Detroit: COVID19 CLINICAL INFORMATICS PREPAREDNESS SHARED FROM THE FRONTLINES: HENRY FORD HEALTH SYSTEM

Submitted by:
Donna Summers MSN RN-BC, Informatics Nursing
Chief Nursing Informatics Officer – HFHS

Notes from the field:

“So first in Michigan (Detroit and Southeast Michigan) – we are not gearing up we are in the midst of a big surge so these are more of our actual actions.
The first day that Michigan declared a state of ER and The Federal Government as well – we came together as an IT team (Epic, Infrastructure, Analytics, Clinical Informatics) and discussed our response. We immediately initiated what we call our “go-live command center.” This was a well-established process from our Epic go-lives that all of our teams are familiar with the process. We have delivered on every request in the time needed so far. We also canceled our April Upgrade and training.” Donna Summer, MSN RN-BC CNIO HFHS

The following are notes from the field sent from the CNIO on how they have met the need so far. (Date: April 1, 2020)
Here is what Henry Ford Health System did:

  1. Activated what we call our go live command center
  2. Stopped all other work
  3. Identified the top priorities and put efforts only toward those items
  4. Documented and provided owners operational and Epic IT team to track work
  5. Put Redeployed PM’s1 on two MACC2 groups (build new depts)
  6. Twice daily meetings to check in and reprioritize work
  7. Embed nursing informatics in site incident command centers to anticipate needs (leaders are too busy to reach out)
  8. Daily team meetings to provide system and Helios updates to teams
  9. Ability to quickly change current practice in order to expedite work. Examples:

1 PM=project managers
2 Healthcare MultiAgency Coordination Center (H-MACC)

  1. Giving Epic access prior to training and then quickly creating elearnings and webinars. Because these areas are part of our teams we could move fast.
  2. Clinical informatics people who can guide clinical build instead of waiting for others to direct.
  3. Identifying change management and education needs.

10. Look at dashboard and capacity and make the decisions for the system to respond to.

Here is just some of the work HFHS has done since emergency declared – and Nursing Informatics has been instrumental

  1. Average creating one to two more departments per day to increase both ICU and Med- Surg capacity (this is a multidisciplinary team that has now been working 19 days straight) and this is not slowing down.
  2. Today (April 1, 2020) we are creating a Medical units in two ambulatory sites and two field hospitals to house in patients who are stable but can’t be transferred to SNIF’s because either the SNIF’s don’t have the ability to care for them or we are waiting for subsequent negative COVID tests.
  3. Amazing Pathology Informatics people who were one of the first in the country to come up with a test so we were fortunate to have internal testing nearly from the beginning
  4. Cancelled all nonemergent procedures/surgeries
  5. Closed multiple clinics
  6. Increased capacity for televisits and added using Haiku for televisits – we are averaging about 300 concurrent sessions now
  7. Developed a Nursing Disaster Navigator with reduced documentation/policy – implemented this within 1 week of the disaster and so much needed (NIS, CNS). We copied Vanderbilt’s design and policy3. Used Epic’s idea but had to build ourselves using our content (Elsevier)
  8. Asked to participate in a regional COVID strategy sharing meeting – we had implemented all of the recommendations but most of the participating hospitals had not. (We shared with Chicago hospitals what we built in our disaster navigator).
  9. Started today on a RT disaster documentation – anticipating standalone vents in unusual places without device integration – need to shorten Vent documentation
  10. Device integration and central monitoring is a big need as we go into unusual areas for patient care – they are as busy as our build teams
  11. We have given as many as 3 Epic documentation roles to redeployed staff
  12. Redeployed many people and nurses – created expedited access and on the fly eLearning training. (Thank God for the disaster navigator because we are just now training nurses to this.)
  13. Screening tents, clinics were deployed in the first days
  14. But it took us about >1 week to set up pools for results for notification
  15. Employee plans for exposure, testing and back to work always evolving – biggest issue with surges is nursing staff. But also EVS, providers. (At one of our sites we have >100 staff awaiting results or recovery to come back to work.)
  16. Updating Body disposition policies and documentation
  17. Added a screening bot for patients
  18. Used MyChart to send messages to patients

