Cheat sheet: 3 imperatives to leverage telehealth against Covid-19

5 ways UCSDH optimized its EHR for Covid-19

1. Established standardized, multimodal screening and triage processes
   
   

   To reduce the spread of infection, UCSDH prioritized the need to screen patients outside of the clinic and through channels such as phone, email, and EHR messaging.

   
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   So, at the beginning of the pandemic, the organization deployed new EHR templates with screening guidance and triage instructions that are easily accessed and used by call center staff and nurses. Front-line staff follow a standardized script when screening patients, and certain responses trigger provider alerts with guidance for follow-up clinical care. Templates are updated in real-time on the back end with the latest local, federal, and global recommendations, enabling a consistent protocol across the organization while also making it easier for front-line staff to keep up with the ever-changing guidance.

2. Leveraged EHR-integrated secure messaging to quickly share updates with staff
   
   

   To quickly respond to evolving needs, UCSDH assembled a seven-person "Ambulatory Covid Team" that included infectious disease physicians, PCPs, and nurses. This team uses the secure messaging platform in the EHR to rapidly communicate updates and share PHI when necessary. The platform enables 24/7 secure communication across clinical teams, and team members can quickly access patient charts attached to messages on computers or mobile devices.

3. Automated lab orders to streamline the testing process
   
   

   Pre-populated Covid-19 lab order sets were added to the EHR for inpatient, ED, and ambulatory settings.

   UCSDH conducts in-house testing for patients in the hospital or ED, but tests done in its ambulatory settings were initially sent to a reference laboratory due to capacity limitations, and then brought in-house a couple of weeks later. The pre-populated lab orders include directions specific to the care setting to avoid confusion among providers and breakdowns in the testing process.

   Clinical decision support was also added to the workflow at the point of ordering to make sure providers are documenting the testing criteria.

4. Created a reporting dashboard to drive data-driven decision-making
   
   

   The enterprise reporting team at UCSDH created easily accessible reports in the EHR as well as a Covid-19 operational dashboard that includes real-time data on patients tested, test results, ICU bed availability, and ventilator availability.

   The dashboard is reviewed in five daily readiness huddles and helps staff members make evidence-based decisions at a time when emotions are high and misinformation is spreading. The dashboard is sent to all health sciences employees and provides visibility into what is happening at any given time, and it helps curb the growing anxiety of clinicians by making the unknown, known.

5. Expanded use of an existing telemedicine platform in the EHR patient portal
   
   

   UCSDH had previously built telemedicine functionality within its EHR's patient portal, but the capability was not widely used—fewer than 2% of all ambulatory encounters were video visits. To avoid unnecessary exposure to Covid-19, UCSDH expanded telemedicine to all outpatient areas, created self-guided learning videos on virtual care delivery, and repurposed an EHR optimization team to train and onboard clinical staff.

   Over 2,000 clinicians have been trained, and the health system conducted more virtual visits in the first three days since expanding telemedicine offerings than in the previous three years. After 2 weeks, over 50% of all ambulatory visits were virtual.

The 4 pillars every IT leader needs to adopt

Why UCSDH was successful

In discussion with us, Longhurst shared three key factors behind UCSDH's success, including how the organization:

• Established an interdisciplinary command center to identify needs, including an IT leader
  
  

  "Every hospital probably has a command center open right now, but not every hospital has an IT leader in the command center. That partnership is the key to success," said Longhurst. On February 5th, UCSDH established a 24-hour Incident Command Center to monitor the rapidly-evolving situation and recommendations.

  The command center team includes infectious disease experts, administrative executives, clinical informaticists, and IT leaders. Having an IT leader in the room helps the team translate operational needs into technical requirements.

• Closely collaborated across clinical and operational leaders
  
  

  UCSDH was able to pivot quickly to Covid-19 because of the team-oriented nature of their leadership. Longhurst serves in a dual-capacity role, which also helped facilitate communication. "It puts me at the juncture of a lot of medical, technology, and operational conversations," he noted.

  This close collaboration helped the IT teams prioritize projects that were valuable for clinicians and front-line staff. EHR updates were added to automate processes and reduce confusion, to keep staff informed on changing guidance, and to provide easy-to-consume real-time data for decision-making.

• Used an agile method to implement new tools quickly
  
  

  For most other projects, the IT team spends time scoping requirements and developing and testing solutions before rolling out changes. UCSDH had to modify this process to implement updates quickly. New features were constructed to enable quick back-end editing as processes and guidance change frequently.

  UCSDH already had a robust system of daily huddles in place prior to Covid-19, but this process was strengthened to enable a lean approach. The organization also made the decision to deprioritize all other IT projects to support its Covid-19 efforts.

What's next for UCSDH

UCSDH is continuing to innovate on the front lines on this pandemic. The organization recently announced a new lung imaging research study aimed at using artificial intelligence to improve the detection of pneumonia.

As for long-term plans, Longhurst believes that IT will play a critical role in continuing to support innovation: "The world has clearly changed, and health IT teams are enabling transformation. For example, telemedicine changed because of the willingness of patients and doctors and the shifting reimbursement landscape, but we were prepared with the infrastructure."

Your top resources for COVID-19 readiness

You're no doubt being inundated with a ton of information on how to prepare for possible patients with the 2019 coronavirus (COVID-19). To help you ensure the safety of your staff and patients, we pulled together the available resources on how to safely manage and prevent the spread of COVID-19.

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