What leading AMCs can teach about using EHRs for COVID-19 response
A report published this week in the Journal of the American Medical Informatics Association examined the ways in which 15 academic medical centers leveraged their electronic health records to address the COVID-19 pandemic – and the ways in which existing initiatives have fallen short.
"EHRs contain many important data elements that can help with a pandemic response," wrote researchers in the study.
"Although EHRs have known shortcomings as the sole source of data for studies that inform public health decisions, utilization of a large number of records from many institutions could help provide mission-critical answers to clinicians, researchers, administrators, public health officials and the public in general."
WHY IT MATTERS
The report examined the experiences at 15 academic medical centers:
- Georgetown University Medical Center
- Vanderbilt University Medical Center
- Harvard Pilgrim Health Care Institute and Harvard Medical School
- University of California, San Francisco
- Oregon Health and Science University
- Indiana University School of Medicine
- University of Michigan
- Vanderbilt University Medical Center
- University of Pennsylvania
- Washington University in St. Louis
- North Carolina Department of Health and Human Services
- Weill Cornell Medicine
- University of Washington
- University of California San Diego Health
- VA San Diego Healthcare System
The goal was to summarize these leading institutions' response to uncoordinated efforts resulting in unnecessary delays in understanding, predicting, preparing for, containing and mitigating the COVID-19 pandemic.
Responding to such a crisis requires the ability to access and analyze large and timely amounts of data. Unfortunately, barriers – such as a lack of interoperability among regional hospitals – present obstacles to such information sharing.
Multiple initiatives do exist to aggregate EHRs for COVID-19, including building specific registries for coronavirus-tested individuals or activation of clinical data networks to access COVID-19 data included in EHRs.
From the perspective of the 15 institutions surveyed, EHR-based COVID-19 data collection and sharing initiatives "are currently stretching the roles of information technology and informatics teams within the health systems providing such data, which are also trying to provide care, conduct research and educate healthcare workers during the pandemic," with few resources put toward those teams.
While EHRs can provide a vital resource to describe results or treatments in real life, variance and biases mean that the data from patient records "must not be interpreted as a substitute for well-designed randomized trials."
The institutions pointed to the many initiatives requesting COVID-19 patient data, with some organizations using different common data models than others.
The research team also flagged the need to incorporate other data in addition to EHR information toward an integrated public health outlook.
"The current state of COVID-19 data reflects a patchwork of uncoordinated, temporary fixes to a historically neglected public safety function," they wrote.
The researchers issued a call to action to allow easy interoperability across institutions across EHR and public health systems, including by using as few common data models, standards and base analytics tools as possible; exploring the ways to extend and enhance existing data interchange standards and interfaces; and deploying technologies that help ethics boards evaluate and monitor patient data use.
From a policy perspective, they urged the elimination of barriers across the data ecosystem; investigation of centralized, decentralized and hybrid solutions; the creation or enhancement of coordinating bodies spanning public health departments, healthcare provider organizations and clinical service providers; and the coordination of virtual, harmonized "clearinghouses" for digital public health.
"Just as the nation has benefited from investments over the past 15 years to encourage EHR adoption and 'meaningful use,' a high level of investment is needed today to ensure we are ready for future crises," wrote the team.
"Significant improvements and capabilities in recent years in EHR adoption allow us to respond to this crisis in ways that would not have been possible a decade ago. And yet, there remain inadequacies in our collective health IT infrastructure that make responding to population-level events far more challenging than they should be," they continued.
THE LARGER TREND
Researchers pointed to the U.S. Department of Health and Human Services' efforts to collect COVID-19 patient data as an example of the kinds of reporting initiatives that rely on hospitals' data, with unclear connections among the various efforts.
Hospitals have also pointed to HHS COVID-19 requirements as leading to uncertainty and "chaos" at a time when providers want to focus on patients.
As far as interoperability is concerned, some cities are already demonstrating great strides in information sharing. But smaller hospitals, and independent ones, lag behind.
ON THE RECORD
"Developing, implementing and evaluating a practical convergence plan for EHR-based data sharing networks and platforms and public health information systems requires the orchestration of expertise from several specialties," wrote the report authors. "It requires public support that moves politicians to write legislation that allocates needed resources and holds recipients accountable.
"A careful and coordinated approach will generate consistent understanding of what is possible to be answered with EHRs and allow stakeholders to feel more confident about emerging analyses," they added. "This will also allow HPOs to focus on reducing the impact of the pandemic, rather than dealing with the multiple regulatory, logistic, and technical requests for their data."
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