Clinical informatics accelerates health system adaptation to the COVID-19 pandemic: examples from Colorado

Abstract

Objective: Large health systems responding to the coronavirus disease 2019 (COVID-19) pandemic face a broad range of challenges; we describe 14 examples of innovative and effective informatics interventions.

Materials and methods: A team of 30 physician and 17 nurse informaticists with an electronic health record (EHR) and associated informatics tools.

Results: To meet the demands posed by the influx of patients with COVID-19 into the health system, the team built solutions to accomplish the following goals: 1) train physicians and nurses quickly to manage a potential surge of hospital patients; 2) build and adjust interactive visual pathways to guide decisions; 3) scale up video visits and teach best-practice communication; 4) use tablets and remote monitors to improve in-hospital and posthospital patient connections; 5) allow hundreds of physicians to build rapid consensus; 6) improve the use of advance care planning; 7) keep clinicians aware of patients' changing COVID-19 status; 8) connect nurses and families in new ways; 9) semi-automate Crisis Standards of Care; and 10) predict future hospitalizations.

Discussion: During the onset of the COVID-19 pandemic, the UCHealth Joint Informatics Group applied a strategy of "practical informatics" to rapidly translate critical leadership decisions into understandable guidance and effective tools for patient care.

Conclusion: Informatics-trained physicians and nurses drew upon their trusted relationships with multiple teams within the organization to create practical solutions for onboarding, clinical decision-making, telehealth, and predictive analytics.

Keywords: COVID-19 pandemic; advance care planning; clinical decision support; clinical pathways; crisis standards of care; electronic health records; onboard training; patient wearables; predictive analytics; telehealth; virtual healthcare.

Figure 1.

Cumulative COVID-19 visual pathway use. Patient encounters with use of pathway (brown). Unique providers using pathway (purple) at UCHealth.

Figure 2.

In-person and video visits per week, Jan–May 2020. In-person visits (red) and video visits (green) for the UCHealth system.

Figure 3.

EHR dashboard with tip sheets on video visits and work from home resources.

Figure 4.

Tablet-to-tablet video overcomes ICU connectivity limitations. Inset shows iPad mounted on rolling stand to capture monitor data for Bed B. iPad at nurse’s station displays vital signs with audio and visual alarms from Bed B. ICU rooms are designed for only 1 bed, therefore there are no network jacks for data from the second bed, and nurses at the nursing station cannot see or hear alarms from second bed. Tablet-to-tablet connection over wi-fi cleverly overcomes this technical limitation and can monitor 4 or more rooms simultaneously.

Figure 5.

COVID-19 clinical practice documents published to the internet. Document contents can be viewed here: https://www.uchealth.org/today/clinical-practice-documents/.