COVID-19 is a global pandemic that has made its way into every state in America. A crisis of this scale requires a globally coordinated response, but how can we have such a response without care coordination at the local and state levels? Coronavirus has tested the resources of our health systems immensely, and the collective efforts of social distancing, the temporary closure of non-essential businesses, and other efforts to slow the spread of the virus are helping. Yet, as states move to reopen gradually, hospitals and other organizations remain fearful of increased outbreaks again.
The role of health information exchanges (HIEs) is to maintain electronic care records that follow a patient wherever they seek care, like their medical history, drug allergies, labs, encounter history, provider history, and other documents. They can help providers during COVID-19 and beyond, and state and regional HIEs must rise to the challenge when they are able and look to vendors to provide the insights to close care gaps.
A Patient’s Care Is Not in One Place
In areas where coronavirus has taken a stronghold, a patient may not have the option to be seen at their normal care venues. Some patients may receive care not in their community, as local hospitals and facilities if there is a “hot spot” of COVID-19 in a particular region. Many providers are trying to practice social distancing and risk mitigation through telehealth to keep their most vulnerable populations as safe as possible.
Health information exchange has played a vital role during COVID-19 from a care coordination standpoint to assist with contract tracing and to close the loop for the sake of public health. The Centers for Medicare & Medicaid Services (CMS) stated:
“CMS is clear that Medicare-certified hospitals with emergency departments are to provide a federally required, appropriate medical screening examination to every patient that comes to the ED, including those suspected of having COVID-19. If the examination indicates a possible COVID-19 case, hospitals should isolate the patient following the guidance established by the Centers for Disease Control (CDC) to minimize the risk of cross-contamination to other patients, visitors, and healthcare workers. Hospitals should also immediately contact state or local public health officials for direction on next steps, including cases where a patient may need to be transferred. Sending and receiving hospitals have an obligation to follow appropriate procedures for the safety of all involved.”
Many health information exchanges can support this notification and send patients’ entire medical records so that the corresponding care team is fully informed. The connectivity promotes public health communication, visibility, and maintains the continuity of care, which only furthers their cause as robust solutions.
Promoting Care Across State Lines
As testing capacity increases to include antibody testing, HIEs have proven to be an avenue for order results delivery and notifications to public health officials and their care teams. The measures can aid in the opening of our economy in a safe manner. HIEs have sent notifications on admissions and discharges for some time, and in other cases have shared records that include medications, current health problems, allergies, and recent encounters. The encounters often include discharge reports, advanced directives, and additional information to improve care coordination. Another value of HIEs during the coronavirus pandemic is their ability to facilitate data exchange between states and communities. For example, patients in New York and New Jersey have sought care across state lines due to the surge in cases and the capacity limitations of their facilities.
As the novel virus has made its way through communities, it has had disproportionate impacts on those with underlying comorbidities and those in underserved communities. Observations indicate that the patients most at risk are people 60 and above, with conditions like hypertension, diabetes, lung disease, cancers, heart disease, respiratory conditions, and immunodeficiencies. These patients require full documentation wherever they seek care.
Stepping Up in COVID-19
Many HIEs across the United States have already stepped up to respond to the needs of medical facilities during COVID-19. HIMSS Media wrote an insightful piece, titled “In Times of Crisis, HIEs are Front and Center.” The article highlights how HIEs have specific roles during the coronavirus pandemic, the roadblocks they may face, and how the added flexibilities allow them to act with fewer barriers in data exchange.
What I have gathered from this article and my own experience are that all states, regions, and vendors must leverage HIEs in:
Test result delivery and alerts. Alerts and notifications are not new features for HIEs, as many have delivered them for admissions and discharges for some time. But as testing capacity plays a critical role in the fight against COVID-19, HIEs are coordinating directly with labs, hospitals, providers, and even public health officials to deliver lab results and alerts for positive cases. The alerts create awareness of community transmission, or in the case of antibody testing, possible declines in cases that can allow providers to better prepare for appropriate interventions, contact tracing, and the like.
Care coordination across communities. HIEs have provided clinical record exchanges for years, but their expansion into communities to bring social determinants of health to light and coordinate within their infrastructure makes for a valuable resource during a pandemic. Care coordination between HIEs can also act as a bridge to share information with other states and regions when patients start to seek care across state lines.
While HIEs can provide much value and have already during COVID-19, many challenges remain. With varying levels of adoption throughout the nation, the HIEs that have risen to the challenge in providing critical functionality during the pandemic are not the standard throughout the United States. Many of these functions are heavily dependent on adoption and widespread data contribution from labs and inpatient facilities. COVID-19 has showcased the value of HIEs and the remaining gaps in the technology and data exchange ecosystem.
Alex Gorman is Lightbeam’s Associate Vice President of Business Development.