How Health Information Exchange Facilitated COVID-19 Follow-Up

A local health information exchange (HIE) helped Veterans Affairs (VA) clinicians identify COVID-19 patients diagnosed in the community and facilitate ambulatory COVID-19 symptom follow-up, according to a study published in the Journal of the American Medical Informatics Association Open (JAMIA).

Most veterans receive their healthcare in both VA medical centers and non-VA facilities out in the community. This can pose a patient data exchange and interoperability problem, which culminated during the height of the COVID-19 pandemic. Veterans receiving COVID-19 care at non-VA facilities needed to see their health data transmitted to their VA providers.

The VA’s health information exchange, VHIE, used alongside New York’s regional health information exchange, RHIO, successfully filled in this gap in New York, the assessment showed.

Researchers assessed patients at the James J. Peters VA in Bronx, New York, with COVID-19 symptoms. Specifically, the team looked at patients who’d been hospitalized at non-VA facilities and who’d received virtual follow-up care from VA providers via telehealth. The follow-up care included symptom assessment, higher level triage, mental healthcare, and infection control advice.

The researchers integrated HIE alerts to trigger hospital events and COVID-19 test results for VA clinicians to initiate VA primary care team follow-up. Clinicians then documented symptom assessment, triage, and follow-up in the EHR.

Of the 180 RHIO alerts VA providers received, 63 percent of patients received follow-up, 41 percent were hospitalized at non-VA sites, and 23 percent passed away.

By the end of June 2020, Bronx RHIO diagnosed 11 percent of the 813 total COVID-positive patients.

“This study presents an example of a process to utilize health information exchange alert notification to identify VA patients diagnosed with COVID-19 in the community to facilitate ambulatory telephone and less often video follow-up by their VA primary care team to manage their COVID-19 infection,” wrote the study authors.

The HIE alert process enabled COVID-19 patients outside of VA to receive the same follow-up by their non-VA primary care teams.

Over 60 percent of COVID-19 patients in the study received follow-up care through custom EHR templates and 76 percent received follow-up care by a VA clinician with or without the template.

“Possible explanations of lack of documented EHR follow-up COVID-19 care include delayed education on template use for some primary care teams, redeployment of staff to inpatient and emergency areas, follow-up calls without EHR documentation, COVID-19 follow-up via secure messaging in the VA health portal, and the large number of outpatients with COVID-19 symptoms VA primary care staff were tracking during this time period,” explained the study authors.

As with most alerts, a significant study limitation was EHR usability. Clinicians prefer to view alerts within the EHR interface. However, this specific workflow required clinicians to manually enter the alerts into the EHR template to view results.

Alerts can often result in clinician burden and are linked to alert fatigue, loss of autonomy, workflow changes, increased EHR usage, and anxiety.

“The VA is working toward greater interoperability with its community partners under VHA Office of Interoperability through the Veterans Health Information Exchange (VHIE) program,” concluded the study authors. “As the VA transitions to the Cerner system, our experience is an instructive example of how HIE between VHA and community partners can improve service to Veterans.”