Health Data Management spoke with a broad mix of electronic health vendors to understand the benefits and potential pitfalls of leveraging EHRs for screening suspected Ebola patients.

Mark Segal, vice president of government and industry affairs for GE Healthcare IT, emphasizes that while Ebola is currently a “critical public health issue” EHRs are “really designed to be general purpose tools that can be used for a range of healthcare needs.” At the same time, Segal argues that an EHR system can be customized to “meet the particular needs for Ebola” and to “enable workflows that a hospital may want to put in place.”

According to Sarah Corley, M.D., chief medical officer for NextGen Healthcare, EHRs typically contain templates or prompts for information about the symptoms (vomiting, diarrhea and fever) that patients are presenting, as well as travel history, to help healthcare workers identify individuals that may be at risk for Ebola. In particular, she reveals that—rather than just asking a series of questions—EHR systems can provide an electronic prompt that serves as an interruptive alert to the workflow.

“Most electronic health records already have functionality to collect these important pieces of information necessary for the proper diagnosis of travel-related diseases,” says Corley. “Most EHRs also include alerts when things are abnormal, such as an elevated temperature, and also contain decision support…They’re not specific to Ebola because, after all, there are a lot of travel-related diseases that are much more common than Ebola.”

Allscripts, in a statement to HDM, says that its solutions are “open and allow for national, local and physician specific configuration” enabling their customers to “have the capacity to implement rules and alerts based on patient history, such as travel.”

 (See also: Epic Defends Integrity of EHR System at Texas Hospital in Ebola Patient Case)

GE Healthcare IT has implemented the Centers for Disease Control and Prevention’s clinical algorithm and a checklist for screening patients for Ebola in the company’s ambulatory EHR products. For its part, NextGen Healthcare has web links to the CDC algorithm and checklist but has not incorporated them “natively” into their client-server product.

“Many customers of ours don’t use the full suite of functionality [including travel history and alerts] that exists in the product, they use what is part of their normal day-to-day workflow,” says Corley of NextGen. Still, CDC has called on healthcare providers to pay particular attention to a patient’s history of travel, which is seen as a vital component for properly identifying and confirming Ebola-type symptoms.

A clinical decision support capability prompts providers with additional questions or recommended actions based on the answers, according Leigh Burchell, a spokesperson for the EHR Association and vice president for government relations at Allscripts. “If there is a positive result from the initial screening, clinicians will be interrupted with instructions to follow reflecting the CDC guidance,” says Segal. Corley adds that these instructions specifically include actions that should be taken, including contacting the CDC and local health departments.

Bryan Clark, managing director of emergency medicine at Cerner, says that the clinical decision support functionality provided by their EHR solution includes “automatically firing an isolation order” for an Ebola patient to get them isolated as soon as possible. Cerner recommends that hospitals put their EHR’s infectious disease screen up front in triage at the first point of contact and on in-take forms that ask questions that can quickly ascertain an increased risk for exposure to Ebola, according to Clark.

Brian Anderson, M.D., athenahealth’s senior manager of clinical content, explains that some of the questions ask whether patients have come into contact with bats, rodents or monkeys that are a potential source for Ebola. Anderson, who is responsible for updating his company’s EHR with CDC guidelines, says that the CDC’s clinical algorithm for Ebola continues to change on a weekly basis. Because athenahealth is a cloud-based EHR, he argues that this continuously changing content can be immediately “pushed out” to its clients.  

Feds Seek Help from Vendors

Under the Public Health-Electronic Health Records Vendors Collaboration Initiative, CDC and the Office of the National Coordinator for Health IT are soliciting industry input on how to configure EHR systems to support screening protocols for Ebola. CDC and ONC held a web seminar on Oct. 16 to discuss electronic screening tools for the virus.

According to Segal, one of the topics discussed in the seminar with vendors was whether screening questions should “begin with travel history and then go on to look for things like fever, or begin with the symptoms and then go to travel history.” Burchell says that CDC is currently recommending that the travel question be asked first, but the protocol is still under final review.

On Oct. 17, ONC held a follow-up call with the EHR Association and chief medical officers representing member companies, as well as a separate call that same day and again on Oct. 20 with CEOs and business leaders from the EHR vendor community. The calls included National Coordinator for Health IT Karen DeSalvo, M.D., according to Burchell, who is also a former vice chair of EHRA.

“It is absolutely the highest priority for the member companies of our association and all resources are being put against it,” she says. Due to “pre-existing” EHR functionality and updated guidance from CDC and ONC, Burchell claims EHRA’s members are making adjustments and are prepared to deal with the Ebola outbreak, including capturing patient travel information.

“What you’re going to see now as an outcome of the phone calls is that most of the vendors will be educating their client base as to how they can leverage those EHR tools,” concludes Corley.

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