more electronic data capture.”

Martin said the primary aims were to create a real time COVID-19 registry of current ICU and hospital care patterns to allow evaluation of safety and observational effectiveness of COVID-19 practices, and to determine practice variations across different hospitals.

Their hypothesis is that the registry will be essential for near-real time observational comparative effectiveness studies to learn effective treatment strategies and/or provide meaningful hypotheses for clinical trials.

Another goal, he said, is to develop a prototype of an EHR-based automated collection of standardized data elements for testing in two community and two academic hospitals equipped with a standard EHR. Before the pandemic struck, Martin added, SCCM had been working on creating a Critical Care Data Dictionary (C2D2), to harmonize critical data definitions for rapid deployment and data collection. The hypothesis is that EHR-based automated collection will be feasible, valid and reliable (compared to manual data entry) with lower workload of data collection. 

The speakers mentioned the challenges involved in spinning up registries during a crisis — and having to do much of the work manually — rather than having the electronic data capture tools in place between cycles of emergency. (Two of the registries use the open source REDCap survey tool developed at Vanderbilt University.) They also touched on the potential benefits (and challenges) of integrating data from different societies’ registries.

Christopher Jason

Regenstrief and Indiana University utilized Indiana’s statewide health information exchange data to automate a previously burdensome process.

For most healthcare organizations, reporting and finding all the necessary information about a new case of a reportable disease can be a burdensome process that could take up to two weeks to fully process, and sometimes it can get lost in the shuffle.

It begins with the laboratory faxing a report to the health department. Then the health department follows up with the clinic to get a more detailed report. If the detailed report does not come back right away, an administrator would have to follow up with the clinic again.

With more cases piling up over the course of a week or two, the health department could be forced to close the case and move on if they did not receive the detailed report from the clinic.

Because of this manual process, Brian Dixon, PhD, director of public health informatics at the Regenstrief Institute, and his team of experts knew they needed to automate disease tracking and surveillance in the state of Indiana.

With sexually transmitted infection (STI) cases on the rise from around 2015 through 2019, a high volume of cases came through the Indiana health department. In return, administrators spent a lot of time calling clinics to get additional information.

“Could we automate this process better?” Dixon posited. “We've done it for labs. Let's try to do it for clinics, but in a way that's going to minimize provider burden.”

Regenstrief had been in this space before, doing a lot of work to automate laboratory-based reporting from labs to the public health department for public health reporting purposes.

“Our public health partners said, ‘The laboratory stuff is working great, but we still have this problem where we're not getting a lot of information from providers.’” Dixon said in an interview with EHRIntelligence.

Because a high volume of STI cases were coming through the laboratory, lab workers noticed providers weren’t sending additional information, such as the symptoms or if the patient was treated.

“That's really where a lot of this was started,” Dixon explained. “We were in communication with the health department. They identified this as a need, particularly for STI's, where they wanted to get additional information to support their activity.”

As a non-profit support community-based organization, Regenstrief works as the connecting organization. In this instance, the organization used its connection to the Indiana Health Information Exchange (IHIE) to link to researchers at Indiana University to utilize IHIE’s data to develop the EHR-implemented clinical decision tool.

To begin the implementation process, Regenstrief utilized Documents for Doctors (Docs for Docs), which has been utilized by IHIE in the past. Docs for Docs is similar to a traditional HIE use case where documents are generated and then exchanged.

“This is the platform that the doctors use to get the laboratory results, the radiology reports, and other consults from specialists, routed back to them at the primary care office,” Dixon explained. “It’s similar to direct messaging where it’s a virtual inbox hosted by IHIE.”

Because this system was already in place, researchers used the platform to integrate IHIE’s patient data into the PDFs, which were previously done by hand and oftentimes not filled out correctly. Once data populates into the PDF, the sheet gets sent to the provider, where the provider can review and sign off on it before sending it to public health.

“We would deliver that right at the same time we were delivering the laboratory results,” Dixon said. “It kind of came to them in parallel through Docs for Docs or the EHR platform. We took advantage of these existing connections and integrations that have already been done by the health information exchange to make the implementation process pretty easy.”

Dixon noted it made life easier for the clinics, which now just had to give IHIE permission to activate the system.

