At UCSD Health, Clinician Leaders Leverage the EHR for COVID-19 Preparedness

On March 24, a team of clinicians and clinician informaticists at UCSD Health in San Diego published online in the Journal of the American Medical Informatics Association (JAMIA) an important paper on their organization’s response to the COVID-19 crisis.

As the authors noted in the article, “The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities.

Upon the release of the article, J. Jeffery Reeves, M.D., the physician lead for perioperative improvement and informatics at UCSD Health and the lead author of the article, spoke exclusively with Healthcare Innovation regarding their conclusion that the EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.

Can you share with me the origins of this broad initiative?

It all started because we realized the important role that technology and the EHR can have in managing this COVID-19 pandemic. We’re trying to automate as much as possible, trying to make everything visual, and just trying to make the day-to-day lives of our clinicians easier.

The most important piece has probably been the use of telemedicine and patient-facing technology. It’s incredibly important to remember that we still have a tremendous number of patients who have needs outside COVID-19. With hospitals becoming overwhelmed, and with the fear of going to hospitals for care, telemedicine has become more important than ever.

Now, a little more than half of our ambulatory encounters are video visits; fewer than 2 percent had been video visits before that. In the first three days, we did more video visits than in the previous two years. We had built video visits out to reach rural patients; we had the technology, but most weren’t using it. So we rapidly trained more than 2,000 clinicians in the first few days.

The second most important part of this is the COVID-19 operational dashboard. This dashboard allows visual, analytic reporting to support data-driven, evidence-based decision-making, particularly at a time when emotions can be present. So over 2,000 providers have this, and you can see the number of COVID-19-positive patients in-house and the number of patients we’ve tested; you can also see the number of ventilated patients who are COVID-19 and non-COVID-19. You can see the number of ventilators and ICU beds we have available in the organization. This is vitally important for driving decisions, and for bed management, and can help curb the ever-increasing anxiety among clinicians.

So that’s important both practically and psychologically, correct?

The psychological aspect cannot be overstated. On a day-to-day basis, we get calls from frightened clinicians. So this dashboard is important to give an accurate, up-to-date, real-time snapshot for what’s happening. What you see on CNN is not necessarily what’s happening at UCSD. This type of dashboard is usually only available to institutional leaders making decisions, but we made the decision early on that we would share this with everyone, so that everyone could see the data driving the policies.

Have there been any particular challenges so far?

Any IT technological build normally has build, testing, and roll-out phases. You sort of scope out an idea, test it for weeks or months, and educate providers; but with COVID-19, we were not able to do any of that. I think everyone in the U.S. woke up at the same time, in early March, recognizing that this was an urgent situation. Those normal processes went out the window, so our IS team worked tirelessly and nonstop to get this built quickly.

We have around 300 IS people in the institution. On this project, everyone pitched in, but we had CMIOs—inpatient and ambulatory—an analytics team, clinical informaticists, Dr. Chris Longhurst (CIO), me, and three infectious disease physicians, working with about 15 dedicated IS folks to complete the rapid build.

Was there any other fundamental challenge apart from the need for speed?

Another one was decision-making. In any project you put out there, you normally have governing boards, or some sort of operational owner. But as recommendations changed on a daily basis from the CDC and others, those decisions were tough to come by; so having everybody in the ‘incident command center’ helped. Those operational decisions happened, and then they changed, and changed again, so that was also a challenge to overcome.

In telehealth, we went from 180 annual tele-visits to 1,000 in one day, so the bandwidth need was enormous in terms of the demands on the technical team and the rapid onboarding that happened in a matter of weeks. For a week, there was 24/7 nonstop work in that area.