Leveraging MEDITECH's EHR During the COVID-19 Pandemic
Your EHR can be a powerful tool to help you screen, isolate, treat, monitor, and report on patients with suspected or confirmed cases of COVID-19. By centralizing patient information across all entry points (e.g. direct admissions, surgery, outpatient services, home care, long-term care, ED, etc.) and ensuring consistent procedures and communications across all care settings, you can help protect vulnerable patients and staff.
We are committed to providing our customers the solutions and guidance they need to get through this pandemic together. The following tools are currently being leveraged in MEDITECH’s EHR to support screening, treatment, and prevention efforts. Our COVID-19 Resources page includes the in-depth guidance and configuration instructions our customers need to support these efforts.
Screening Assessments and Queries
Screening assessments include site-defined queries and are shared across MEDITECH’s EHR. Whether screening patients over the phone, in the ED, the practice, pre-surgical, or at a special location set up for coronavirus screening, responses can alert all responsible staff. Questions may include travel history, contact with those under investigation, symptoms, and high risk areas for community spread. Rules can also be defined to trigger additional queries based on query responses, or to present precaution messages to staff should a patient be at risk.
Actionable indicators alert all clinicians and office staff accessing “at risk” patients of the potential risk within their respective workflows, including ED trackers, physician and nurse status boards, surgical trackers, surveillance boards, Ambulatory homescreens, the Patient Summary, or within physician documentation. Doing so guides clinicians to take the appropriate precautions.
Based on responses to screening, staff can be automatically notified of the next steps, such as masking and isolating the patient, contacting the appropriate response teams, or directing patients to the appropriate location. Orders can also be automatically queued up, such as collecting specimens (nasopharyngeal and oropharyngeal swabs, etc.),
Organizations can use the latest WHO and CDC guidelines to establish standard order sets for patients under investigation (PUI) for COVID-19. In addition to containing all the appropriate orders and therapies currently being recommended, order sets can instruct users to take pertinent steps, such as contacting public health agencies, collecting specimens, or taking appropriate precautions. COVID-19 PUI order set interventions and orders can be attached to queries and associated to ED chief complaints.
Emergency Department Isolation Tracker
In an effort to track all patients at risk for COVID-19 and those that have been tested, an isolation tracker can be built and linked to an ED isolation location or treatment area. These trackers can include responses to the COVID-19 screening assessment queries or questionnaire and the surveillance profile alerts for patients at risk, patients who have had a test ordered, and patients who have a positive test result. These surveillance alerts display the most severe level first.
Quality and Surveillance (Expanse and 6.1)
Clinicians can use Quality and Surveillance to identify and continually monitor patients who meet the COVID-19 criteria: patients at risk based on screening questions, patients for whom testing has been ordered (suspected), and patients who have tested positive. Upon identifying a patient who meets the criteria for any of the three COVID-19 profiles, surveillance tools generate electronic alerts on physician status boards, ED trackers, surgical trackers, nursing status boards, and surveillance status boards, all of which reflect the patient’s current status. These notifications help protect staff by enabling them to easily review any patients who may need special precautions.
A Surveillance Watchlist, which lists all patients who are at risk for COVID-19 and their current statuses, can also be monitored by an infection control employee or nurse manager. MEDITECH also released a series of recorded webinars to support Surveillance Profile builds.
Virtual visits help you manage the growing volume of patients seeking clinical assessment, while protecting patients and staff from crowded waiting rooms. Providers can practice social distancing by screening and treating patients remotely and directing them to the safest and most appropriate testing location, including drive-up testing. They also help practices respond more quickly to patients in need of immediate guidance, and prioritize those in critical condition.
Patient Registries (Expanse 6.15 or higher)
Providers, nurses, care managers, administrators, and executives alike can use patient registries in the practice setting to identify and monitor confirmed or at-risk patients, and follow up as needed. Registry lists can be tailored to organizational needs and workflows. Real-time data is obtained from the patient’s chart. Information can also be obtained from patients through questionnaires or patient-generated health data (patient monitors or wearables). Staff can aggregate lists of patients and proactively contact them to discuss their current health status, and help mitigate the risk and spread of COVID-19. Filters can disaggregate populations into smaller, more appropriate groups for tracking COVID-19 and stratify patients by such factors as age, multiple chronic conditions, or gender. Clinicians can also compile a list of patients that meet high-risk criteria to ensure appropriate interventions are in place.
Common uses of registries include the ability to:
- List selected patient populations to be pre-screened (using email notification and pre-visit questionnaires, telephone contact, and virtual visits) prior to attending appointments .
- Monitor risk assessments and test results of patients who are suspected or confirmed COVID-19 (or influenza, strep, etc.) positive.
- Identify and categorize patients who may benefit from Expanse Population Health remote monitoring and follow-up.
- List selected at-risk patient populations if/when active community surveillance is deemed necessary.
Guidance and client service trainings have been taking place to ensure health systems are using registries for COVID-19 identification and monitoring.