3 Tie to Vanderbilt’s Nursing Documentation recommendations—see additional resources

  1. Developed dot phrases that have discharge instructions centrally and can be updated when changing
  2. Worked with Healthwise to get basic discharge instructions, patient videos. Put in English and Spanish, but paid to get Bengali and Arabic too (large populations in our areas).
  3. Really hard to help redeployed staff: AMB RN to IP, CRNA’s to ICU/ED or APP role, Techs, Aides, IP RN to ICU RN, – no end to the different combinations – so lots of access/training with elearnings and webinars by nursing informaticists
  4. Stopped all onsite classroom training last week (not ideal in helping our RN’s who are redeployed). Even new hire nurses – webinars (not a best practice but only option right now)
  5. Lots of NI support for CRNA’s in new roles – want to use their Anesthesia tools for an IP encounter – same with their perioperative nurse counterparts.
  6. In general a lot of scared redeployed nurses both of COVID but also of their lack of experience in these specialties. Started this week with some alternate nursing models
  7. Analytics, Analytics – everybody and their brother external to the health system wants data – one letter from VP Pence had approximately 72 data elements in it.
  8. We were able to get basic dashboards going quickly – COVID admitted patients, pending tests, patients in isolation. Recently added our discharged alive and deaths. Doing our own predictive models related to our data only.
  9. Employee testing dashboards, transfer data – now working on hand off preparation if we send patients to the newly planned FEMA field hospital.
  10. Analytic challenge tracking capacity – we have to continually update as we change units to COVID, NON-COVID, ICU, GPU, Mixed acuity etc. . . .
  11. Some absolutely phenomenal build done by our Epic team that fortunately has NI’s on it and our NIS. And thank goodness we have nurses – because operations can’t spare anyone to help us with order sets, bpa’s and triage build
    1. Triage system with auto-calculation of SOFA/mSOFA (amazing) and color codes. (Hoping we don’t have to do this but ready.)
    2. Order sets for terminal weans
    3. Comfort Hospice care orders – the protocols are really hard to follow and we anticipate some might happen outside our ICU’s. Influenced the decision to use an assessment score to determine actions. NIS developed a Visio and education. We go live with that tomorrow.
    4. Amazing pharmacist informatics people for complex order sets
    5. COVID order sets
    6. Constant movement of providers and clinics and then schedules too

“I am sure I missed at least 50 things because the pace is crazy. Glad to share with anyone who needs help. They should have a plan!”

Notes on staffing challenges:

“Frequent thanks and reminders that our clinicians have it worse than us (many have worked 14 days straight). Not good at thinking long term on staff and their ability to keep this pace. We have people that do not have back up. Good at short term; we have to figure out how we maintain this pace.”

Donna Summers MSN RN-BC, Informatics Nursing Chief Nursing Informatics Officer – HFHS

THANK YOU HENRY FORD HEALTH SYSTEM AND NURSES STAND STRONG!

NYC: COVID-19 Approaches to Consider from Victoria Tiase, NewYork-Presbyterian Hospital, Director of Research Science

Thanks to Vicky Tiase for sending out a list of recommendations at a very busy time:

  • Develop COVID initial assessment templates and tailor alerts quickly
  • Consider scribes for ED triage/high volume areas
  • Permit nurses to place electronic orders for lab tests (dependent on state policies)
  • Perform remote/video triage to preserve PPE
  • Use of data for Bed tracking/vent tracking/nurse tracking
  • Ability to capture/confirm a remote consent
  • Coordinating patient/family visits via video to address social isolation for patients
  • Answer patient questions using Telehealth
  • Community/public health nursing workforce to distribute/deploy remote monitoring devices to the homes of at risk populations (ability to identify at risk pts)
  • Future thoughts: enable use of robots for eldercare or patients that are quarantined 

Logica is coordinating iterative releases of COVID-19 and SARS-CoV-2 -related clinical information models, value sets, and interoperability resources. All assets are available under Open Source license free of charge.

