Why it's so hard for hospitals to track incidental COVID-19 cases

Hospitals are seeing an increasing number of incidental COVID-19 cases, where patients are being admitted for other ailments but testing positive for the virus. These cases aren't easy to track, and hospitals are finding many challenges trying to decipher between patients admitted for the virus as their primary condition and those with incidental cases.

Becker's interviewed hospital CIOs about the issue of tracking incidental cases to determine why this has been so difficult. Answers about incidental tracking pointed to three elements — COVID-19 testing and reporting, EHR systems, and hospital staff shortages — proving that incidental COVID-19 tracking data, at this moment in time, might be hard to come by for some hospitals. 


One major challenge is that there isn't a cohesive system between hospitals on COVID-19 reporting. Some hospitals are labeling all of its patients who test positive, whether incidental or not, as COVID-19-positive and not as incidental cases, while others are tracking incidental COVID-19 cases in a separate category.

Los Angeles-based UCLA Health has documented the amount of incidental cases coming into its hospitals. On Jan. 19, Ellen Pollack, MSN, RN, interim CIO of UCLA Health, told Becker's that its hospital documented an incidental COVID-19 rate of 62 percent. 


Mike Saad, chief information officer of Knoxville, Tenn.-based UT Medical Center, said hospitals around the country are also testing differently, making it difficult to understand how many incidental COVID-19 cases there are. 

"For example, in some hospitals, every patient admitted is required to be COVID tested. Doing so increases the number of patients who are COVID positive even though the patient was not admitted to the hospital specifically for difficulty directly related to COVID," Mr. Saad said in an email to Becker's. "Due to the amount of testing, these organizations will have a higher prevalence of incidental COVID-positive cases."

On the other hand, hospitals that are not requiring testing for all of their patients will not be recording incidental cases. 


Some hospitals' electronic health records do not have the capabilities to determine whether a patients' COVID-19 diagnosis was incidental or primary, making it difficult to quickly distinguish patients who have been admitted because of COVID-19 complications from those who tested positive for COVID-19 while admitted for something else.

Daniel Nigrin, MD, CIO at Portland-based MaineHealth, said the only way to figure out if a COVID-19 case was incidental is to do a manual chart review or ask physicians to identify each case. But with the number of staffing shortages hospitals are facing, that is almost impossible for MaineHealth to do at this time. 

"Considering how short-staffed and overwhelmed our clinicians are right now, that's not an easy task," Dr. Nigrin wrote in an email to Becker's. "I'm certain that doing some NLP analyses on the clinical documentation within a patient's chart could be used, but right now, we don't have that kind of functionality available yet."

Mr. Saad also stated that a manual chart review is necessary to get incidental COVID-19 data.


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