Clinical Informatics (CI) Checklist for COVID-19 · system resources. Provide links to educational reference material regarding COVID-19 including health ... Doors Open (LODO)”

Clinical Informatics (CI) Checklist for COVID-19

Bridging the Gap Clinical informatics (CI) programs have always been important to driving technology-enabled clinical transformation but are even more so during the current COVID-19 pandemic. Solutions to the present crisis rely heavily on technology as an enabler to support onsite and offsite diligent care of providers and other caregivers. Just as a physical bridge carries people and resources from one side of a river to the other, CI professionals bridge the gaps between caregivers and information systems (IS). Informaticists operate from the unique perspective of experienced clinicians keeping the customer (patient and caregiver) top of mind while understanding the capabilities of the tools on which they must depend. The checklist on the following pages identifies many of the currently known COVID-19 health system needs which CI teams can help manage. It is organized based on the dimensions of standard work exemplified by best-in-class CI teams and further identified by the timing of those activities into pre-surge, surge and post-surge. While this document is specific to CI, Chartis also published a broader COVID-19 IS checklist. For a copy, click here.

SURGE

Rounding

Workflow Enhancements

Technology Innovation

POST-SURGE

Rounding



PRE-SURGE

Rounding



ABOUT THE AUTHORS

SUMMARY

SOURCES

https://www.chartis.com/resources/files/Chartis-COVID-19-IS-Checklist.pdf

© 2020 The Chartis Group, LLC. April 2020 Page 2 All Rights Reserved.

Rounding Ongoing Training

Provide caregivers navigational support to find new COVID-19-associated reports, orders, order sets, pathways, assessments and other documentation tools.

Broadly communicate essential updates (in person when possible or virtually) and ensure appropriate execution of documentation changes.

Demonstrate quick tips for new workflow documentation.

Convey approved abbreviated documentation requirements to all caregivers.

Embed meaningful “Message of the Day” or other log-on alerts based on position (e.g., ED clinician, ICU nurse, ambulatory APP, pre-op holding area, etc.), as needed.

Provide virtual at-the-elbow support for those caregivers that may need it (e.g., working at temporary care sites).

Support transition to online training for new caregivers or those taking on new roles.

Personalization

Determine caregiver optimal screen flow for documenting key elements of COVID-19 history, physical exam and daily/shift progress.

Create COVID-19-specific shortcuts by caregiver position and venue of care.

Leverage the capabilities of super users and champions to convey daily COVID-19 clinical care updates to unit and clinic staff.

PRE-SURGE


Workflow Enhancements Order Sets and Documentation

Create COVID-19-specific care pathways and order sets.

Identify quick-order COVID-19 screening panel to lessen burden for busy clinicians.

Establish simplified, online tool for requesting and replenishing PPE.

Create a unique standardized pick list for quick documentation of COVID-19-related signs and symptoms.

Develop workflows for documentation, orders, results and billing for new temporary care sites (e.g., testing tents, college dorm rooms, hotels, sporting and other civic function arenas, children’s hospitals enabled for adult care, etc.).

Clinical Decision Support (CDS) Alerts

Evaluate new alerts based on a combination of predictive worsening characteristics.

Add a prompt for diagnosis to be completed for medication orders which are identified as high potential for misuse during crisis (e.g., certain anti-malarials, anti-virals or antibiotics).

Incorporate into pharmacy workflow for an appropriate authorized resource to page the on-call caregiver based on CDS for novel off-label drug use order.

Develop talking points for COVID-19 positive test results to help guide dialogue with patients and identify the appropriate location to display the talking points within the EHR.

PRE-SURGE


Patient Portal

Create up-to-date messaging for service availability, testing and closures.

Set up ability for scheduling routine telehealth visits.

Identify location-specific COVID-19 testing and care sites (if available).

Ensure appropriate patient history (e.g., medications, allergies, problems, etc.) is entered online in pre-visit questionnaires to facilitate COVID-19 and non-COVID-19 telehealth patient and provider interaction.

Evaluate timing of release of new lab information and data sharing (e.g., immediate release, provider released or embargo period).

Push updated patient education materials and information including video learning.

Develop patient education related to COVID-19.

Identify chatbot capabilities for facilitating triage to appropriate health resource, if applicable.

Technology Innovation Telehealth

Prioritize disciplines by appropriateness of telehealth visits, highest impact for patient care and provider readiness to participate in telehealth visits.

Create tip sheet and detailed instructions for all providers and non-provider caregivers (e.g., physical therapists, occupational therapists and medical social workers) with virtual training for how to use telehealth.

Evaluate documentation and coding requirements for telehealth visits with HIM and revenue cycle.

Educate providers to ensure they select the appropriate site of care for virtual care visits.

