Like its peers, the UW Medicine health system has been struggling to keep up with the preparations for COVID-19 patients seeking treatment. To address this problem, the medical center’s health IT leaders made some broad changes to its processes which are allowing to rapidly deploy solutions that support clinical responses to the pandemic.
The UW Medicine system incorporates four hospitals, 15 neighborhood clinics the University of Washington School of Medicine. It handles roughly 64,000 hospital admissions and nearly 205,000 emergency department visits per year.
In February, when it began to see a growing volume of COVID-19 patients, one of its responses was to create a new governance structure allowing its IT department to tackle emerging problems quickly. The structures UW Medicine put in place include the following:
- Emergency management infrastructure
The health system established a system designed to respond to emergencies, which includes eight site-based incident command centers. Each of the incident command centers includes a clinical informatician whose key responsibilities include addressing people, EHR/clinical issues and technology.
The command centers are tied into an enterprise-wide Hospital Incident Command System which helps with shared planning, logistics and operational issues. The system’s Business Continuity and Disaster Recovery program manages IT integration into the Command System.
- Changes in IT procedures
To see that the IT team was prepared to respond to changes as needed, HIT and administrative leaders restructured the change control process to address the current crisis, making it possible to turn around time-sensitive changes within hours rather than weeks. For example, COVID-19 related changes to the EHR were assigned as emergency change requests. Early EHR change changes included creating an order set for home visits and updating alerts.
- Creation of a new dashboard
To coordinate the COVID-19 response, HIT leaders created a real-time dashboard providing updates on the key metrics those in the field needed to track. The metrics they targeted included the number of tests by result and facility per day, laboratory turnaround time, current admitted patient counts, counts of personal protective equipment on hand by facility, COVID-19 related telehealth visits per day, number and percentage of COVID-19 positive patients in ICU settings.
- Clinical decision support
IT created a COVID-19 order set offering direct access to useful hyperlinks, laboratory orders, appropriate ICD-10 diagnoses, billing codes and discharge instructions. Also, the COVID-19 documentation template includes a checklist of symptoms and risk factors and the latest testing recommendations, standards that also address telemedicine and telephone visits, as well as the reason for the visit.
- Telehealth clinic visits
To preserve PPE and limit exposure to potentially infectious patients, the health system created a process allowing them to screen patients offsite or remotely while isolating a patient in a room with telemedicine capabilities. Meanwhile, the health system trained roughly 500- providers to offer COVID-19 telemedicine services. IT leaders helped by acquiring equipment, managing software licenses, supporting remote access and integrating teleconferencing into the ambulatory EHR.
While UW Medicine accomplished a great deal quickly in tackling COVID-19, health leaders there noted that there were things that in hindsight, they would have done differently. They note that if they had to do this again, they would have prioritized full integration of video conferencing into the ambulatory EHR, done more to emphasize expanding its telemedicine capabilities, and would have had more equipment available to support both telemedicine and teleworking.
That being said, UW Medicine seems to have pulled off an impressively coordinated, prompt and targeted approach to dealing with the demands imposed by the pandemic. By supporting teamwork and identifying what needed to happen quickly, the health system was able to get its arms around the COVID-19 challenge in relatively short order.
(Want more ideas on how to manage the COVID surge? Check out our recent piece laying out Stanford’s efforts to tackle the problem using machine learning.)