In addition to the Center for Disease Control’s National Syndromic Surveillance Program, regional and state health information exchanges are stepping up to play a part in sharing data and coordinating care in the COVID-19 crisis. The emergency highlights the importance of tracking and recording accurate data in HIEs.
Public health data infrastructure in the United States has long been underfunded, but the crisis demonstrates the value of strong regional efforts at data collection and sharing. The Indiana Health Information Exchange (IHIE) is playing a key role in the Hoosier State’s response efforts. IHIE is working to deploy a visual data dashboard for the state department of health and public health departments to track important measures on how COVID-19 is impacting Indiana.
The Indiana State Department of Health gets real-time updates of COVID-19 testing results made possible, IHIE notes, through the correct testing, coding and data processing of critical information at the time of care and through connecting labs with electronic health information exchange.
IHIE also is strengthening its Notifiable Condition Detector (NCD) tool, which sends daily alerts of reportable labs to ISDH and public health departments. Since the outbreak of COVID-19, 15 new tracking codes have been created for detecting this virus with conditions to trigger alerts; this list may grow. These reporting mechanisms make it possible to predict and monitor the spread of the virus and can prevent more harm and deaths.
The Health Collaborative (THC) is a regional nonprofit health and healthcare improvement organization based in Cincinnati that runs an HIE. Alex Vaillancourt, THC’s CIO and senior vice president of informatics, said that the organization is working with the local departments of health on determining what data THC gets in real time that can supplement their data sets. “We are having conversations around the ADT [admit, discharge and transfer] space,” he said. “If we have high-risk patients around Ohio who have upper respiratory issues, COPD, chronic conditions, we want to flag them so that when there is an ADT notification that they have landed in the ED, on in an inpatient setting, we set off bells and whistles.”
But the Health Collaborative actually is even more deeply involved in COVID-19 preparation. With a grant from the Health Resources and Services Administration, THC serves as the emergency preparedness coordinator for the region. “We are much more heavily involved than just the data side,” Vaillancourt said. “We are in Zoom meetings 16 hours per day — working on everything from helping set up remote tents to do external testing for patients so they don’t come into the ED, to coordinating from an HR perspective across the community – what does it mean for nurses if their children’s schools are closed? We are knee deep in that.”
Healthix, the large HIE in New York City, is working with the New York City and New York State Department of Health to assist in daily reporting of new COVID-19 cases. It is providing an understanding of patients’ clinical conditions, as well as helping to identify high-risk patient populations to support prevention efforts.
• Alerts for existing participant patient subscription lists when a COVID-19 lab has been ordered (LIVE)
• Alerts when COVID-19 lab results are obtained (LIVE)
• Alerts will be provided for high-risk patients (ON HOLD)
At Healthix’s request, the New York State DOH has made an exception and will allow the COVID-19 Alerts to be sent to providers without patient consent.
To supplement the reports, Healthix has prioritized the development of new alerts that detect encounters of COVID-19 infected high-risk patients (geriatric patients, history of respiratory disease, chronic hypertension and cardiovascular disease, diabetes, cancer, HIV+). These alerts will be delivered to NYC Health Authorities in the form of a daily digest.
Daily reporting to NYCDOHMH and NYSDOH provide vital clinical data about patients infected by COVID-19, such as hospital encounters that result in respiratory procedures and intensive care. Healthix is preparing a report identifying the following data types:
• Demographics
• Encounter type and location
• Lab orders and results (pertaining to COVID-19 LOINC Codes)
• Diagnoses
• Ventilation
• Discharge disposition
Other HIEs, provider organizations and vendor partners involved in encounter notification services (ENS) are helping identify high-risk patients. Quality Medical Consultant Group, a Florida hospitalist group, is working with vendor MDFlow Systems to process thousands of ENS messages from the Florida statewide HIE daily and share with South Florida care management organizations.
When an identified high-risk patient receives care at one of Florida HIE’s participating hospitals, a secured e-mail goes out to the patients’ care team (PCP, case manager, caregiver, patient family members). “This partnership with MDFlow brings about a special opportunity for us to use the technology to help with the care of elderly high-risk patients, during this difficult time,” said Ray Stein, CEO of QMC Cares, in a statement. “Having the ability for a high-risk patient’s care team to receive an alert when the patient arrives at a hospital, in real time, is definitely something which can change the way healthcare is being practiced.”
