A regional hospital in New Hampshire was able to work with its EHR dashboard vendor to successfully track COVID-19.
June 30, 2020 - When Concord Hospital implemented its EHR system in 2017, Paul Clark, MD, faced a challenge that disrupted the way the providers were getting patient information and ultimately patient care. Information overload clogged up the EHR dashboard, pushing Clark to consider EHR optimization.
“Providers were struggling a little bit to find information,” said Clark, who is the chief medical information officer at Concord Hospital. “They were jumping around to a lot of screens to get the information. So, we were trying to optimize the EHR system. But what became clear to us is that we would like something that was a little bit more agile in terms of making changes to deliver information to providers so it was more meaningful.”
In other words, Clark’s interactions with his EHR vendor weren’t quick enough, keeping the hospital from being able to pivot to different EHR optimization projects.
Once COVID-19 hit New Hampshire, Clark and Concord Hospital had a difficult time figuring out how they were going to track patients and the pandemic. Initially, the health IT team thought they would have to suffer through the previous burdensome, manual process to track patients.
“Our emergency room director, who was managing the movement of patients in our facility for COVID wanted to be able to view the COVID status,” Clark said. “That is in terms of what they're testing, whether their test was pending, or whether the patients were COVID-positive or COVID-negative. He also wanted to be able to quickly see what level of ventilatory support people were on.”
But once Clark contacted Wellsheet, their predictive clinical EHR tool vendor, their optimization turnaround time could occur quickly, confirming this is how the hospital would fight the pandemic.
Once implemented into the EHR, Concord Hospital providers saw an immediate decrease in clinician burden, which was contrary to its previous EHR optimization tools.
A task such as list management once took 20 clicks and now it is visible on the same workflow.
“Previously, our advanced providers spent an excess of an hour to get the list teed up for when the team came in to see patients,” he explained. “When they did these lists, they'd manually do them. Cross off names. Write in names for the advanced providers. It was a really manual process. Then they'd have to take the paper and fax it down to every unit so the units knew who was responsible for the patients.”
“Now, we've cut that process down to 15 minutes,” he said.
Not only was Clark able to find this EHR-integrated tool, but he was also able to work hand-in-hand with the vendor to optimize it for COVID-19 care.
Clark and his health IT team got a big surprise when their predictive workflow platform for their EHR became their end-to-end COVID-19 patient dashboard.
“By clicking into the platform, you can go to the COVID team,” Clark explained. “I can see exactly where the patients were and know what level of ventilatory support they're on. It’s pretty powerful stuff.”
“When our patient volumes were in the 30s, it was a real big deal. We got up to, I think at one point, 40 or more COVID patients in the hospital. We maxed out on maybe eight to 10 ventilator cases. But we could see exactly where they were. It was a tool that was ended up being used by our emergency room director in management of patient movement.”
If this optimization did not occur, the hospital would have likely had to utilize a number of spreadsheets with manual inputs of data that would have been quickly outdated, Clark continued. Now with the optimized COVID tool, the regional hospital has instantaneous updates on COVID-19 and its patients.
“We get notified when the lab test results come back. Again, that notification functionality is pretty cool,” Clark continued. “I never thought we'd be using it for COVID, but it was a major way for our ED director to know when a pending test came back.”
Once a patient is discharged, the nurse navigator add-on also makes a call within 48-hours of discharge to take the patient off the list.
With COVID-19 cases winding down in New Hampshire — at least for now — Clark is looking for more ways to use his EHR tool.
Clark and his team are using this tool to engineer a chronic obstructive pulmonary disease (COPD) initiative to have data displays of information on COPD patients. Leveraging the tool’s optimizations to sort by class, clinicians could see medications that are appropriate for COPD.
“We think those capabilities are going to be useful for multiple other providers,” Clark explained. “For the hospital list, it's going to be a primary way to just manage their census and also give them a potentially a strong hand off too, stronger than what they have currently in our EHR system.”
He also noted his current EHR system does not select medications by class, which he said could result in a patient safety issue. However, the tool has the capability to process and list that information.
“I've been working with EHRs for a long time,” Clark said. “The difficulties with EHRs in general is they've got a ton of information. We've got every piece of information you would possibly want on a patient. But it's really difficult sometimes to get a picture of what's going on with the patient, or a summary that's meaningful to you as a provider.”
While Clark comprehends the work that large EHR vendors have to offer, quick optimization and increased communication is something that he’s finding with the add-on tool vendor, but not the EHR vendor.
“The power of this tool is that we can really put a tool in the hands of the providers that is going to drive better care,” Clark concluded. “It's going to give us ability to do meaningful clinical physician support. It's going to really drive improvement and care for populations of our chronically ill patients.”
“So that's part of the reason I'm pretty excited about the tool. It’s not that the EHR vendors are bad, it’s just that their optimization is so slow that you put in requests for an update, but then it takes two years for that update to get adopted. It doesn't replace the EHR. I think it's just an adjunct to help people really understand their patients better.”