One year has passed since the declaration of what became the largest Ebola outbreak in history that resulted in more than 10,000 deaths. When the Ebola epidemic reached its peak and the threat moved to U.S. soil, healthcare systems across the country went into red alert and some feared they weren’t prepared to handle an illness such as this.
Compiled by Amanda Griffith, Contributing Writer
The North Shore–LIJ Medical Group refined its workflows and EHR processes to respond to last year’s Ebola outbreak, providing a blueprint for how to leverage technology to address future health epidemics.
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One year has passed since the declaration of what became the largest Ebola outbreak in history that resulted in more than 10,000 deaths. When the Ebola epidemic reached its peak and the threat moved to U.S. soil, healthcare systems across the country went into red alert and some feared they weren’t prepared to handle an illness such as this.
EHR vendors have since scrambled to add screening questions and alerts to their systems in the wake of the missteps with Eric Duncan, the Ebola patient at Texas Health Presbyterian Dallas Hospital. Duncan, who had recently come to the U.S. from Liberia, was initially misdiagnosed as having sinusitis and sent home, only to return three days later, gravely ill, before ultimately dying from the Ebola virus.
Medical experts say cases such as Duncan’s can serve as “teachable moments” for providers. One such expert is Dr. Mitchell A. Adler, CMIO for the Medical Group of the North Shore-LIJ Health System, which is comprised of 19 hospitals. The North Shore-LIJ Medical Group employs nearly 2,700 full-time physicians and offers nearly 400 regional ambulatory physician practices, approximately 75 percent of which use the Allscripts TouchWorks EHR.
Q. What prompted North Shore-LIJ Health System to revise its EHR processes to facilitate and prepare for health epidemics like Ebola?
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A: With the Ebola crisis, our leadership proceeded very quickly to establish us as one of the 35 centers throughout the country equipped to treat Ebola victims. We had already implemented and begun recording the answers to two screening questions required by the CDC and New York State Department of Health, relating to travel and the presence of symptoms.
We wanted to be able to retrieve those responses and display them in our EHR because clinicians needed to know whether or not patients had been properly screened and what the results of those screenings were. When patients arrived at a practice, a time and date stamp was entered into the scheduling system and sent with the answers to the screening questions as an HL7 message to the EHR. We accomplished all of this in less than a week and within two weeks were fully equipped to offer care to Ebola patients across the organization.
Q. How did you ensure the data that was captured was seen and reviewed by physicians caring for patients across the health system?
A: It was a matter of implementing the correct workflows. First, were the screening questions asked and the responses recorded? Second and most importantly, what would happen if the responses to both questions were “yes”?
Our clinical administrators — and the quality department — established a workflow whereby if two “yes” responses were recorded on the phone when someone was scheduling an appointment, they were transferred to a clinician in our call center who would administer further screening questions. If those questions revealed the patient was at risk, they would be advised to stay put and one of our medic teams would retrieve that patient and transport him to our center or to another established Ebola treatment center closer to the patient’s home.
Q. What are some examples of the challenges you faced regarding operational deficiencies surrounding the screenings?
A: One site actually felt the process of registering a patient electronically in the practice management system took too much time so they were initially registering patients on paper, only to enter that information minutes or hours later and sometimes not at all. This came to light because we weren’t seeing the screening question responses. We worked with them to optimize the scheduling system to make it less burdensome.
Q. How do you ensure the information your practices collect through the Allscripts EHR is integrated into the network’s hospital systems?
A: Across our network, many of our hospitals use Allscripts Sunrise Clinical Manager, and while there is not yet a direct integration between Sunrise and Allscripts Touchworks EHR (Allscripts’ ambulatory product), our health system is building its own internal health information exchange (HIE). We already have in place some automated exchange of information between these two systems so when patients arrive at an emergency department or are admitted to a hospital, those ADT (Admit Discharge Transfer) messages trigger an exchange of information in the form of a continuity of care document (CCD), either from the ambulatory EHR into the hospital system or vice versa, depending upon the direction of travel of the patient.
Also, in the ambulatory EHR, when a patient arrives at an emergency department or is admitted to a hospital, that physician receives a task — which is a message in the ambulatory EHR — that the event has happened. Other clinical information is subsequently transferred when it’s available.
Q. How important is an open and interoperable system in a process like this?
A: There are two aspects to this. One is that it is obviously invaluable to be able to get information from two other systems and import that into an EHR so physicians have access to that data. The second aspect, which is only indirectly related in terms of open technology, is that the interface allows for a much more robust integration with other applications. We implemented the new workflow for the Ebola epidemic in one week, but maybe next time we’ll be able to accomplish it in a day or two. Certainly, though, we know it can be done and we know how to do it.
Q. How did you harness the power of the data in the EHR to better understand how to better prepare for future epidemics?
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A: The reports we generated proved extremely valuable in showing us how the workflows we wanted to institute for this particular process, the Ebola screening, could accurately be monitored across different sites. It also allowed us to see other operational deficiencies, totally unrelated to the Ebola crisis, so we could remedy them in real time. This was eye-opening for me because I never expected those Ebola screening reports would give me so much information and insight into the operations of the reception desk, for instance, at the various practices within our health system.
Q. What recommendations would you offer to other providers to ensure proper preparation from an IT perspective?
A: The first step is to understand what the imperative strategic intent is, then to determine what workflow will most effectively achieve that strategy? From the perspective of what we wanted to achieve, screening the patients at the right time and at the right place and then recording the results in a way that allowed real-time access to everyone involved, our EHR proved invaluable.
The next step is utilizing the technology to facilitate that workflow, in terms of both the workflow itself — prompting people using the registration scheduling system to ask the questions — and then providing data to display the results to all those who need it.
We were able to put this together very quickly, efficiently, and effectively. The people who had to act knew what they had to do and did it. Internally, there was plenty of support from the clinical, administrative, and technical staffs that, when combined with the exceptional support we received externally from Allscripts, meant our health system could be fully prepared to deal with these types of emergencies and almost any type of situation.
One year has passed since the declaration of what became the largest Ebola outbreak in history that resulted in more than 10,000 deaths. When the Ebola epidemic reached its peak and the threat moved to U.S. soil, healthcare systems across the country went into red alert and some feared they weren’t prepared to handle an illness such as this.
A: With the Ebola crisis, our leadership proceeded very quickly to establish us as one of the 35 centers throughout the country equipped to treat Ebola victims. We had already implemented and begun recording the answers to two screening questions required by the CDC and New York State Department of Health, relating to travel and the presence of symptoms.
A: The reports we generated proved extremely valuable in showing us how the workflows we wanted to institute for this particular process, the Ebola screening, could accurately be monitored across different sites. It also allowed us to see other operational deficiencies, totally unrelated to the Ebola crisis, so we could remedy them in real time. This was eye-opening for me because I never expected those Ebola screening reports would give me so much information and insight into the operations of the reception desk, for instance, at the various practices within our health system.