PRE-SURGE


Remote Caregiver Workforce

Roll out smartphone and tablet versions of EHR to providers as broadly as possible.

Educate with quick tips related to smartphone and tablet access in addition to secure login from home/remote PCs.

Evaluate and revise ambulatory clinic rooming flow notification of telehealth patients if patient is seeing more than one provider during a scheduled visit (e.g., bariatric surgery patient being seen by psychologist, surgeon then dietician).

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PRE-SURGE



Develop plan for off-loading certain tasks from frontline caregivers (e.g., shift all discharge planning/instructions to social workers to decrease burden on clinical staff).

Determine appropriate in-person or virtual rounding support model.

Evaluate rotating CI resources with most informaticists rounding virtually and at least one on-site.

Create multi-modal communication with video for tip sheet ease of use.

Deploy rapid training for non-acute and/or non-adult caregiver overflow staff for temporary sites of care (e.g., children’s hospitals, rehabilitation facilities and others) on minimal data set for documentation and adult order dosing.

Provide rapid new hire training for voluntary retired providers and other caregivers not formerly part of the health system, as needed.

Personalization

Facilitate daily CI team huddle to share personalization and education tips and tricks identified by rounders.

Make available and teach providers quick tools for ethics and palliative care consultation.

Create and suggest shortcut prompts for more extensive wording for COVID-19 for history, physical exam and treatment options to ease documentation burdens.

SURGE



Establish quick orders and documentation for drive-through testing sites.

Determine documentation flow for virtual visits to EHR (if from third-party provider or outside of native system).

Create heads up SOFA (Sequential Organ Failure Assessment) score in ICU and ED dashboards to assist in potential resource triage.

Implement early detection of patient deterioration tools for patients requiring a higher level of care.

Communicate assurance of appropriate lab labeling of specimens for COVID-19 and PUI (patients under investigation) individuals.

Communicate talking points to assist conversations with patients and families regarding positive COVID-19 test results.

Develop COVID-19-specific discharge instructions and communicate broadly to nursing staff, social work, care management and providers.

Assist in establishing room change definitions as needs arise for redesigning med-surg floors into ersatz critical care units.

Clinical Decision Support (CDS) Alerts

Identify COVID-19 positive cases, ventilator utilization, ICU, ersatz ICU, med/surg and temporary location bed availability and coordinate with analytics resources for reporting purposes to appropriate internal and external agencies.

Calculate appropriate acuity scoring systems (e.g., SOFA, APACHE, etc.) and display for resource management and prediction of intervention.

Display link on screen for talking points next to COVID-19 positive test results to help guide dialogue with patient.

Present recommended new COVID-19 pharmacologic combination therapies based on evolving knowledge.

Analyze critically ill intubated COVID-19 patient lab parameters for consideration of therapeutic interventions (e.g., arterial blood gas combination with ventilatory settings meeting criteria for prone repositioning).

SURGE


Patient Portal

Provide links to educational reference material regarding COVID-19 including health system resources.

Consider using a chatbot to facilitate triage, based on patient-entered signs and symptoms to appropriate health resource.

Identify health system capabilities for supporting care in collaboration with community resources.

Technology Innovation Telehealth

Monitor and report on wait times for non-scheduled/urgent telehealth visits to adjust to potential gaps in care and improve consumer satisfaction.

Deploy inpatient patient use of tablet devices utilizing communication software (e.g., Microsoft Teams, Zoom, Skype, etc.) in COVID-19 or PUI patient rooms to facilitate communication and decrease caregiver exposure and PPE use.

Facilitate and educate all associated staff on tele-rounding capabilities within a health system or among health systems where provider resources are limited.


Deploy smartphone and tablet versions of EHR application when possible to assist in patient-provider communication and documentation.

Provide universal shortcut prompts for more extensive wording for consenting to a telehealth visit, such as, “With the concerns surrounding COVID-19, we are trying to minimize exposure to you by shifting to telehealth appointments when possible. Do you consent to this option? If not, I would be happy to see if we can reschedule your appointment in person when possible.”

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SURGE



Provide education regarding EHR documentation and alert tools to help recognize wave 2 COVID-19 patients.

Capture lessons learned from frontline staff on EHR workflow and documentation under COVID-19 surge conditions.

Create a playbook and facilitate training for how to manage rare but potentially catastrophic and resource-intensive events (e.g., rapid transfusion of blood in med-surg floor GI bleeding patient).

Personalization

Create ambulatory quick orders to document COVID-19 immunity status.


Identify documentation optimization opportunities based on lessons learned from COVID-19 documentation results.

Evaluate interoperability options to better capture documentation from external disparate EHR sources.

