Necessity is the mother of invention. This truth may extend back to Plato's time, but today it is more relevant than ever before.
Public health crises tend to expose glaring weaknesses that have been ignored because of lack of time, money or resources. The current COVID-19 outbreak is no exception, as our health system has struggled to manage the pandemic. Triage teams have been challenged to handle large numbers of patients worried about a rapidly evolving health threat.
Whether they’re on the front lines in hospital emergency departments and urgent care centers or primary care doctors and care management teams attempting to manage an onslaught of patients seeking virtual visits, these providers deal every day with the significant shortcomings in traditional triage solutions.
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It’s clear that innovation is required to help them scale quickly and address pandemic-related demands—both now and in the future.
Historical precedents demonstrate the need for smarter, integrated solutions
The concept of rapid innovation in times of crisis is not new. Following the Ebola outbreak in 2014, a JAMA article discussed how applications based on Fast Healthcare Interoperability Resources (FHIR) could be developed for patient triage during a public health crisis.
The problem then: Very few electronic health record (EHR) solutions in commercial use had deployed FHIR application programnming interfaces (APIs) or the SMART on FHIR standard for connecting applications to EHRs at scale, and updates to EHRs one by one in response to the public health crisis was too slow to support clinical needs.
Fast forward six years. The time is ripe to apply these ideas, as FHIR and SMART have been widely adopted as common data standards that enable applications to interface with EHRs in a uniform and scalable way. This was further bolstered by the recent release of the Office of the National Coordinator for Health Information Technology’s (ONC's) final rule implementing certain provisions of the 21st Century Cures Act.
Since the current coronavirus outbreak, many COVID-19 screening tools, such as chatbots, have been rapidly developed and deployed. However, the majority of these tools were quickly deployed to assist in screening the general public, and very few are integrated within the EHR, limiting providers’ visibility into valuable data about underlying medical conditions, patient demographics, medical history and risk factors that could result in more targeted and effective screening.
While these tools are useful, without FHIR and SMART, they will not enable our healthcare providers and those on the front lines to truly address the main challenges we are facing in the COVID-19 era—making data actionable for both clinicians and public health officials and improving workflows to effectively diagnose and treat growing numbers of patients while also preventing or lessening the risk of spreading the virus.
Patient-reported outcomes assist in delivering positive impact
One promising innovation that does bridge these gaps, however, is tech-enabled patient-reported outcomes (PROs). PROs include information provided directly by the patient in his or her own words, offering physicians better insights into all aspects of the individual’s health.
Taking a FHIR-based approach, new innovations leveraging PROs have been used by health systems to deliver screening questionnaires to help identify potential COVID-19 patients—or those who may have been exposed to it. Automatic queries of the EHR enables physicians to quickly evaluate who is at risk so they can suggest follow-up care as needed. This type of solution also automates follow-ups to monitor patient status during self-isolation and home management.
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For example, so far at Desert Oasis Healthcare—a provider in Palm Springs, California—more than 7,400 patients have received a brief COVID-19 screening survey inquiring about current symptoms and recent travel or exposure along with their text message appointment reminder.
Patient responses were integrated within the EHR, then captured and analyzed by clinical teams.
Depending on their response, patients were provided with guidance on next steps:
- The majority—88%—were told they should continue best practices for prevention, including social distancing
- Those reporting COVID-19 exposure and symptoms were directed to self-isolate, and provided information about warning signs and potential complications so they would know when to seek further care, if needed
- The triage team reached out to patients who had symptoms and additional risk factors, including age and underlying medical conditions, to schedule further evaluations and testing as needed.
The program found that the initial implementation of a FHIR-enabled PRO application successfully identified patients who experienced worsening symptoms and needed additional care, as well as several who were experiencing mental health distress.
Easing the burden on providers to support better patient care
It’s clear that the surge of patients needing care or seeking answers during the current pandemic is challenging physicians, practices and hospitals. Add this to the stress of personal protective equipment shortages, significant paperwork and appointment documentation, and staff sidelined because they've contracted the virus, and you have a healthcare system on the brink of failure.
We need innovation and better integration in healthcare in order to change this narrative once and for all.
EMR-integrated PRO tools for triage are an excellent starting point in addressing core shortcomings in our healthcare system.
This served as a building block for the integration of lab results with PRO data to build COVID-19 registries that will support management of viruses in our communities in the years to come. Now is the time that our industry must innovate—and must be able to do so quickly—to meet the needs of our front-line providers.
These critical healthcare personnel need solutions that will ease their burdens, solve workflow challenges and ensure they can provide the highest level of care to their patients.
Lucienne Ide, M.D., is the founder and chief health innovator of Rimidi.