COVID-19 and the Electronic Health Record: Tool Design and Evolution at the U.S. Pandemic Epicenter
Open Access
- 29 July 2022
- journal article
- case report
- Published by Georg Thieme Verlag KG in ACI Open
- Vol. 06 (02), e85-e93
- https://doi.org/10.1055/s-0042-1756435
Abstract
Objective We detail inpatient electronic health record (EHR) system tools created at Mount Sinai Health System for the clinical management of patients with coronavirus disease 2019 (COVID-19) during the early pandemic months in the U.S. epicenter, New York City. We discuss how we revised these tools to create a robust Care pathway, unlike other tools reported, that helped providers care for these patients as guidelines evolved. Methods Mount Sinai Health System launched a Command Center on March 8, 2020. The Chief Medical Information Officer launched a workgroup of clinical informaticists and Epic analysts tasked with rapidly creating COVID-19-related EHR tools for the inpatient setting. Results Initial EHR tools focused on inpatient order sets for care standardization and resource utilization. In preparation for a fall 2020-winter 2021 surge, we created a clinician-facing, integrated Care pathway incorporating additional Epic System-specific tools: a Care Path, a dedicated Navigator, Summary and Timeline Reports, and SmartTexts. Discussion Initial tools offered standard functionality but included complex decision-making support to account for the lack of COVID-19 clinical knowledge, operational challenges during a dramatic patient surge, and resource limitations. We revised content and built a more comprehensive Care pathway that provided real-time clinical data along with treatment recommendations as knowledge evolved, e.g., convalescent plasma. Conclusion We have provided a framework that can inform future informaticists in developing EHR tools during an evolving pandemic.Keywords
This publication has 26 references indexed in Scilit:
- Care Pathway Effect on In-Hospital Care for ST-Elevation Myocardial InfarctionCardiology, 2018
- User-centered design to improve clinical decision support in primary careInternational Journal of Medical Informatics, 2017
- Usability Evaluation of a Clinical Decision Support System for Geriatric ED Pain TreatmentApplied Clinical Informatics, 2016
- Benefits of improving processes in cancer care with a care pathway-based electronic medical recordPractical Radiation Oncology, 2015
- Governance for clinical decision support: case studies and recommended practices from leading institutionsJournal of the American Medical Informatics Association, 2011
- The Extent and Importance of Unintended Consequences Related to Computerized Provider Order EntryJournal of the American Medical Informatics Association, 2007
- A user-centered framework for redesigning health care interfacesJournal of Biomedical Informatics, 2005
- Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementationJournal of the American Medical Informatics Association, 2004
- Computer-based Guideline Implementation Systems: A Systematic Review of Functionality and EffectivenessJournal of the American Medical Informatics Association, 1999
- Integrated care pathwaysBMJ, 1998