Clinical Decision Support (CDS Alerts)

Identify and create heads up dashboard alerts in EHR for rapid response to new patient care issues (e.g., infectious agent, security threats, missing patient).

Patient Portal

Communicate evolving capabilities for home medication delivery and testing kits.

Develop processes and documentation to support family link for hospitalized children, elderly and other loved ones in preparation for wave 2.

Provide education for patient and family wayfinding services.

POST-SURGE (Initial Recommendations)


Technology Innovation Artificial Intelligence/Machine Learning

Evaluate use of chatbot in routine surveillance of patient-entered data to enable the following:

Enhanced enrollment in clinical trials;

Expedited access based on combination of consumer-entered information, EHR data and genomic findings;

Improved personal pharmacokinetics based on known medication usage and compliance information.

Identify preferred office location and testing sites based on physical location of patient via smartphone app.

Deploy remote patient monitoring devices (e.g., sphygmomanometer, scale, ECG monitoring) with algorithmic notification based on defined criteria.


Enable hospital at home data capture, ordering and documentation workflow.

Facilitate education and efficiency for new remote work models.

Increase utilization of remote monitoring tools for tele-critical care services including biophysiological monitoring, virtual rounding and on-call back-up capabilities.

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POST-SURGE (Initial Recommendations)


Summary Clinical informatics will help transform healthcare into becoming a more digitally interactive experience for providers, patients, caregivers and consumers. The operations and IT adage referred to as “Lights On, Doors Open (LODO)” is a philosophy of the past. Going forward, the COVID-19 crisis will catalyze a new health system and healthcare mantra of “Lights On, Virtually Enabled (LOVE).” LOVE will more heavily rely on programmatic CI resources, thus reducing the friction experienced by both the consumer and caregiver in the previous LODO mindset.

Sources Derek C. Angus. Optimizing the Trade-off Between Learning and Doing in a Pandemic, JAMA - Published Online: March 30, 2020. doi:10.1001/jama.2020.4984 Douglas B. White. A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic, JAMA - Published Online: March 27, 2020. doi:10.1001/jama.2020.5046 Ateev Mehrotra, MD, Kristin Ray, MD, Diane M. Brockmeyer, MD, Michael L. Barnett, MD, Jessica Anne Bender, MD. Rapidly Converting to “Virtual Practices”: Outpatient Care in the Era of Covid-19, Vol. No. 1, April 1, 2020 DOI: 10.1056/CAT.20.0091 https://catalyst.nejm.org/doi/pdf/10.1056/CAT.20.0091

https://catalyst.nejm.org/doi/pdf/10.1056/CAT.20.0091


Authors

G. Daniel Martich, MD Principal, Informatics and Technology 412.721.0441 [email protected]

G. Daniel Martich, MD, a Principal with The Chartis Group, is a proven physician executive with excellent leadership, organizational and interpersonal skills and over 30 years of experience in the industry serving across academic medical centers, large integrated health systems and population health companies. He has a strong background as a research leader in clinical informatics, with a focus on patient engagement and consumerism. His efforts have resulted in being recognized as one of the Top 25 CMIOs in the U.S. Dr. Martich is a nationally and internationally recognized speaker on patient safety, quality improvement, organizational effectiveness and information systems. Prior to joining The Chartis Group, Dr. Martich served as Interim CMIO for PeaceHealth Medical Group, Chief Medical Officer for WVU Medicine and CMIO for UPMC.

Sue Atkinson, RN Principal, Clinical Informatics and Technology 970.948.6798 [email protected]

Sue Atkinson is a Principal with The Chartis Group. She is a leader in the firm’s Informatics and Technology practice area focusing on clinical informatics and technology. She has over 30 years of experience and has advised clients ranging from academic medical centers, integrated delivery systems and managed care organizations. Her breadth of expertise includes strategic EHR planning and implementation, change management and operational readiness, workflow optimization and clinical informatics. Ms. Atkinson thrives in helping organizations achieve the greatest value from their technology investments. She has assisted leading healthcare organizations in building their clinical informatics programs including EHR implementation post-live governance, informatics, data, analytics, IT structure and benchmarked staffing to support maximum value.

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The Chartis Group® (Chartis) provides comprehensive advisory services and analytics to the healthcare industry. With an unparalleled depth of expertise in strategic planning, performance excellence, informatics and technology, and health analytics, Chartis helps leading academic medical centers, integrated delivery networks, children’s hospitals and healthcare service organizations achieve transformative results. Chartis has offices in Atlanta, Boston, Chicago, New York, Minneapolis and San Francisco. For more information, visit www.chartis.com.

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Clinical Informatics (CI) Checklist for COVID-19 · system resources. Provide links to educational reference material regarding COVID-19 including health ... Doors Open (LODO)”