On Vancouver Island, Canada, local health authority Island Health uses its integrated electronic health record (EHR) to help clinicians diagnose and treat patients efficiently while helping ensure patient and staff safety during its COVID-19 pandemic response. Island Health leverages Cerner Millennium® to communicate each patient's status and treatment plans. The EHR also helps support clinicians in reaching out to the community to provide in-home care and monitoring, as well as public health surveillance in communities and residents who can be difficult to reach.
“The benefit of this integrated system of outreach, testing centers, assessment centers, community health and public health is they all connect with our acute care system,” said Amy Williams, Director of Clinical Informatics for Island Health. “No matter where that patient ends up in their journey with COVID-19, that information will be at the fingertips of any health care worker interacting with that patient.”
When a patient first demonstrates symptoms, they often reach out to a primary care provider.
“A patient’s journey may start with providers seeing patients virtually,” said Williams. “When providers complete their virtual visits, they assess the patient and determine if they need further assessment.”
If the patient needs a COVID-19 test, the primary care provider connects them to a central registration service organized by Island Health, which arranged an appointment time and provides directions to the screening location. While results are pending, an order triggers alerts to any clinicians' healthcare providers or clinicians interacting with the patient. Those alerts provide information about the testing status and precautions that should be taken.
Test results are returned in real-time to the primary care provider and are made available to the patient via Island Health’s patient portal, MyHealth, enabled by Cerner’s HealtheLifeSM solution.
If the patient tests positive, the EHR alerts public health surveillance officers, so they can quickly begin the contact tracing process and determine if the patient needs additional monitoring.
For patients who require monitoring while isolating at home, Island Health has developed an intensive home monitoring program, where Community Health nurses follow patients’ progress remotely via reporting from biometric equipment in the home. That data integrates within the EHR and populates a special MPage® with the pertinent COVID-19 information. If the patient needs to visit an emergency department (ED), clinicians have full access to that information in the MPage.
When the pandemic first hit, Island Health leaders realized they needed to improve communication. While all the information was there, it wasn’t readily apparent unless someone went looking for it.
“We had a patient being managed for COVID-19 symptoms [at home], who had some cognitive impairment and ended up in the ED,” said Williams. “The patient was unable to tell us about their history and didn’t meet the criteria for a swab test. As a result, our care team did not initiate isolation precautions and continued as if there was minimal risk. We took this incident seriously and looked for solutions to better protect our health care workers as well as provide efficient, appropriate care.”
Island Health leaders implemented new rules and logic to automate processes and make COVID-19 information more readily apparent.
“It’s freed up our staff time. They trust things have already been done and don’t have to reorder tests or do certain assessments again. They can see if they were completed a day or even just hours ago,” said Williams.
The integrated record also helps Island Health clinicians manage the pandemic by reaching out to the community for testing.
“Physicians and nurses have full access and documentation ability within the Cerner EHR for population screening and assessment of our homeless populations. They also have access to our indigenous populations and rural and remote communities that have a harder time getting health care access,” said Williams.
Previously, public health nurses would operate separately, making it hard for Island Health clinicians to see assessment results for difficult-to-reach populations. Now, having everyone interacting within the same record helps improve communication about a patient’s condition.
“It’s giving us momentum,” said Williams. “I followed up with some clinicians the other day, and they commented on how it’s seamless. The information flow across all our care venues is helping us to work better and more efficiently for our patients and for each other in this stressful time.”
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