Electronic Health Reporter

By Dr. Chris Hobson, chief medical officer, Orion Health.

Health information exchanges (HIEs) represent a key piece of health information technology and are ideal tools to assist providers and managers in flattening the COVID-19 case count and fatality curves. HIEs were designed from the start to enable “right care to the right patient at the right place.”

Getting real-time, complete clinical information to where it’s needed, when it’s needed assists clinicians in the delivery of individual patient care. By virtue of the high-quality data held on every patient across a population, HIEs are also rapidly becoming essential tools in population health management. Real-time, high-quality data is essential for clinical and public health decision making.

The emergence of COVID-19 illustrates how high-quality individualized data can be leveraged to help a population level effort.

COVID-19 offers the challenge and opportunity to apply HIE capabilities in a flexible way to the management of a novel infectious disease where public health measures of social distancing, contact tracing, testing and isolation are so far the only real options for management.

A range of HIE functionalities and capabilities add value here. One is the ability to generate configurable notifications to providers based on new information arriving in the HIE. The first notification type tells providers when their patients have tested positive. This can be achieved easily based on the arrival of a positive test for COVID-19 into the HIE. Providers can subscribe to alerts for specific patients, or all of their patients.

Additionally, it’s important to note that patients with access to their HIE data via an API (per the new Centers for Medicare and Medicaid Services/Office of the National Coordinator for Health Information Technology rules) or a patient portal also benefit from rapid access to their test results and any other information that the organization or their provider has approved. Patient access helps conserve provider resources by reducing time spent hunting for results or calling patients to tell them their COVID-19 results are negative.

Additionally, HIE notifications play a significant role in the care coordination of COVID-19 patients across the entire patient experience. HIEs notifying providers in real time when their patients are admitted to the emergency room and/or hospital, or are discharged with a positive diagnosis for COVID-19 enables a much better understanding of the patient population.

Knowing that a patient is in the emergency room or hospital saves community providers effort in chasing those patients. Similarly, when they are discharged, notifications can convey not just the discharge, but also the exact diagnosis and likely need for future intervention by their community provider.

Another example where HIEs can share information with other providers to enable an improved response to COVID-19 is sharing with emergency medical services (EMS) personnel. If EMS personnel know while going to an emergency call that the residence is COVID-19 positive, they can take appropriate precautions while travelling to that residence, thereby avoiding wastage of personal protective equipment (PPE) which is in short supply.

Simply giving EMS dispatchers access to the HIE is all that’s necessary.

At the population cohort level, HIEs are an ideal approach to the safe remote monitoring of patients who are at home. This could be for patients who are quarantining because they have been in contact with a positive case, or for low risk patients who are COVID-19 positive and are being managed at home.

HIEs can present dashboards of relevant data on a cohort list, displaying each individual patient and highlighting their key results. This enables providers to rapidly assess a large list of patients quickly and direct their attention to those patients who are most deserving of attention.

As well as providing notifications to providers, HIEs are an excellent location for providers to access the full clinical history of the patient, placing their COVID-19 diagnosis in the context of any other issues. Now that COVID-19 is understood as having cardiovascular, renal, digestive and blood clotting issues, it is more important than ever that providers have access to complete information about their patient.

HIEs also play a role in the ongoing surveillance of their populations. As the current lockdown restrictions are slowly lifted, it’s essential that relevant organizations (public health, payers and providers with population health responsibilities) can see whether cases are developing and can rapidly move to identify, isolate and perform contact tracing with respect to any new COVID-19 cases. HIEs with complete information are the ideal first place to check for the development of new cases. New cases can be automatically routed to the Center for Disease Control and/or local public health departments as appropriate.