In this unprecedented time, the EMR has great potential to support patients and clinicians in the fight against COVID-19. Here I outline some of the key considerations for your EMR and your IT team and processes. In this post, I have mainly concentrated on clinical considerations. Billing and coding are topics for another day.
Preparing for Surge Needs
In my home of New York and other areas around the country, the patient surge is already well underway. In other areas like Illinois, Michigan, and Connecticut, it looks like the surge is on the horizon. As hospitals ramp up in preparation, the EMR and downstream systems will need to keep pace, with new beds and units built out virtually to reflect the real-world expansion. In many respects, this will echo what you may have done in the past as new units or clinics open – only on a vastly accelerated build and testing timeline.
Supporting New Users
Many hospitals are also rapidly expanding their clinician base to prepare for the surge in-patient population and for outages due to illness. As those new care providers come on board, they will need to be credentialed in your clinical systems, instructed on system access, and trained and supported as they become accustomed to your EMR. This a perfect time for computer-based training and Optimum has already had great success in providing virtual training and at-the-elbow support.
If your hospital is anticipating a surge, consider the impact of decision support tools and hard stops when the hospital is functioning at over 100% capacity. With your clinical leadership, consider streamlined profiles with reduced pop-ups and minimized hard stops for the duration of the crisis. Most EMRs can provide standard reports showing you the impact of individual CDS interventions. Now is an excellent time to revisit, with a critical eye for what truly is and isn’t valuable when every second is needed to meet surge demand.
Monitoring and Dashboards
Epic and Cerner have released recommended reports and dashboards, and both continue to provide guidance. Those reports are a good starting point and will help your organization focus on key COVID-19 metrics such as testing rates, infection status by hospital department and by patient demographics, and discharge rates. Those standard reports will need to be updated to ensure they match your workflows and data model. Your EMR also provides valuable risk scoring tools, such as Epic’s acuity scoring system. Use these tools not just to monitor patient status, but also to proactively plan for likely impact on the ventilator and other resource capacities.
Standing up Your Incident Response Center
Just as in a go-live, you’re launching new build and functionality, and there are going to be inevitable hiccups. Also, COVID-19 research and understanding are progressing at a rapid pace, and your EMR needs to evolve to keep pace. Having regular, shift change check-ins with your key stakeholders will ensure your IT team can understand the needs and rapidly update protocols, decision support tools, and reports to give your clinicians the support they need. Unlike a go-live or most incidents, the COVID-19 crisis won’t be complete in a couple of weeks. Plan for how to continue to provide 24/7 IT support in the coming months, while balancing out the risk of staff burnout.
Also, consider the impact on your standard IT change management process. If you have been live on your EMR for a while, you likely have relatively rigid standards on what can get moved and when and a thorough vetting process. With the pace that is needed now, make sure you revisit that process to ensure your team has the flexibility and speed they need to address the current crisis while ensuring efficient quality control.
Expanding Functionality for Care Outside of the Hospital
A couple of weeks ago, I wrote about how to approach rapidly deploying telehealth solutions. Other EMR considerations will include updating patient forms through your patient portal to enable at-home screening and support for asynchronous (i.e., secure message-based) provider communication.