Workgroup creates FHIR-based clinical practice guideline for COVID-19

Providers and vendors collaborated to build a guideline aimed at helping emergency physicians determine when to admit or discharge patients.
By Kat Jercich
09:00 AM
Clinicians gather around the bed of a COVID-19 patient

 (Photo by Mario Tama/Getty Images)

A national workgroup on Tuesday unveiled a new evidence-based clinical care guideline to help emergency physicians determine when to admit or discharge COVID-19 patients and provide the appropriate level of care.

The project leaders include the American College of Emergency Physicians, the COVID-19 Healthcare Coalition Digital Guidelines Working Group, Apervita and EvidenceCare, among others.  

The workgroup's COVID-19 Severity Classification Tool uses HL7's Computable Practice Guidelines on Fast Healthcare Interoperability Resources (FHIR).   

"A global pandemic requires clinicians and informaticists working together to quickly determine what the evidence says and push guidance to the front lines quickly as that evidence emerges," said Dr. Christopher Tignanelli, an assistant professor of surgery at the University of Minnesota Medical School, in a statement.   

"We have the data, we have the technology, we have the clinical expertise," Tignanelli continued.  


Clinical practice guidelines present current medical evidence in flow charts advising clinicians on current best practices for conditions.   

Although guidelines often take years to create, stakeholders say effort on the project began in earnest in early April, when the Digital Guidelines Working Group was formed in the COVID-19 Healthcare Coalition consortium.  

"Clear and concise steps to triage COVID-19 patients enable emergency physicians to provide the best possible care during this pandemic, which is still ongoing," said ACEP Associate Executive Director of Clinical Affairs Dr. Sandy Schneider.  

"This tool will help emergency physicians determine the most appropriate care for patients quickly and safely in a rapidly changing clinical environment," Schneider added.  

According to a press statement, the guideline development method includes the same clinical rigor as traditional guidelines. It is an early example of the Learning Health system, aimed at allowing clinical experts to evaluate and update digital guidance quickly as more information about a healthcare condition emerges.   

The seven-step triage process required an agreed-upon framework for essential data from health systems, as well as a rapid review process by emergency physicians from around the country.  

The COVID-19 Severity Classification Tool is currently in use at Veterans Administration Medical Centers, among other hospitals and hospital systems. Among its key indicators of success are adoption, what percentage of patients get guideline-concordant care and effectiveness.   

In the future, collaborators hope to use a similar approach for other health issues beyond COVID-19, such as "routine problems in healthcare delivery, across both ambulatory and acute care environments (like heart failure management, aFib, diabetes care, and many more)," said Dr. Blackford Middleton, chief informatics and innovation officer at Apervita.  

"Further, the computable practice guideline on FHIR approach includes specification of appropriate quality measures, and specification for a case report, for example, to public health surveillance systems," Middleton said.  


Clinical decision support has proved to be a vital tool amidst the COVID-19 crisis, particularly as more information became available about the disease.  

And studies have shown that CDS, along with predictive models, can be even more important in times of resource scarcity at health facilities.  

"To the extent hospital resources are constrained, the ability to target resources to highest-risk individuals is likely to be valuable, and expansion and refinement of risk models may represent a useful approach to optimizing care," wrote researchers in a study published this past November.  


"If there’s one silver lining to this pandemic, it’s been our ability to come together and deploy tools to help clinicians take better care of their patients as quickly as possible,” said Dr. Brian Fengler, chief medical officer for EvidenceCare. 


Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

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