COVID-19 Process Implementation and Optimization
Problem:
In early 2020 when COVID-19 began to quickly sweep across the U.S., many hospitals were left scrambling to devise their processes for testing staff and patients, preserving PPE and reporting epidemiological information to public health agencies.
There was an urgent need for organizations to set up their EMR with capabilities for their clinical staff to document COVID-19 risk assessments, order COVID tests, document and communicate test results, request EAU treatments and share information as soon as it became available to optimally utilize limited supplies and resources.
Administrative staff needed to be able to code and bill for a new set of services and diagnoses. They also needed visibility through reports and dashboards to keep a close eye on testing and results for both management and public health reporting purposes.
College Medical Center was one of many hospitals that needed assistance configuring their EMR to become an effective information system for managing the many nuances introduced by the COVID-19 epidemic.
Solution:
We worked closely with the Chief Nursing Officer to get the details of College Medical Center’s first iteration of processes for dealing with COVID-19. We also engaged with colleagues at other facilities through Cerner’s client collaboration forum to learn what industry standards were being developed and to stay abreast of new recommendations and content from Cerner.
After gathering information from a variety of sources, we shared our findings with the clinical leadership team and together we defined priorities for the items that needed to be built in their EMR to manage their new COVID processes.
First and foremost, we built a new lab order in Cerner so clinicians could order a COVID-19 test for hospital patients. We set it up so when the lab staff received and documented the test results, the result was linked to the original order. Positive COVID results were flagged as critical in Cerner to indicate their significance. The system-wide banner bar was configured to display a patient’s most recent COVID result or pending order. We also configured a custom discern rule that alerted clinicians to a patient’s most recent COVID result each time they opened their chart in Cerner. Once a result was documented, the system automatically added a charge to the account to bill insurance. To further coordinate and standardize COVID treatment, we worked with physicians, pharmacists, laboratory staff and medical executives to design and build a custom orderset.
To assist with screening and risk assessment, we modified the infectious disease screening section of the existing nurse triage form used in the ED to include COVID-specific questions.
When the hospital received several doses of Remdesivir from the county, we built a new order that enabled clinicians to send a request for Remdesivir to the in-house pharmacy.
As a means of tracking all COVID-19 orders and results, we developed a custom CCL report. The data set generated by the report was leveraged for a variety of analytics, staff communication and public health reporting purposes.
Outcome:
In the early stages of the COVID-19 pandemic, College Medical Center was struggling to manage seemingly countless new processes and requirements; namely assessing COVID risk, testing for the infection, treating infected patients, preserving PPE, preventing spread, keeping staff safe, reporting new information to public health agencies, and adhering to changing guidelines from the state and county.
With the configuration changes and updates we made to the EMR, College Medical Center became equipped with a sophisticated information system for handling the many critical new processes and requirements. Staff knew they could rely on the EMR to provide important and timely information on their patients’ conditions, testing status and results. The new orderset provided clinicians with a template to quickly order treatment options, concurrent lab tests and medications. The new system elements helped organize new COVID processes, minimize wasted PPE and coordinate the clinical teams to treat infected patients. Using the report we developed gave administration the visibility over key information such as the location of all in-house, COVID-positive patients, and leaders were able to make well-informed decisions in operational areas such as staffing, testing supplies and medical equipment.
Overall, our contribution played a crucial role in helping the hospital manage its operations and care tactics throughout the COVID-19 pandemic.