Why COVID-19 is a Breakout Moment for HIEs

The following is a guest article by Daniel Cidon, Chief Technology Officer, NextGate.

The COVID-19 crisis has exposed a painful number of deficiencies in our nation’s healthcare system, including just how severe the lack of an interconnected health infrastructure has hampered response efforts. As the need for collaboration and access to quality data for tracking and reporting cases intensifies, many organizations remain stifled by applications and systems that fail to transmit information effectively.

However, amid the turbulence and enormous obstacles brought on by this pandemic, health information exchanges (HIEs) have risen to the challenge as vital contributors—sharing and aggregating essential information. As hospitals, health systems and public health agencies look to overcome the sticky data challenges of COVID-19, state and regional HIEs are stepping up in five crucial areas to support emergency preparedness and response efforts.

Complete view of patient data

Whenever clinical staff treat a patient, they need to know as much about a patient as possible – pre-existing conditions, medications, allergies, recent hospitalizations, and so on. This enables them to make the most informed care decision possible.

During an emergency situation, this need for information is only heightened. Some patients may need to be treated at a hospital they have never been to – or at a pop-up triage clinic that was quickly built to handle a surge in patients. Others may be unable to communicate their medical history. Under this stress, providers simply don’t have time to pick up the phone and ask other facilities to send information by fax, email, and other outdated and insecure media.

Data interoperability is critical in disaster response because it provides clinical staff with a complete view of aggregated and standardized patient data. It’s not just electronic health record (EHR) data from multiple hospitals in a region, either. It also includes lab results, prescription data, and claims records. Lack of comprehensive medical data can greatly impair a provider’s ability to know how many people have the virus, the geographical location of confirmed cases, and the effectiveness of treatment.

Epidemiologists are already feeling the impact of data collection shortfalls, according to the Council of State and Territorial Epidemiologists (CSTE), 40 percent of patient demographic data has been missing from commercial laboratory test feeds for COVID-19. Lack of demographic elements such as phone numbers, addresses, and other critical contact information results in significant delays when trying to notify patients of their status and trace contacts to contain the spread of the disease.

A unifying identifier employed by HIEs safeguards patient data quality and automates demographic data matching to compare records in real-time between disparate clinical and financial data sources, ensuring that the right data is attached to the right patient. This empowers clinical staff to make informed, data-driven – and potentially life-saving – decisions at the point of care.

Care coordination

Disasters require an “all hands on deck” response. Clinical staff in the emergency department (ED) and intensive care unit (ICU) often serve as the front line of care delivery, but first responders, laboratories, acute care, and post-acute care also play a key role in supporting patient care. These providers typically use different clinical information systems to gather patient data – even if they are based in the same hospital.

HIEs gives disparate providers access to a single version of the truth that’s updated as clinical staff enter new information. Consider the example of an alert from an admission, discharge, and transfer (ADT) system that a patient needs to be transferred to the ICU. The ICU team knows that it needs to get a room ready, while the other members of the care team know that a patient’s status has changed. In response to the COVID-19 pandemic, many state HIEs create similar alerts for lab results so care teams would find out right away if a patient tested positive for COVID-19.

In addition to sharing data on individual patients, HIEs can support care coordination by aggregating and transmitting operational data. Sharing data about personal protective equipment (PPE) supplies, ventilator availability, or ICU and ED capacity at a community level enables hospital leaders and public health officials to develop a more coordinated response to triage, staffing, and testing.

Regularly updated data dashboards

To develop a disaster response plan, health systems need information quickly. However, much of what they need to know comes from external sources – neighboring hospitals, local health departments, state agencies, and so on. Collecting and interpreting that data, and preparing reports for internal use, requires time and resources that are in short supply when organizations are treating a surge of patients.

HIEs can aggregate this data into dashboards on behalf of their members. For example, as COVID-19 spread, health systems requested a few key data points from their HIE partners: The number of patients who had been tested across the state; the number of positive and negative test results; the age, gender, race, and ZIP code of the positive cases; and the trending data about where the number of cases was increasing and subsiding. Other data points, such as ICU/ED bed and ventilator availability, also proved valuable.

Creating data dashboards and updating them regularly allows state HIEs to provide members with a single version of the truth – one report for many health systems. This reduces the reporting burden, allowing providers to focus on patient care.

Transitions of care

During disaster response, patients receive care at numerous sites. They may first seek treatment at a temporary triage or testing location, from an urgent care clinic, or through a telehealth provider. As their care needs change, patients may need to be quickly transferred to the ED, ICU, or trauma center. Or, in order to reduce the risk of getting others sick, they may be sent home with remote monitoring equipment and placed under quarantine.

Patient matching, location data, and real-time alerts – all available from an HIE – let hospitals better track individual patients as they more through the care delivery system. Amid a surge of patients, it’s critical for clinical staff to have the most up-to-date information about where a patient has been treated, how their symptoms have been progressing, and whether they have been tested.

Beyond tracking transitions for individual patients, health systems can use data streams from their HIE to analyze trends such as which hospitals have ICU beds available or which ZIP codes have the most patients who have been discharged home. This saves time for organizations who no longer need to make phone calls to decide where to transfer a patient. It also allows hospitals throughout a community to provide a more coordinated response, as everyone has access to the same information about facility capacity, test availability, and ADT trends.

Prescription drug monitoring

A patient’s clinical record is not complete without prescription data. State prescription drug monitoring programs (PDMPs) make this data available, but it is not readily available through the EHR, which disrupts clinical workflows and hinders utilization. Patient matching supports prescription monitoring for health systems as well as pharmacists, as they are able to complement their data with the records available within an HIE.

A comprehensive picture of a patient’s prescription history can be particularly valuable during disaster response. If an infectious disease is spreading, clinical staff benefit from knowing which medications a patient has started, stopped, or is currently taking; this helps avoid triggering a harmful interaction or restarting a treatment that has not worked. In the event of an accident or other trauma, the care team can see if a patient may be at risk for prescription drug abuse and consider different treatment options.

Daniel Cidon is CTO of NextGate, the global leader in healthcare enterprise identification.