See Logica site here for more information: https://www.logicahealth.org/covid-19-interoperability-project/

Upcoming AMIA COVID-19 Webinars Announced for April 7, April 9, and April 10:

  1. April 7 at 10am ET: Managing the Global COVID-19 Pandemic with Health Informatics – Successes and Challenges. Zhu Hong, PhD; Gong Mengchun, MD; Tuan Ngo; Carl Leitner, PhD; Hamish Fraser, MD. 
    As part of AMIA’s ongoing COVID-19 Webinar Series – and in collaboration with Digital Square – this webinar will provide an up-to-the-minute presentation of the use of informatics on a global scale to screen for and manage the COVID-19 pandemic. The session will include officials in China and Vietnam, and a view from the situation in Singapore, Korea, and Hong Kong. Presenters will engage in frank discussions of successes and innovations as well as the challenges and roadblocks. There will be a particular emphasis on the development, deployment, and evaluation of medical information systems in East Asia, and the lesson learned from China’s initiatives to bring the outbreak under control. 
      
  2. April 9 at 1pm ET: Dispatches from the Front: Virtual Care Models, Health Information Exchange, and Cancer Care During COVID-19. Shaun Grannis, MD, FAMIA; Ted Palen, PhD, MD, MSPH; Deepti Pandita, MD, FAMIA; Paul Fu, Jr., MD, MPH, FAAP, FAMIAIn collaboration with AMIA’s Clinical Information Community of Practice, this session will feature AMIA members who are working to develop and deploy tools to manage COVID-19 patients in the local health systems, and across state-wide geographies. Presenters will discuss the role of clinical informatics plays in facilitating the rapid switch from traditional modes of care delivery to virtual care modes, informing the workflow and monitoring of inpatient care through the development of patient dashboards and remote monitoring. Informatics clinicians and researchers working together with healthcare operations is an essential partnership for the development of structured documentation tools, tracking utilization, planning for staffing, and for predictive models. This session will offer CME.  
  3. April 10 at 2pm ET: Dispatches from the Front: Combating the Coronavirus with Clinical Informatics and Health IT
    Brian Clay, MD; Howard Landa, MD; Margaret Lozovatsky, MD; Kevin McEnery, MDIn collaboration with AMDIS, this session will feature clinicians who are leveraging electronic health records and other health IT tools to deploy rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. Presenters will discuss strategy and pitfalls related to managing clinical information related to COVID-19 patients and reporting such data to public health authorities during this national epidemic. Presenters will also discuss some of the long-term implications to clinical informatics caused by responding to the coronavirus. This session will offer CME.

Thanks to Judy Murphy for sharing this information!

For more information on these webinars, please see: https://www.amia.org/education/live-webinars/shifting-sands-how-policymakers-are-addressing-covid-19-pandemic-and-what-it

Vanderbilt Nursing Informatics COVID Response: Interview with Patricia M. Sengstack and Karen Hughart

ANIA 2020 National President, Cheryl D. Parker, PhD, RN-BC, CNE, interviews experts at Vanderbilt University Medical Center regarding how they are handling the COVID-19 crisis in America. Dr. Sengstack and Ms. Hughart also provided some materials describing their SOP for reduced nursing documentation. Thank you to: Karen Hughart, MSN, RN-BC Senior Director, Nursing Informatics Vanderbilt University Medical Center Patricia P. Sengstack DNP, RN-BC, FAAN Associate Professor, Vanderbilt University School of Nursing Nursing Informatics Executive, Vanderbilt University Medical Center

Additional Resources related to Reduced Nursing Documentation:

Rapid Response: Sharing Informatics Knowledge & Processes

by Cheryl D. Parker, PhD, RN-BC, CNE – 2020 ANIA President: On Tuesday, 3/31/20 at 4:42 PM (CT), Dr. Patty Sengstack, my friend and colleague, reached out to me in my role as the 2020 President of the American Nursing Informatics Association. She asked for help in getting information about what they are doing at Vanderbilt about COVID-19. She said she had fielded eight individual calls for information in the last four days. Could ANIA help get the word out? My answer was absolutely, and we made arrangements to do a video interview on Friday. On Wednesday, 4/1/20, I get a call from another friend and colleague, Dr. Susan McBride, telling me she and others from the American Academy of Nursing’s Expert Panel on Informatics & Technology have heard about the interview I am going to do with Patty.  She asked if ANIA could work together with her team as they had created this site to disseminate information about what facilities are doing about the COVID-19 crisis from an informatics and technology viewpoint.

