Editor’s Note: Find the latest news and guidance from COVID-19 at the Medscape Coronavirus Resource Center.
When President Donald Trump began promoting hydroxychloroquine as “one of the biggest game changers” for the treatment of COVID-19, researchers hoped that electronic health records could quickly tell them if he was on the right track.
However, bundling data from digital record systems into thousands of hospitals has proven to be a technical nightmare thus far. This is primarily because software created by rival tech companies often cannot retrieve and share information to help doctors judge which coronavirus treatments are helping patients recover.
“I am amazed at the inability of EHR providers to consistently extract data from their systems,” said Dale Sanders, chief technology officer for Health Catalyst, a medical data analysis company. “It is hampering our ability to understand and react to COVID.”
Over the past decade, federal officials have spent about $ 36 billion to switch from paper to electronic health records, or EHRs, hoping, among other things, to take advantage of volumes of medical data to reveal which treatments work best.
EHRs document every step that doctors or other health care workers take to treat a COVID patient, from prescription drugs to signs of progress or setbacks. Data collected from large numbers of patients could quickly give answers about which treatments are succeeding.
But the pandemic is highlighting how far the nation is from achieving its promised benefits, critics say.
Research Scientist and Health Safety Specialist Dr. Richard Cook traces data issues back to the missteps dating back to the launch of EHR, which started in earnest in 2009 and has been controversial ever since because commercial gamers They produced, and hospitals purchased, systems that have proven to be more suitable for billing than public health. “This was a hoax from the get-go, and the promoters knew it at the time,” said Cook.
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Although some health systems are beginning to draw on EHR data to detect coronavirus trends and beneficial treatments, most health organizations across the country cannot easily do so.
“If we had a national database, we would get a quick read on responses to treatments [COVID-19],” said Dr. Eric Topol, director of the Scripps Research Translation Institute.
Medical researchers are in favor of studies testing the efficacy of a drug in a formal clinical trial, and trials are underway for a variety of possible drugs to fight COVIDs, including hydroxychloroquine. However, the results could take months or more, and doctors treating critically ill patients have few options in the meantime.
Topol said the “real-world” evidence gleaned from computerized records of COVID patients, while not as reliable as a clinical trial, is “still very useful” to help guide medical decisions.
Medical information has been difficult to decipher because much of it resides in electronic “silos,” which government officials have not required technology companies to open and dispose of.
“We will see partial readings of small amounts from individual health systems,” Topol said, but “we don’t have the important data we need.”
Sanders, whose firm is a member of the COVID-19 Healthcare Coalition, a business-sponsored group that promotes the sharing and analysis of data on coronaviruses, said federal health officials wasted precious time failing to address this need in mid-January.
He said the federal Centers for Disease Control and Prevention, or CDC, should have devised a COVID data collection plan using standardized terminology so that hospitals with incompatible EHRs could compare notes on the accelerated pandemic.
The CDC did not respond to written requests for comment. A spokesperson for the Health and Human Services office that coordinates health information technology policy said, “This is a new disease, so the healthcare system did not know what data we needed to collect; we are learning that the system you need to generate reporting information on multiple clinical features. ”
Still, several of the leading EHR makers have joined the data-sharing coalition, which pledges to at least partially fill the information gap. The group has access to COVID data from approximately two dozen health systems and hopes to add more.
“This is the first attempt at this that I know of where inherently competitive EHR providers have come together to work alongside clinical researchers,” said Dr. Brian Anderson, chief digital health physician at MITER Corp., a technology group without profit. which formed the coalition in late March.
Anderson said the coalition is “getting closer” to being able to share some results of reports of treatment of people with convalescent plasma recovered from patients who have survived COVID-19. The group is also examining treatment data on the drug remdesivir, as it solves some of the technical difficulties that complicated its analysis of hydroxychloroquine. Last week, the Food and Drug Administration warned that hydroxychloroquine could cause heart problems and should be used only in a hospital or clinical trial.
There are other signs that the EHR industry is relaxing its grip on medical data in response to the emergency. EHR’s main provider, Cerner Corp., has offered researchers access to some types of COVID-19 data, including “clinical complications and outcomes that could help make important medical decisions.”
And some health systems have started publishing data extracted from EHR. A study published this month, for example, tracked the outcome of 5,700 coronavirus patients treated at 12 hospitals in a New York City health system and found that 88% of patients who received ventilators had died. All hospitals shared the same record provider.
“In crisis, people are looking for data and the authorities are demanding it,” said Cook, the health care security specialist. But, he said, “it is not possible to build such a system on demand.”
Ross Koppel, a longtime University of Pennsylvania professor and security expert at EHR, said the COVID-19 pandemic illustrates both the “strengths and disappointments” of digital systems.
While healthcare systems using a single provider have been able to pool data, Koppel said, the industry has struggled with regulators seeking to adopt common standards, a practice known as interoperability.
“Failing to exploit these oceans of invaluable data reflects the power of providers to circumvent government requirements for data standards and interoperability,” he said.
Limits on electronic data collection systems are also hampering COVID-19’s public health and surveillance efforts.
Authorities said they are sometimes required to manually fill out and fax some forms, wasting valuable time. Some of the information must be printed from EHR and re-entered by public health authorities because it cannot be sent electronically.
Certain CDC forms, such as COVID reports of person under investigation, can take up to 30 minutes to complete. Other forms exchanged between hospitals and laboratories often lack critical information, leading to delays in contacting patients and identifying people with whom they had close contact. In some states, demographic information on race and ethnicity is missing 85% of the time, and patient addresses half the time, according to Janet Hamilton, executive director of the Council of Territorial and State Epidemiologists.
“We are using yesterday’s technology for the biggest public health emergency in our lives,” said Hamilton. “COVID has shown people what we have known all along. You cannot leave public health at the end of the line.”
The government’s health IT chief says a new administrative rule to promote interoperability and ban EHR manufacturers from impeding the flow of information will take time to change behavior.
“If this had happened three or four years into the future when we have interoperability … we would be in a much better place here. But unfortunately, that is not the case, but we still keep up our work,” Donald Rucker, national coordinator of technology for health information, he said during a virtual meeting on April 15.
Source: Newsdio