“We could just drop it right into where they were receiving documents from IHIE, and away they went,” he explained. “It's similar to getting an automated reminder saying, ‘This needs to be reported the public health,’ rather than getting that phone call from public health days later.”

The clinical decision tool cannot be optimized for COVID-19 until there is a vaccine or treatment. But, once there is a vaccine, the team will aim to optimize it for COVID-19 when patients are getting outpatient treatment.

On the other hand, COVID-19 has made Regenstrief and their partners think of other technological advances throughout the pandemic.

“COVID-19 has really shifted our focus to looking at how we can apply analytics, machine learning, and advanced techniques, to identify the diseases earlier in the process,” Dixon said.

“But on the analytics front, they’re doing more community-wide dashboards for diseases of focus. The community really came around the health system during COVID-19 to work together to address this major threat to health.”

Since COVID-19 has the nation’s attention, Regenstrief and its partners plan to try to keep the same level of attention and direct it towards other major health challenges in their community. If they can spend the same energy on obesity or diabetes, for example, as they did on COVID-19, then the possibilities are endless, Dixon said.

“So that's what we're thinking about for the future,” Dixon concluded. “How we can develop these technologies that can push information out, not just to the frontline physicians, but also to the health system administrators, to the two community-based organizations and to the public itself, to keep them informed about healthcare in their community.”

Christopher Jason

SSM Health will now provide its local EMS personnel with real-time access to EHR patient data.

SSM Health, a non-profit health system made up with 11,000 providers in Wisconsin, Missouri, Oklahoma, and Illinois, announced a connection to the ESO Health Data Exchange, which enables interoperability between emergency medical services (EMS) personnel and EHR patient data.

Interoperability and patient data sharing between first responders and hospitals is not always timely. However, this connection allows SSM Health to integrate patient data into its connected EMS documentation systems.

“This technology is the future of healthcare, setting the standard for integration between the pre-hospital and hospital environments,” Kacey Kronenfeld, MD, SSM Health EMS program medical director, said in a statement.

“It will allow us to streamline the way we communicate with our EMS partners, and thus, provide a higher level of exceptional care to our patients.”

The EMS record connects directly to the SSM Health’s EHR, and in real-time, the health system’s clinical outcome data is made available to EMS personnel on a secure portal. This data includes patient demographics, billing, vitals and procedures with results, emergency room physician notes, lab results, and imaging results.

Real-time access to this data enhances care coordination in-and-out of SSM Health facilities and leads to improved patient outcomes.

Efficient and timely access is especially crucial during a health crisis, such as COVID-19, Kronefeld said. 

SSM Health is the first health system in Wisconsin to connect to ESO Health Data Exchange, and Fitch-Rona EMS is one of the first EMS agencies to attach its documentation system to the health system.

“First responders often treat patients and never learn about their outcomes,” Patrick Anderson, chief of Fitch-Rona EMS, said in a statement. “We will have access to that health information and our caregivers can receive feedback on their efforts, which will allow us to better serve our community.”

Leaders at SSM Health said they are aiming to add as much as 50 EMS agencies to the ESO Health Data Exchange collaborative.

Health organizations and health information exchanges (HIEs) across the country are aiming to improve interoperability and allow easier EHR data access to EMS workers.

Within the last year, the American Heart Association launched a collaborative initiative to improve EHR data access for EMT personnel.

To make this happen, American Heart Association partnered with an emergency health IT company, RapidSOS, to connect EMS personnel with real-time patient data.

“Heart disease and stroke are the first and fifth leading causes of death in the United States. If emergency medical responders had access to a patient’s medical information when arriving on-scene, this could dramatically change the way in which care is delivered and tailored to the person’s medical needs,” Michael Kurz, MD, chair of the American Heart Association’s Systems of Care Subcommittee, said at the time of the announcement.

“Delays in recognition and treatment of time-sensitive conditions like heart attacks, strokes and cardiac arrest can be the difference between life and death,” Kurz continued. “RapidSOS helps us close the gap between emergency medical response and patients, resulting in better and more efficient emergency care.”

