Co-Author: Keith Boone
Even as healthcare providers are fighting the present Ebola epidemic, the next one may still take them by surprise. For example, public health workers who developed projects for tracking and monitoring avian flu might recall how little of that specific infrastructure was sufficient to address the later emergence of swine flu (i.e., H1N1). Rather than swine flu, imagine, as U.S. providers and public health workers are doing today, preparing for patients having the Ebola virus. Even with its extremely low incidence and prevalence in the U.S., Ebola has certainly created high levels of concern. In order to identify and manage patients potentially at risk for being infected with Ebola, providers need to be able to gather appropriate travel history, risk factors, and other details without interfering with the care they provide their patients in their day to day work. Ideally, they need general purpose tools to do this that are informed (but not limited) by past disease outbreaks and that can be adapted to reflect the most current public health and clinical guidance, as well as ongoing patient care needs.
At this stage of (very limited) experience with the Ebola virus in the U.S., patients and physicians must remember that usual medical care must continue even while Ebola awareness is added to daily practice. Solutions must therefore be carefully crafted to address the risk without unduly slowing down the work of nurses, physicians, and other clinicians. Providers who are prepared with such solutions now will be more able to identify and help contain spread of the disease, and will also be ready if the situation worsens and workflows need to shift, for example if Ebola cases originating in the U.S. significantly increase.
The need for a general purpose capability for providers to screen for and manage diseases mirrors the Centers for Disease Control (CDC) and public health agencies’ mission to deploy and adapt a standard set of tools and methods to combat new epidemics. In this respect, it is notable that one of the central and intended benefits of the electronic health record (EHR) as a platform for care is that it can quickly be reconfigured to take on new responsibilities.
For example, as the potential for Ebola exposure in the U.S. increased, GE Healthcare began ramping up resources to identify and develop EHR workflows and tools for its Centricity™ ambulatory EHRs to support capture of Ebola risk factors (primarily travel history and signs and symptoms) as well as diagnosis and treatment for this disease. Working with a content development partner, GE initially rolled out this capability for pilot testing and review at selected customer sites and it is now freely available to GE’s entire ambulatory EHR customer base (similar “tailoring guidance” has been provided to enterprise EMR sites).
Clinical decision support guides providers with questions and recommended actions based on the screening. Should there be a positive result, clinicians will be immediately prompted with instructions regarding patient protocols and staff protections based on CDC guidance. Instructions include recommended actions for clinicians and providers as well as guidance to inform local infection control staff, health department, and the CDC.
No new standards were needed to provide this customer support, nor any new product features. Existing product capabilities and ecosystem partners were used to develop forms, workflows, and clinical decision support logic, reflecting the most recent CDC guidelines. Customers can implement and adapt this content to their own circumstances and workflows without additional support from GE. No special “apps” were needed to implement and adapt the CDC algorithms and guidance into EHR clinical workflow.
It is important to emphasize that GE Healthcare is not alone in being able to take advantage of the broad focus and inherent flexibility of EHRs to meet emerging disease and public health challenges; many other EHR developers have adopted similar strategies. Although EHRs received initial and ongoing negative comments regarding readiness to assist providers in responding to Ebola, subsequent reports on the initial Dallas situation have indicated that the EHR was not responsible for the events that occurred. Moreover, although there is always room for improvements in EHR usability and interoperability, what is remarkable is how unremarkable it is for EHRs to be quickly updated by vendors and/or users to adapt CDC protocols into forms, screening questions, and clinical decision support.