CC BY 4.0 · ACI open 2022; 06(02): e85-e93
DOI: 10.1055/s-0042-1756435
Case Report

COVID-19 and the Electronic Health Record: Tool Design and Evolution at the U.S. Pandemic Epicenter

Surafel Tsega
1   Department of Medicine, Division of Hospital Medicine, The Mount Sinai Hospital, New York, New York, United States
,
Mahima Vijayaraghavan
2   Clinical Informatics, Mount Sinai Health System, New York, New York, United States
,
Marianne Chronister
2   Clinical Informatics, Mount Sinai Health System, New York, New York, United States
,
Sindhu Srinivas
2   Clinical Informatics, Mount Sinai Health System, New York, New York, United States
,
Adel Bassily-Marcus
3   Department of Surgery, Division of Critical Care, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Jeffrey Gumprecht
2   Clinical Informatics, Mount Sinai Health System, New York, New York, United States
,
Avniel Shetreat-Klein
4   Department of Rehabilitation and Human Performance, Clinical Informatics Group, Information Technology Department, Mount Sinai Health System, New York, New York, United States
,
Bruce Darrow
5   Department of Medicine, Division of Mt. of Cardiology, Sinai Hospital, New York, New York, United States
,
Catherine K. Craven
2   Clinical Informatics, Mount Sinai Health System, New York, New York, United States
› Author Affiliations
Funding None.

Abstract

Objective We detail inpatient electronic health record (EHR) system tools created at Mount Sinai Health System for the clinical management of patients with coronavirus disease 2019 (COVID-19) during the early pandemic months in the U.S. epicenter, New York City. We discuss how we revised these tools to create a robust Care pathway, unlike other tools reported, that helped providers care for these patients as guidelines evolved.

Methods Mount Sinai Health System launched a Command Center on March 8, 2020. The Chief Medical Information Officer launched a workgroup of clinical informaticists and Epic analysts tasked with rapidly creating COVID-19-related EHR tools for the inpatient setting.

Results Initial EHR tools focused on inpatient order sets for care standardization and resource utilization. In preparation for a fall 2020-winter 2021 surge, we created a clinician-facing, integrated Care pathway incorporating additional Epic System-specific tools: a Care Path, a dedicated Navigator, Summary and Timeline Reports, and SmartTexts.

Discussion Initial tools offered standard functionality but included complex decision-making support to account for the lack of COVID-19 clinical knowledge, operational challenges during a dramatic patient surge, and resource limitations. We revised content and built a more comprehensive Care pathway that provided real-time clinical data along with treatment recommendations as knowledge evolved, e.g., convalescent plasma.

Conclusion We have provided a framework that can inform future informaticists in developing EHR tools during an evolving pandemic.



Publication History

Received: 09 July 2021

Accepted: 19 July 2022

Article published online:
18 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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