How Regenstrief Institute Has Enhanced COVID-19 Reporting in Indiana

COVID-19 has exposed the cracks in healthcare systems across the country. In Indiana, Regenstrief Institute and its partners had to make some critical patient data exchange adaptations and optimizations to improve public health reporting.

But according to Shaun Grannis, MD, Regenstrief Institute vice president of data and analytics, the state of Indiana already had a strong data exchange foundation in place with Indiana Health Information Exchange (IHIE), its statewide health information exchange, which has supported public health use cases for the last two decades.

“Our health information exchange provides notifiable laboratory cases to the state and it also provides syndromic surveillance information to the state,” Grannis said in an interview with EHRIntelligence. “When COVID came along, we were able to leverage existing infrastructure.”

To leverage this infrastructure, Regenstrief had to add new codes, new diagnoses, and new laboratory tests to deliver COVID-19 results to the state.

In February, the organization utilized roughly $2 million in funding from the Office of the National Coordinator for Health Information Technology (ONC) and the National Library of Medicine (NLM) to improve Logical Observation Identifiers Names and Codes (LOINC) standards adoption. This was set to increase interoperability between public health organizations and health systems.

Researchers use LOINC standards to streamline EHR use and health data exchange, which has proven critical during the COVID-19 pandemic.

“Given all of the information that we needed around COVID patients, we've also worked to develop clinical summary reports,” Grannis said.

“There's a lot of information that one needs beyond just the positive COVID laboratory results,” Grannis continued. “We strengthened our laboratory reporting connections with the state. We've also strengthened and expanded our ability to characterize from a broader clinical perspective for them. Most recently, with vaccinations beginning to ramp up, our health information exchange has also been able to be a mediator for a variety of COVID-19 vaccine related reports and information exchange.”

In July, Regenstrief leveraged IHIE to link to researchers at Indiana University to utilize IHIE’s data to develop an EHR-implemented sexually transmitted infection (STI) clinical decision tool. But because there was no COVID-19 vaccine or treatment at that time, Regenstrief and its partners could not optimize the tool for COVID-19.

At that time, a high volume of STI cases were coming through the laboratory and lab workers noticed providers weren’t sending additional information, such as patient symptoms or if the patient was treated.

Now with vaccines in place, Regenstrief optimized the tool to boost COVID-19 reporting and provide analytics for the state.

“Right now, we are identifying patients so healthcare systems can provide to our health information exchange, a list of individuals and we can determine who has and has not been vaccinated,” Grannis explained. “It's interesting for health and human services reporting because it's all aggregate and we are providing aggregate reports.”

“If a provider gives us a list of people, we can tell you how many of those people have been vaccinated, but we can't give you the individual names. If a physician uses the health information exchange, logs in and checks on an individual person, they can determine whether they're vaccinated.”

To further Regenstrief’s COVID-19 mitigation efforts, Grannis said the organization is partnering with the CDC to evaluate vaccinated individuals and observe their subsequent outcomes.

“The pharmaceutical companies go through the appropriate FDA trials to evaluate the efficacy and we hear efficacy is roughly 95 percent Pfizer and Moderna,” Grannis concluded. “But we also want to validate that on the much broader population. We are going to work with the CDC epidemiologist to evaluate the efficacy of these vaccines. Then we can look at individuals who have and have not been vaccinated, what their clinical outcomes are, and be able to do a comparative effectiveness evaluation.”

COVID-19 has made Regenstrief and its partners innovate other technological advances and other reporting methods throughout the pandemic.

For instance, Regenstrief dispersed a statewide COVID-19 survey as a public health tool and according to Grannis, the results were more positive than they initially imagined and they are in the midst of putting out a second survey.

“The first and foremost lesson from the first survey was that it's possible,” Grannis said.

“It's possible to do a broad survey to capture symptom information and information related to COVID or any infectious disease on a very large scale. Now that seems perhaps a simplistic outcome, but it's not common to do this type of survey quickly. After proving that it works and is feasible, I think is important to know that for the future. We also identified symptoms, such as the lack of the inability to smell, which was very important,” he continued.

Next, Grannis described the possibility of developing an EHR alert that notifies the clinician when a non-vaccinated individual arrives for patient care. However, Grannis said the array of vaccination sites could present a major challenge.

“If an individual shows up at a lab to get her blood drawn, and the laboratorian gets a reminder that she needs a vaccination, what are they going to do about it?” he posited.

That logic stands in other sites of care, like the emergency department of the primary care office.

“There are some ongoing conversations there about how we can better support clinical decision support for vaccinated persons. But reporting notifiable conditions and getting someone vaccinated are really two different topics. They're related, of course, but they're distinct.”