The Front Line: Thoughtfully Leveraging Technology in a Pandemic

The COVID-19 pandemic presents an almost unprecedented challenge for health systems. Incredible strains on critical care providers and resources have forced health systems to reimagine screenings, testing and care delivery almost on the fly. Information and technology has enabled innovations facilitating the delivery of the right care for COVID-19 patients, while protecting other sick patients and the healthcare workforce.

I had the opportunity to speak with a handful of HIMSS Davies Award recipient health systems about how they are leveraging information and technology to deliver quality care during the pandemic. These systems have proven how, even in times of crisis, the thoughtful application of health IT can sustainably improve outcomes and help realize the full health potential of their patients.

Atrium Health (Charlotte, North Carolina), Greater Baltimore Medical Center (Towson, Maryland), Mackenzie Health (Richmond Hill, Ontario), Rush University Medical Center (Chicago, Illinois), and Texas Health Resources (Dallas, Texas) shared some of their work. Consistent model practices for screening and testing, care delivery and using analytics to monitor intensive care unit (ICU) beds, testing supplies and ventilator availability emerged from the conversations.

Most of these sites indicated there were challenges to develop systems and workflows to treat COVID-19. With social distancing required to keep healthcare workers healthy, several organizations reported significant strains on their internal communications framework. Like most, improving teleconferencing capacity and tools which allowed sheltered subject matter experts to communicate and plan with caregivers on the front line was a critical factor in success. With teleconferencing, teams could gather virtually to determine how to screen and treat COVID-19 patients while minimizing risk of transmittal to healthcare workers or other hospitalized patients.

Screening and testing, care delivery and analytics are seeing innovations intended to enable the standard of care being met for COVID-19, even outside of traditional care delivery spaces.

Screening and Testing in a Pandemic

Having limited COVID-19 tests at the onset of the pandemic placed significant importance on screening patients using a variety of virtual entry points. Options for virtual screenings include filling out a version of an online survey, engaging a provider through a chatbot, using a personal app, or a low-cost face-to-face video chat with a provider.

Most of the tools consisted of a series of template questions which identify basic demographic information—used for public health analytics to track spread—exposure risk, and red-flag symptoms like fever, coughing, fatigue, a lack of appetite and shortness of breath. For most of the organizations I spoke with, a patient needed a physician order for a test in order to receive a test at the onset of the pandemic. These virtual screenings lead to the creation of a testing order if a patient met CDC criteria.

Several health systems were concerned with staffing resources to manage the increased virtual encounters. A common lesson learned was that primary care visit traffic significantly slowed, and those primary care providers were much more available to staff virtual encounters. The CMS expansion of reimbursement covering telemedicine services also aided health systems, although there is still complex series of challenges surrounding telemedicine reimbursement before a healthcare ecosystem can exist where virtual visits can replace standard primary care follow-up visits and screenings, at least in the United States.

A significant number of health systems established remote testing facilities to use during the pandemic where patients can receive a test while maintaining social distancing guidelines with healthcare workers. Templated testing workflows—called care pathways and care plans—allow trained staff ranging from nurses, certified nursing assistance and paramedics to administer the tests while clerical staff are on hand to assist with the documentation. These testing centers require the availability of tests, and computerized access to the health system’s EHR for orders and documentation. From a hardware and infrastructure perspective, having the tools, like laptops and tablets, enhanced Wi-Fi and mobile Wi-Fi hotspots, and wired capability with the appropriate privacy and security protocols in place is critical to successful launch of these centers.

Of those I interviewed, the clinical staff at the testing centers utilize a templated workflow designed not only to administer the test, but to also capture critical risk strata criteria and identify areas and other individuals who may be at risk. A variety of risk strata determine the course of treatment for patients who test positive, while patients who receive a negative test are notified, often through text message. Some systems also established closed-loop notification systems to share the testing results with the patient’s normal primary care provider and the clinician responsible for the initial testing order.

Standardizing Care Delivery with Decision Support

Once a patient receives a positive COVID-19 diagnosis, several health systems have reported the use of an algorithm to assess the patient using a series of risk strata criteria. Asymptomatic patients who are otherwise in good health are instructed to quarantine at home to minimize the risk of virus transmittal and spread. Low risk patients have access to continued follow up via virtual care. If the patient deteriorates, the patient can be hospitalized.

One organization reported that low risk COVID-19 patients get a daily survey with clinically relevant questions about how they are feeling. Responses which indicate the onset of a fever or shortness of breath trigger on-site clinical staff to follow up with a virtual visit. Higher risk patients also receive regularly scheduled virtual visits.

Higher risk COVID-19 patients require a higher standard of care. Risk criteria include COVID-19 symptoms, age, or other underlying health conditions. For moderate risk patients, home quarantine is still the preference. However, some organizations drop-ship remote monitoring devices and provide virtual instruction for utilizing those devices. Through remote monitoring, clinicians can identify worsening vital signs or the presence of a fever for higher risk patients and get them hospitalized faster.

For the highest risk patients—severe symptomatic patients, symptomatic patients with significant comorbidities, older symptomatic patients—hospitalization may be required. All patient care follows a standardized templated clinical plan based on patient risk and clinical presentation, ensuring that every sick patient receives the appropriate standard of care, regardless of the entry point into the system. Several organizations also added virtual decision-support tools which allowed providers to access information like the latest CDC guidelines and FAQs without leaving the electronic medical record.

Managing Resources with Analytics

In order to effectively manage the availability of tests and ICU beds while effectively tracking patient care and outcomes, organizations reported the development of real-time dashboards. Dashboards have been launched to monitor the amount of testing supplies available and the amount of patients utilizing each testing site. This allows the appropriate amount of tests to be available at each location without creating an unnecessary shortfall of tests. This also allows the clinical management team to adjust triage protocols to make sure that the most at-risk patients receive tests.

Dashboards also monitor the availability of ventilators and ICU beds to ensure health systems have the ability to deliver the right care at the right time to symptomatic patients during the pandemic.

Several organizations also reported using the demographic data collected through the screening process to create real-time geographic information system mapping tools for monitoring the spread of the disease. The tools show where testing has been most heavily in demand and contrast those heat maps with positive tests. This allows health systems to demonstrate COVID-19 clusters and spread. With this data, system leadership can make informed decisions involving where to establish new testing centers, conduct outreach and education, ramp up ICU resources and reallocate testing supplies.

Updated April 28, 2020.