Patient and Consumer Health Portal
We recommend using the Patient and Consumer Health Portal to share announcements regarding an organization's COVID-19 guidelines and screening processes, as well as any precautions patients should take. Mass emails can also be sent to all portal subscribers, or to targeted registry lists, such as those patients who are at a higher risk due to age or comorbidities. External links can direct patients to the most trusted sources for information. The portal can also be used to support social distancing efforts, such as:
- Having patients complete questionnaires online to minimize their time in waiting rooms or interaction with front-end staff, or to pre-screen for COVID-19.
- Pre-registering for appointments online.
- Secure messaging with providers, to keep patients out of the office and to also help remotely monitor and treat patients with mild symptoms who are staying home.
- Holding virtual visits (further details above).
Using patient portal questionnaires enables patients to provide timely and updated information prior to their appointments, which is shared with clinicians within MEDITECH’s EHR. Using questionnaires during the COVID-19 pandemic can help:
- Pre-screen patients for COVID-19 - if they are deemed to be at-risk, clinicians can provide virtual visits and direct them to the appropriate location for testing.
- Conduct community surveillance to a targeted population (e.g., high-risk immuno-compromised patients) to gather information on patients that may not have any upcoming visits.
- Protect the safety of patients and staff by capturing information (screening questions) without face-to-face visits.
- Redirect surgical patients completing pre-surgical questionnaires who are deemed at risk.
MEDITECH customers have received a mass delivery of updated EMR IDs, including the laboratory and microbiology tests related to COVID-19. EMR IDs are the identifiers that MEDITECH uses to build the Expanse, 6.0, and Client/Server Electronic Medical Record Panels and the MAGIC Clinical Review Panels.
As testing for COVID-19 changes and additional EMR IDs are added, MEDITECH will continue to update all affected customers.
Home Care Screening
By creating a COVID-19 Risk Assessment care step in MEDITECH Home Care, staff can pre-screen patients prior to visiting their homes. Assessments can be used to document travel history, symptoms, contact with infected individuals, and whether patients live in an area with known community spread. By pre-screening for COVID-19, clinical managers can alert clinicians to take appropriate safety precautions prior to home visits.
Long Term Care Screening
Long-term care facilities can share the same COVID-19 screening assessments for admission to the facility, but due to the length of stay can also elect to have daily stand-alone assessments completed. They can also add COVID-19 queries to an existing shift assessment.
Reporting and Analytics Tools
MEDITECH’s Data Repository and Business and Clinical Analytics solutions can be used to monitor and report on COVID-19 cases internally, as well as compile reports to meet state and local public health reporting requirements. Data Repository queries can compile the appropriate information from across MEDITECH’s EHR as well as other vendor solutions, allowing for a single source of truth and eliminating manual data collection and the need to maintain separate spreadsheets.
Visualization tools, such as Business and Clinical Analytics (BCA), or other third-party reporting solutions, can be used to map queries to the appropriate dashboard views for timely reporting and analysis. BCA includes a combination of standard datasets and dashboards, as well as the capability to perform self-service analytics to customize content per organizational needs. For example, dashboards can be created to track confirmed COVID-19 cases, suspected cases, supplies, geographical location of cases, or occupancy rates by department (e.g. ICU, pediatrics). Source data can also be pulled in from outside organizations, such as the Public COVID-19 Tracking Project. Reports can be extracted in the appropriate format to meet mandated public health reporting requirements.
Daily Lab COVID-19 Test Reports
To support the latest regulations issued by CMS on March 29th (per order of Vice President Mike Pence), MEDITECH released standard reports that customers can upload to their systems to meet the requirements for reporting daily COVID-19 test result statistics to the Federal Emergency Management Agency (FEMA), for inhouse COVID-19 testing using MEDITECH’s reporting tools. They also provided in-depth workflow guides for customizing these reports.
MEDITECH provided updates and guidance for supporting hospitals/clinics who are implementing drive-thru testing for COVID-19. Guidelines were included for placing and retrieving orders, labeling collected swabs or specimens, and entering collection data accurately.
Patient Education and Discharge Instruction Content
We provide updated patient discharge instruction content to support COVID-19, and details on those changes made by third-party patient education vendors integrated within MEDITECH’s EHR.
As nurses and physicians are being rapidly recruited into hospitals from medical schools, retirement, clinics, and other settings MEDITECH is also offering rapid onboarding training for end users. Doing so helps them begin treating patients right away. Our Professional Services Team can also offer guidance for optimizing software as well as quick access to subject matter experts, staff augmentation, clinical and financial guidance, analytics tools, and interoperability strategies. Also, be sure to visit our Webinars page for the latest offerings.
MEDITECH will continue to monitor the WHO and CDC guidelines, as well as update our guidance and system configuration instructions as needed. We will also continue to share innovative stories from our customer community highlighting how they are leveraging their solutions to combat the COVID-19 pandemic.