AHA said they want to simplify the communication between individuals who call 911 and responders. Instead of having the individual communicate her personal and clinical information over the phone in a stressful situation, the collaboration enables public safety personnel to access critical health data, such as patient medical history, medications, allergies, and emergency contacts, for a more timely, streamlined response.

Also in 2019, California’s statewide HIE, Manifest MedEx, received a $4.9 million grant from the Emergency Medical Services Authority (EMSA) to promote interoperability with EMS personnel.

This grant connects six California EMS agencies, 13 EMS providers, and 16 hospitals across the state, to enable interoperability.

In 2017, ONC published its SAFR guide to help EMS services link bidirectional health data exchange with HIEs.

A lack of HIE connection to EMS providers is why ONC put an emphasis on a better longitudinal patient health record. This disconnect had a negative impact on patient care between the time a patient is cared for in an emergency situation and the healthcare facility.

Christopher Jason

Only 22 percent of prescribers located within a high opioid prescribing area had PDMP EHR integration that allowed efficient prescribing oversight.

Hospitals located in areas with high rates of opioid prescribing were less likely to have prescription drug monitoring programs (PDMPs) integrated into the EHR, which limits the impact of PDMPs in these vital areas of the country, according to research published in JAMA Network Open.

A PDMP that is implemented into the EHR can decrease the strenuous process of checking the PDMP, which as a result, can reduce the cognitive workload and clinician burden.

However, EHR-integrated PDMPs are not particularly widespread.

PDMPs are state-run electronic databases that create a record for the patient so that healthcare providers can access the PDMP to understand a patient’s full prescription drug history.

A PDMP aims to enhance prescribing rates, mitigate the risk of opioid abuse or fraud, and target treatment to at-risk patients.

With opioid overdose rates quadrupling between 1999 and 2015, the opioid epidemic has shown no signs of stopping. However, an easy to use PDMP could help clinicians slow down the epidemic.

While study authors noted increased awareness surrounding PDMP usability, there have been limited studies about PDMP adoption and EHR integration.

Additionally, hospitals located in counties with high opioid prescribing rates may benefit more from PDMP EHR integration, due to the providers being in contact with more people who are prescribed opioids.

Researchers evaluated the number of hospitals located in counties with high opioid prescribing rates, compared to other hospitals closer to the mean opioid prescribing rate, and the level of PDMP EHR integration at those hospitals.

Researchers analyzed data from over 3,500 hospitals that took the American Hospital Association Annual Survey and IT Supplement for 2018. Using this data, researchers wanted to answer three PDMP-related questions: the ability to e-prescribe, the ability to conduct a PDMP query within the EHR, and PDMP EHR integration.

Along with those three questions, researchers gauged hospital data, such as size, rurality, region, system membership, and teaching status to identify whether or not each hospital was located in a high opioid prescribing county based on 2017 prescribing rates.

Of the 3512 hospitals, 639 were located within a county with a high opioid prescribing rate.

However, the 2,873 hospitals in other counties were more likely to be able to e-prescribe than the hospitals located within a high opioid prescribing county. Only 57.3 percent of those high prescribing hospitals could e-prescribe, compared to 65.2 percent of other hospitals.

Only 10.8 percent of hospitals located within counties with high prescribing rates had PDMP EHR integration, compared to 15.1 percent of other hospitals.

Finally, while EHR-based PDMP queries were lower across the board, only 22.1 percent of hospitals with high prescribing rates had that capability, compared to 30.3 percent of other hospitals.

While over half of hospitals with both high and normal prescribing rates had the ability to e-prescribe, the majority of hospitals were unable to integrate PDMP data into the EHR, and thus were unable to query from within the EHR. If a PDMP is not implemented directly into the workflow, it is not unusual for a query to take up to seven minutes to process, putting a major strain on clinician workflow.

Hospitals located in counties that needed these capabilities the most, were unable to fully maximize the benefits of an EHR-integrated PDMP.

“Physicians and policy makers are actively considering new strategies to manage the opioid epidemic,” concluded the study authors.

“Focusing efforts on hospitals in areas with high rates of opioid prescribing to build PDMP integration into their EHR may be associated with improved PDMP effectiveness and reduced prescriber administrative burden.”

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.”