By Wilson Wang & Allan Freedman
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During the Ebola epidemic, response and recovery were hampered by the absence of heath data management technology that could do two things:
1) Make it clear and easy for medical providers to act on evidence-based protection, diagnostic and treatment protocols for a fatal, unfamiliar disease.
2) Record and provide the results of clinical care to public health bodies to inform strategies for reducing the trajectory of the epidemic.
Five years later, the covid-19 response is hampered by the same deficiency in technology. US health data management is falling short in providing life-saving protocols for patient care and clinician safety and in sharing data needed to track and respond to the pandemic.
There is room for hope. US hospitals rely on sophisticated electronic health management software based on an electronic medical record (EMR) backbone used by virtually all medical providers. This tech provides the opportunity for adaption, integration and much needed revisions against a virus which has outpaced our capacity to respond.
Clear protocols
In a public health crisis, clinicians need protocols. This is especially true with pandemics, when clinical care is uncertain and patient care is a threat to health and safety. The medical curriculum greatly favors treatment of chronic disease, not infectious diseases like covid-19. Absent direction, health providers find it difficult to protect themselves, make mistakes and deploy individualized concepts of safety. Imagine your doctor with two masks and a helmet.
This was seen at the outset of the pandemic. Emergency Room clinicians were not systematically provided basic information, such as: a) the criteria for testing B) how to test for the virus and c) how to test safely. Knowing testing was critical, providers swabbed away, sending samples of varying quality to labs that would take days to return a result. In the process, many providers risked patient health, infecting themselves and contributing to community spread.
The gaps in treatment standardization were concerning. Clinicians admitted covid-19 patients for monitoring. Later, they discharged anyone who did not require oxygen with instructions for voluntary quarantine. Some prescribed antibiotics. Lacking access to protocols promulgated through a single technology channel, doctors turned to Google. No one could argue that this is the way doctors should determine patient treatment.
Open Data
In the US, patient data is tightly held. One justification is patient privacy. Another is that providers perceive records will be misinterpreted and open themselves to legal action. Lack of open data deprives public health bodies of trend and treatment information critical to formulating effective recommendations to clinicians and the public, particularly in pandemics where the characteristics of pathogens constantly change.
One result is care based on fear care. Patients with asthma are denied standard sometimes life-saving respiratory treatment for fear they will spread covid-19, even if there are no studies that show overlap in the two diseases. At many New York hospitals, doctors routinely administer the anti-malarial chloroquine, which still lacks data to substantiate its use. Using an experimental treatment may be justified, but the lack of data collection and study is a missed opportunity.
Data gaps are still lacking in the breakdown of age groups, the percentage of sick patients with co-morbid illnesses and common clinical presentations. Public health leadership is left developing strategy without the latest clinical information.
New Solutions
The information and data backbone of our healthcare system – the EMR– must be reoriented from a simple recording platform to one offering critical decision support. Health data management can no longer forsake worker protection and accurate disease diagnosis and treatment when these are exactly the outcomes for which technology is created.
Industries including aviation and food-services have used information technology for decades to standardize work and review performance. This approach in healthcare would improve safety and speed recovery. A revised EMR would allow clinicians to enter patient vitals, symptoms and signs. The technology would alert for covid-19 risks and recommend safety protections and treatment.
Structured EMR data could be aggregated to coordinate the public health response. Positive tests could inform enforced quarantines and better analytics to determine at-risk populations. Therapeutics could be tracked more comprehensively, so too could the experience of patients on respirators to better determine deployment and use.
The challenge is not the investment in healthcare technology but the orientation of its use. EMR systems are designed to facilitate administrative tasks, such as billing. But in assisting medical decision making, we must face and overcome limitations. Without a reboot, clinicians, public health officials and the public will continue to lack a critical tool in pandemic response.
