Rapid Implementation of a Complex, Multimodal Technology Response to COVID-19 at an Integrated Community-Based Health Care System

Abstract

Background The rapid spread of severe acute respiratory syndrome coronavirus-2 or SARS-CoV-2 necessitated a scaled treatment response to the novel coronavirus disease 2019 (COVID-19).

Objective This study aimed to characterize the design and rapid implementation of a complex, multimodal, technology response to COVID-19 led by the Intermountain Healthcare's (Intermountain's) Care Transformation Information Systems (CTIS) organization to build pandemic surge capacity.

Methods Intermountain has active community-spread cases of COVID-19 that are increasing. We used the Centers for Disease Control and Prevention Pandemic Intervals Framework (the Framework) to characterize CTIS leadership's multimodal technology response to COVID-19 at Intermountain. We provide results on implementation feasibility and sustainability of health information technology (HIT) interventions as of June 30, 2020, characterize lessons learned and identify persistent barriers to sustained deployment.

Results We characterize the CTIS organization's multimodal technology response to COVID-19 in five relevant areas of the Framework enabling (1) incident management, (2) surveillance, (3) laboratory testing, (4) community mitigation, and (5) medical care and countermeasures. We are seeing increased use of traditionally slow-to-adopt technologies that create additional surge capacity while sustaining patient safety and care quality. CTIS leadership recognized early that a multimodal technology intervention could enable additional surge capacity for health care delivery systems with a broad geographic and service scope. A statewide central tracking system to coordinate capacity planning and management response is needed. Order interoperability between health care systems remains a barrier to an integrated response.

Conclusion The rate of future pandemics is estimated to increase. The pandemic response of health care systems, like Intermountain, offers a blueprint for the leadership role that HIT organizations can play in mainstream care delivery, enabling a nimbler, virtual health care delivery system that is more responsive to current and future needs.

Keywords

COVID-19 - surge capacity - telemedicine - electronic medical record - health information interoperability

Protection of Human and Animal Subjects

We reviewed this work with our Institutional Review Board and concluded it was not human subjects research.

