COVID-19: You Aren’t Ready
By Jeremy Harper
Jeremy Harper, MBI is chief research information officer of Regenstrief Institute of Indianapolis, IN. The views and opinions expressed in this article are his personally and are not necessarily representative of current or former employers.
Chief research information officer means that I design systems to connect clinicians, research, and IT for a living. I’m paid to think outside the box.
I’ve been tracking coronavirus since mid-January. I want to acknowledge as I write this that as of March 19, 2020 we have about 10,000 individuals in the US who have been identified with this disease. We are not at a crises today, but we might be in a week. About 3,000 new cases were identified yesterday.
Our health systems are built upon a tower of electronic assumptions for patient care, triage, and scheduling. If you review the CDC pandemic preparation documentation, we are focused on minimization of the event in lowering the curve. I’m calling on the IT and informatics Industry to look beyond minimization to what happens if we fail. We are not ready.
A crises of this magnitude brings us back to a simpler time, one that requires a massive streamlining. We’re seeing vendors begin to release capabilities for streamlined remote visits, but we need to be prepared internally for our health system operations.
We can’t just focus on how our back office connects remotely, because if the worst happens, our health administration will be ignored in favor of saving lives. We’re going to be rushing to convert swaths of our hospital beds to ICU beds like Italy has done, or creating new hospitals like China did. We are going to see all those beautiful individual rooms that have been built at hospitals over the past 30 years doubled up.
This will be a new health system in a matter of days, and we have not designed our systems to deal with this. As an executive consultant, I’ve participated in pandemic preparedness and emergency drills in numerous health systems. We are suddenly faced with a situation that has the potential to dwarf the worst-case scenarios we have envisioned.
Almost every report that you have spent years building will suddenly become useless. They will be repurposed for decisions they weren’t intended to support. AI/ML won’t solve this one for you, because this is something new, something that will break every model we have worked to build.
Think about your automated systems to alert clinicians to close charts. If people are dying in the hallways, it doesn’t matter. Closing charts, filling in discrete fields (this one kills me as a researcher — we need discrete data desperately to identify best practices), and most clinical decision support suddenly go out the window.
I’ll take a personal example of what we’re about to face on the clinical and administrative front. My father had an esophagectomy about five months ago. They caught the cancer early. He was asymptomatic, aside from a cancer that was going to kill him. His 10-hour “elective” surgery might not be taking place or might be delayed right now as health systems gear up for COVID-19. He has had strictures (throat closing off) since the surgery. He has already been informed that they might cancel his next appointment (where they put him under and stretch his throat) depending on patient load due to COVID-19.
If we see mass cancellations of these an other “elective” process items, then we’re going to need better reports that prioritize patient rescheduling that is based on acuity rather than who gets on the phone and connects first, or who knows how to manipulate the scheduling system the best. This isn’t Ebola, where simple screening questions and changing our triage process will cut it.
What you can do now:
- Start building reports to support your providers in triage to get the right people to the front of the line.
- Identify how we’re going to support a world where we might ask the public to donate CPAP/BIPAPs to keep people breathing through the disease.
- Stop assuming that you are dealing with a “business as usual, just remote” situation, and use this time to prepare for a world where the EMR is low on the priority list.
- Work with researchers to identify the data we need to get treatment recommendations out to the world quickly.
- Use your time and expertise to help groups in need.
- Figure out your best practices and start telling people about the changes you are making.
I have a full-time job. I do executive consulting on the side. I have a beautiful three-year-old and a wife I love. I know how hard it is to find more time during an “all hands on deck” situation. We are all in this together. Let’s be ready.