Better Electronic Medical Records Needed to Support COVID-19 Infection Control

By Will Boggs MD

May 20, 2020

NEW YORK (Reuters Health) - Current electronic medical records are insufficient to support the work of infection preventionists (IPs) during the COVID-19 pandemic, according to members of one hospital's infection-prevention program.

"Electronic medical records (EMR) must be improved to meet data needs of hospital-based infection-prevention programs," said Rachel Pryor of Virginia Commonwealth University Health System's Hospital Infection Prevention Program, in Richmond.

"EMRs are of limited utility if they cannot synthesize and track patient data and information in real time. If infection-prevention teams are able to spend less time manually tracking patient information, they can prioritize answering questions and giving guidance to frontline healthcare workers," she told Reuters Health by email.

The ideal EMR would automatically notify IPs of a positive case of COVID-19 or a person under investigation for COVID-19 so that they could track them and ensure that isolation orders are implemented.

Instead, the EMR in its current state poses significant barriers to IP work efficiency during a pandemic, Pryor and her colleagues note in the American Journal of Infection Control.

No standard, centralized EMR view is accessible to all hospital teams, so rapid stakeholder notification of suspected or confirmed COVID-19 patients is impossible. This barrier creates even more confusion when COVID-19 test volume surges, the authors write.

Moreover, most EMRs do not communicate between separate health systems, so delayed IP notification of suspected or confirmed COVID-19 patients at the time of facility-to-facility transfer can hinder the application of appropriate isolation precautions and lead to staff exposure.

With the growing pandemic, providers could order COVID-19 testing without IP oversight, and there was no EMR notification system in place to alert IPs of new COVID-19 orders or results, which resulted in delayed and poorly coordinated guidance and implementation of isolation precautions for patients who tested positive.

As patient volume increased, it became untenable to track the location of COVID-19 patients and patients under investigation in real-time, as the EMR did not have the capacity to create a patient tracking list for diagnoses of interest.

Finally, many EMRs are not flexible enough to program an automatic isolation order when a provider orders a COVID-19 test, an action that is critical during an escalating pandemic. Instead, the provider has to order appropriate isolation separately, and confusion over which isolation type is appropriate and when isolation should be discontinued can result in unnecessary staff exposure and overuse of personal protective equipment.

To address these barriers, the EMR should incorporate at least three components: real-time modifiable patient lists or tracking boards visible on demand, with pertinent safety information; automatic generation of appropriate isolation orders based on COVID-19 orders and patient symptoms; and automatic IP alert of COVID-19 patients and patients under investigation, regardless of where or when the order is placed.

"EMRs are a helpful and necessary tool in the modern healthcare world," Pryor said. "However, EMRs must improve prior to the next pandemic. EMRs should be both a patient medical record and a source for patient-data extraction."

"At our institution, we partnered very closely with information technology (IT) to develop solutions to the issues mentioned in the manuscript," she said. "Through this partnership we were able to create solutions to better manage COVID-19 patients and track COVID-19 data in the way we needed (real time, shareable with all relevant stakeholders). However, these solutions were time-intensive."

"Some solutions were changes to the EMR itself (changing COVID orders to automatically prompt isolation orders)," she said. "Others involved utilization of additional software to extract data in real time to populate a COVID-19 dashboard. The dashboard shows where patients are located, what isolation orders have been placed, and whether a patient is a person under investigation (PUI) or COVID-19 positive. The dashboard is adequate, but ideally there would have been a solution within the EMR rather than having to use a secondary software solution to host the dashboard."

Pryor recommended "that other institutions work closely to collaborate with IT to create their own solutions."

SOURCE: American Journal of Infection Control, online May 11, 2020.