Publication History

Received: 22 April 2020

Accepted: 24 September 2020

Article published online:
16 December 2020

• References

• 1 World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it . Accessed October 12, 2020
• 2 Ruoran L, Rivers C, Tan Q, Murray MB, Toner E, Lipsitch M. The demand for inpatient and ICU beds for COVID-19 in the US: lessons from Chinese cities. Version 2. medRxiv
• 3 Glass RJ, Glass LM, Beyeler WE, Min HJ. Targeted social distancing design for pandemic influenza. Emerg Infect Dis 2006; 12 (11) 1671-1681
• 4 Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag 2017; 6 (08) 431-435
• 5 Hanefeld J, Mayhew S, Legido-Quigley H. et al. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan 2018; 33 (10) 1144
• 6 Lipsitz LA. Understanding health care as a complex system: the foundation for unintended consequences. JAMA 2012; 308 (03) 243-244
• 7 Burton C. Heavy tailed distributions of effect sizes in systematic reviews of complex interventions. PLoS One 2012; 7 (03) e34222-e22
• 8 World Health Organization. Responding to community spread of COVID-19: interim guidance, March 7, 2020. Available at: https://apps.who.int/iris/handle/10665/331421 . Accessed October 12, 2020
• 9 Office of the President of the United States. Proclamation on Declaring a National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak. Available at: https://www.whitehouse.gov/presidential-actions/proclamation-declaring-national-emergency-concerning-novel-coronavirus-disease-covid-19-outbreak/ . Accessed October 12, 2020
• 10 Governor Gary R. Governor Herbert announces two-week dismissal of Utah's Public Schools. Available at: https://schools.utah.gov/file/d50bddb8-a7bb-417a-9016-20b317a8b32b . Accessed October 12, 2020
• 11 Legido-Quigley H, Asgari N, Teo YY. et al. Are high-performing health systems resilient against the COVID-19 epidemic?. Lancet 2020; 395 (10227): 848-850
• 12 National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Pandemic Intervals Framework. Available at: https://www.cdc.gov/flu/pandemic-resources/national-strategy/intervals-framework.html . Accessed October 12, 2020
• 13 Utah Hospital Association Crisis Standards of Care Workgroup. Utah Crisis Standards of Care Guidelines. Available at: https://www.utahhospitals.org/images/Final_Utah_Crisis_Standards_of_Care_011719.pdf . Accessed October 12, 2020
• 14 World Health Organization. Shortage of personal protective equipment endangering healthcare workers worldwide. Available at: https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide . Accessed October 12, 2020
• 15 James BC, Edwards DP, James AF. et al. An efficient, clinically-natural electronic medical record system that produces computable data. EGEMS (Wash DC) 2017; 5 (03) 8
• 16 President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak. Available at: https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak#:∼:text=%E2%80%9CThe%20Trump%20Administration%20is%20taking,%2C%E2%80%9D%20said%20Administrator%20Seema%20Verma.&text=On%20March%2013%2C%202020%2C%20President,and%20the%20National%20Emergencies%20Act . Accessed October 12, 2020
• 17 Health Information Privacy. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. Available at: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html . Accessed October 12, 2020
• 18 Ranieri VM, Rubenfeld GD, Thompson BT. et al. ARDS Definition Task Force. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307 (23) 2526-2533
• 19 National Center for Immunizationand Respiratory Diseases. Interim Clinical Guidelines for Management of Patients with Confirmed Coronavirus Disease (COVID-19). Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html . Accessed October 12, 2020
• 20 Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342 (18) 1301-1308
• 21 Needham DM, Yang T, Dinglas VD. et al. Timing of low tidal volume ventilation and intensive care unit mortality in acute respiratory distress syndrome. A prospective cohort study. Am J Respir Crit Care Med 2015; 191 (02) 177-185
• 22 Fan E, Del Sorbo L, Goligher EC. et al. American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2017; 195 (09) 1253-1263
• 23 Weiss CH, McSparron JI, Chatterjee RS. et al. Summary for clinicians: mechanical ventilation in adult patients with acute respiratory distress syndrome clinical practice guideline. Ann Am Thorac Soc 2017; 14 (08) 1235-1238
• 24 Thompson BT, Chambers RC, Liu KD. Acute Respiratory Distress Syndrome. N Engl J Med 2017; 377 (06) 562-572
• 25 Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med 2013; 369 (22) 2126-2136
• 26 Brown SM, Peltan ID, Webb B. et al. Hydroxychloroquine versus azithromycin for hospitalized patients with suspected or confirmed COVID-19 (HAHPS). Protocol for a pragmatic, open-label, active comparator trial. Ann Am Thorac Soc 2020; 17 (08) 1008-1015
• 27 Morse SS. Factors in the emergence of infectious diseases. Emerg Infect Dis 1995; 1 (01) 7-15
• 28 Jones KE, Patel NG, Levy MA. et al. Global trends in emerging infectious diseases. Nature 2008; 451 (7181): 990-993
• 29 Madhav N, Oppenheim B, Gallivan M. Pandemics: risks, impacts and mitigation. In: Jamison DT, Gelband H, Horton S. et al. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd Edition ed.. Washington, DC: The International Bank for Reconstruction and Development; 2017
• 30 Reeves JJ, Hollandsworth HM, Torriani FJ. et al. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc 2020; 27 (06) 853-859
• 31 Hick JL, Hanfling D, Wynia MK, Pavia A. Duty to plan: health care, crisis standards of care and novel coronavirus SARS-CoV-2. NAM perspectives. Available at: https://nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2/ . Accessed October 12, 2020
• 32 Ravaud P, le Ouay F, Depaulis E, Huckert A, Vegreville B, Tran V. Reconfiguring health services to reduce the workload of caregivers during the COVID-19 outbreak using an open-source scalable platform for remote digital monitoring and coordination of care in hospital Command Centres. Available at: https://arxiv.org/ftp/arxiv/papers/2003/2003.05873.pdf . Accessed October 12, 2020
• 33 Mehrotra A, Jena AB, Busch AB, Souza J, Uscher-Pines L, Landon BE. Utilization of telemedicine among rural medicare beneficiaries. JAMA 2016; 315 (18) 2015-2016
• 34 Caffery LJ, Farjian M, Smith AC. Telehealth interventions for reducing waiting lists and waiting times for specialist outpatient services: a scoping review. J Telemed Telecare 2016; 22 (08) 504-512
• 35 Brewster L, Mountain G, Wessels B, Kelly C, Hawley M. Factors affecting front line staff acceptance of telehealth technologies: a mixed-method systematic review. J Adv Nurs 2014; 70 (01) 21-33
• 36 Almathami HKY, Win KT, Vlahu-Gjorgievska E. Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients' homes: systematic literature review. J Med Internet Res 2020; 22 (02) e16407-e07
• 37 Edwards A, Hollin I, Barry J, Kachnowski S. Barriers to cross–institutional health information exchange: a literature review. J Healthc Inf Manag 2010; 24 (03) 22-34
• 38 Bashshur RL, Shannon G, Krupinski EA, Grigsby J. Sustaining and realizing the promise of telemedicine. Telemed J E Health 2013; 19 (05) 339-345
• 39 Ross J, Stevenson F, Lau R, Murray E. Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update). Implement Sci 2016; 11 (01) 146