How Providence outfitted its EHR within 24 hours of its 1st COVID-19 patient

As soon as the care team at Renton, Wash.-based Providence realized they had their first case of COVID-19 in late January, the IT team sprang into action to update their Epic EHR with tools to support identifying and treating future patients with the coronavirus.

"The good news for us was that we had the infrastructure for screening patients coming in with a virus for a long time," said Tabitha Lieberman, senior vice president of clinical and revenue cycle applications at Providence. "This isn't the first virus healthcare organizations needed to screen for. We took the tools that we have used in the past for other viruses and applied them to the COVID-19 pandemic. We modified the underlying toolset within 24 hours so that patients connecting to us at any entry point was assessed for whether they were at risk for having the coronavirus."

Whether the patient called to schedule an appointment, used online scheduling tools or arrived at a Providence-supported clinic, they were asked the same questions about their symptoms and whether they had recently traveled from China. As the situation evolved, the team was able to rapidly update the questions for a more targeted response. The team was even able to customize the questions by community so that patients in Washington and California both got the right questions based on risk.

"Now it's so widespread we don't have to be that specific anymore having modified the screening appropriately," said Tabitha Lieberman. "We are trying to capture as much information as possible to direct patients to the right care modality and not increase the spread. We are a bit ahead of the rest of the country in Washington, but the virus is spreading rapidly and we are deploying change management tactics across our system.

Within the first few weeks, the system made about multiple changes every day to the EHR toolkit; the number of changes has since dwindled, but efforts to ramp up virtual visit capacity and develop a virtual command center are still a top priority. The system launched its virtual command center about one month after patient zero to manage all IT functions remotely. The virtual command center teams hold daily calls to coordinate tickets and resolutions for IT updates with about 700 people working together on COVID-19 related items.

"The work that Tabitha and her team have done is fantastic," said Providence Executive Vice President and CIO B.J. Moore. "Not only have they been agile, but they have done it in a scalable and extensible way. When the crisis is over, we will have durable assets that will change the way we deliver care in the U.S."

The team's efforts now go beyond supporting the health system's physical locations, and community connect sites using Providence's EHR network, to also support new drive-thru testing locations, labs and expanded telehealth.

"We want to make sure we're tracking everything and know what is happening at all locations," said Ms. Lieberman. "For the infectious disease group within our system, we have a variety of clinical areas we can tap into for information and IT people working with the group to iterate data analytics for key insights during the pandemic. We have a single Epic platform across a number of our sites, so we can share data and information across all locations."

Providence supports around 70 non-affiliated community connect organizations with its IT systems, which has accelerated communication across all platforms during the coronavirus pandemic. The IT affiliates have a chance to give feedback on which tools they need to serve their communities well. The ability to flag COVID-19 cases in different geographies helped Providence track the virus and plan for resource management ahead of the spike in cases.

"We have been able to set up labs and innovate quickly because we can see the trends in where COVID-19 cases are growing within the communities we cover," said Ms. Lieberman. "We want to make sure we have the right labs in the right places and they can obtain results quickly.

Prior to treating its first COVID-19 patient, the virtual care team at Providence saw around 40 to 50 patients per day; however, that number has grown to around 1,000 per day in the past few weeks. The health system is now launching a broader telehealth effort to ensure its more than 7,000 providers who would typically see patients in the office can now conduct their visits virtually. Providence providers will use Zoom to connect with patients and the IT team has made it easy for clinicians to interface with patients, document the visit and bill for the visit.

"We have worked with Epic to automate as much as possible so it was easy for them to do the right thing," said Ms. Lieberman. "We built the tools so they correspond with the operational needs of the video visits and we have a team out there to provide different levels of support to clinicians based on need."

Finally, Providence has boosted its home monitoring capabilities with a combination of tools that ensure direct communication with the patients to report on their vitals and overall health. The patient's information also shows directly in EHR so the provider can see all documentation in near real time.

"We went from zero patients home monitored to over 350 patients in a span of weeks," said Ms. Lieberman. "This allows patients with less severe symptoms to stay at home, when clinically appropriate, and not take up a hospital bed."



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