“It’s not so much a question of if this will happen any more, but rather more a question of when this will happen and how many people in this country will become infected and how many of those will develop severe or more complicated disease,” Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, told reporters at a news briefing.
The virus will likely stress the physical healthcare delivery systems (diagnostic labs, inpatient beds, emergency departments,) as well as IT infrastructure. We believe health IT can play a critical role in enabling the health system to best prepare for the COVID-19 outbreak.
When delivering high-touch primary care isn’t an option, we’ll need to rely on high-tech solutions. The CDC has released a preparation and prevention guide to help mitigate the impact of COVID-19.
One of the specific ways CDC calls out to help prevent the influx of patients to hospitals, potentially overloading capacity, is to use “existing telehealth tools to redirect persons to the right level of care.”
Health IT leaders, a bipartisan group of house members, and advocacy groups such as the American Telemedicine Association have urged Health and Human Services (HHS) to loosen reimbursement requirements for telemedicine visits during this ”emergency period.” Expanding reimbursement for telemedicine. Expanding reimbursement for telemedicine visits will help drive provider adoption, thus ensuring a more efficient COVID-19 triage solution. This in turn will help hospitals and EDs avoid undue inundation.
The ability of regional, state, and national healthcare organizations to share data effectively across networks is critical for epidemiologists and public health workers to be successful. The CDC’s preparation and prevention guide specifically mentions the need to have “linked public health agencies and healthcare systems.”
Data Sharing from Public Health Agencies to the CDC
Advancements in public health interoperability — such as the formation of the Public Health Laboratory Interoperability Program (PHLIP) — have many state departments of health well prepared for epidemics and pandemics.
When a new condition such as the coronavirus is identified, the CDC determines whether it is nationally notifiable and creates a condition code for reporting. Public health agencies add functionality to their surveillance system to accommodate case investigation (e.g., risk factors, test results, diagnosis status) and adapt functionality to report data to the CDC based on some specification.
In the case of coronavirus, agencies are using an existing method for reporting case data via HL7 called “Generic Version 2.” The difference is that the nationally notifiable code is added.
This is where labs come into play.
“We now have 75,000 tests available out there in the United States, and over the next week that will expand radically,” said Alex Azar, Secretary of Health and Human Services, on ABC’s This Week.
As labs add testing for a new pathogen, they add new orders/results to their laboratory information management system (LIMS) and flag them for reporting via their usual paths.
In addition, any additional database infrastructure work (like adding coronavirus to the PHLIP feed) is fairly trivial. State departments of health can easily add the coronavirus test to their existing PHLIP feed, update a lookup table with their new test/result values, enabling results to be send to CDC.
Handling Peak Message Volume
The newfound ability for state departments of health to test for COVID-19 and transmit the results to the CDC is critical for public health and epidemiological coordination. Regional organizations must ensure they have peak load capacity and elastic load leveling. With increased stress on existing networks, it’s important for organizations to understand how their IT messaging/interoperability systems handle these external forces. Ensuring your health IT system can scale to peak capacity, while guaranteeing message delivery, will be key in reporting and surveilling outbreaks of COVID19.
As the U.S. and other countries brace themselves for widespread COVID-19 infection, it is paramount for every healthcare organization both domestically and abroad to review their IT infrastructure to ensure preparedness. For federal, state, and local healthcare organizations, as well as departments of health, IT infrastructure can often be the difference in early detection and effective treatment. Inaction, keeping information in silos, and an overwhelmed infrastructure can be truly detrimental in a public health emergency.
Between a robust message delivery system allowing networks to stay afloat with higher message volume, to leveraging integrated telehealth services to lessen the demand for hospital beds, health IT has a prominent role to play to help control the COVID19 outbreak.
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