Team-Based Approach Key to Boost EHR Public Health Reporting

Public health reporting challenges during COVID-19 are a direct result of EHR inefficiencies. Although health IT specialists cannot re-invent the EHR at this time, these challenges could be mitigated by forming cross-functional teams, such as combining clinical operations, informatics, data analytics, and research, according to a study published in the Journal of Biomedical Informatics. 

EHRs should be able to respond to urgent data and reporting needs, such as COVID-19. However, EHRs were primarily created for patient care and billing, which has stunted patient data exchange and public health reporting in a real-time format.

COVID-19 response efforts have included collecting and analyzing individual and community EHR data from healthcare organizations, public health departments, and socioeconomic indicators. But those resources haven’t been deployed the same way in all healthcare organizations.

“The ability to quickly ascertain a high-level view of COVID-19-related hospital data is not only important for the state and the nation’s pandemic response, it has been essential to guiding crisis planning within health systems,” the study authors wrote.  

“An ability to understand, for example, which intensive care units (ICUs) might allow for an influx of patients in the event that another ICU were to become overburdened, requires an ability to look across multiple hospitals and quickly obtain near real-time information about capacity and occupancy.”

During a public health emergency, data needs to be accurate and produced in real-time. Although it is possible to validate data in real-time, such as evaluating whether a recent death was a COVID-19 death, health systems must produce reporting for multiple facilities and manual verification is not realistic.

Researchers analyzed the COVID-19 response efforts from the California-based Sutter Health, and confronted several challenges when attempting to source data from the EHR system for daily hospital COVID-19 reporting.

Study authors noted a difficulty in reporting hospital capacity, encountering hiccups. Reproducing the actual bed count from EHR bed records or, changes in bed classifications due to the pandemic surge capacity.

Researchers also reported challenges when reporting COVID-19 confirmed patients. They found it difficult to identify COVID-positive patients who had external results and found inconsistencies in problem lists.

The research team also reported difficulty identifying COVID-19 patient deaths without utilizing discharge diagnoses.

Study authors looked at the many collaborative relationships from previously unconnected departments and individuals that went into the health system’s COVID-19 response efforts. As a result, the research team recommended a cultural shift toward team-based care that could help clinicians engage with patient data.

“As researchers, analysts, and data scientists, this means engaging more closely with clinical operations, and increasing our understanding of how EHR data are generated, not only how they are extracted,” the study authors explained. “For those in clinical operations, this means engaging with researchers, analysts, and data scientists not only as service providers, but as part of the clinical team. As our society moves to a model of larger health systems, reliability and quality in EHR data will only become more important.”

Limited health IT infrastructure and EHR system interoperability stymie health system efforts to produce and exchange accurate and timely patient data. Thus, implementing a team-based approach could patch technical inefficiencies.

“We are unlikely – at least in the short term – to re-invent the structure of our EHRs,” the study authors wrote. “We can reinvent, however, the structure of our teams. There is an important opportunity to recognize the gaps in collaboration that exist, and to respond by working to close those gaps.”

The study authors said that change could begin now and it will not only support current COVID-19 efforts, but it could provide the framework for future solutions.

“This framework can be used to work toward the goal of making future data more reliable and easier to produce – to fully unleash the power of our EHRs, and make sure that they can give us the insights we need to utilize cutting-edge methodologies to full advantage in responding to future public health crises,” concluded the study authors.