Well, of course, ANIA’s Board of Directors were all-in on a collaborative effort. On 4/2/20, I was honored to join Susan McBride, Rosemary Kennedy, Judy Murphy, Jane Carrington, Liz Johnson, and Mollie Cummins to discuss how we could pool our efforts and how ANIA could support the work.

By Saturday 4/4/20, I had recorded our first ANIA’s “Nursing Informatics Experts Interview” with Patty Sengstack and Karen Hughart, the video was processed, scheduled five more interviews for next week, and we launched this sharing-of-knowledge initiative.  My head is spinning, but I am so proud of the fast work of combining the two visions into a single reality in 4 days!

ANIA Resources: https://www.ania.org/article/coronavirus

HIMSS COVID-19 Digital Think Tank

https://www.himss.org/news/covid-19-digital-think-tank

“In light of the COVID-19 crisis, Healthbox, a HIMSS Solution, has developed a digital think tank where healthcare professionals across the globe can share best practices about how to best test, triage and treat patients and manage their facilities during the pandemic.

The HIMSS COVID-19 Digital Think Tank is a valuable resource for you and your peers as you lead your facility, team and patients through the crisis. Share what you know, see what’s working for others, and bring lessons back to your community.  

  • Share. Have a COVID-19 related process or solution that’s working well in your organization? Submit it.
  • Learn. Looking for ways to better manage COVID-19? Explore solutions from fellow healthcare professionals.
  • Ask. Have questions about a solution? Comment on it and engage in the discussion.”

Please visit the HIMSS web site at: https://www.himss.org/news/covid-19-digital-think-tank for more information.

AMIA Launching COVID-19 Webinar Series Today

Material directly quoted from the AMIA site here: https://www.amia.org/education/live-webinars/shifting-sands-how-policymakers-are-addressing-covid-19-pandemic-and-what-it

Shifting Sands: How Policymakers are Addressing the COVID-19 Pandemic and What it Means for Health Informatics Professionals

April 2, 202012:00PM- 1:00PM,EDTFee: Free for AMIA members and non-members; no fee.Presenters: Jeff Smith, MPP; Joseph Kannry, MD; Susan Hull, MSN, RN-BC, NEA, FAMIA

AMIA is announcing a new COVID-19 Webinar Series to highlight how the informatics community is addressing this global pandemic from all angles. From front-line informaticians and public health informaticists, to clinical and bioinformatics researchers, AMIA’s members are uniquely positioned to leverage data and evidence in the fight against COVID-19.

The AMIA COVID-19 Webinar Series will look at the pandemic through a health informatics lens and is designed to share informatics responses to the COVID-19 pandemic. Panelists will share their specific domain expertise, including clinical informatics, public health informatics, translational bioinformatics, clinical research informatics, and consumer health informatics. We will also have special emphasis webinars covering topics related to global health, telemedicine, and public policy during the COVID-19 pandemic.

Beginning the week of March 30, AMIA will host a series of 60-minute webinars on specific pieces of this wildly complex situation and highlight how individuals and organizations are using informatics to address critical issues. The Series will begin with an overview of Public Policy issues, including shifts in the regulatory landscape and new legislation developed by the US Congress. Next, the Series will pivot internationally to focus on key global health issues being tackled around the world. Register for the first webinar in the series by clicking here: https://attendee.gotowebinar.com/register/3849749055436073995

We hope this Series helps highlight why informatics is so important to combatting the novel coronavirus and will demonstrate how our community of informatics experts are leading the way.

The first webinar of the COVID-19 Series will be an overview of Public Policy issues, including shifts in the regulatory landscape and new legislation passed by the US Congress. We will focus on the key health informatics policy issues to watch and discuss additional steps that may be needed to address this ongoing epidemic.

Please join us Thursday, April 2 at 12:00pm EST by registering here: https://attendee.gotowebinar.com/register/3849749055436073995  

Additional webinars in this Series will be announced shortly and will be produced over the course of several weeks. These webinars are for both members and should-be members of AMIA. Please feel free to pass along to colleagues and promote publicly.

Keep up to date on COVID-19-related activities and conversations by joining AMIA’s COVID-19 Community & Discussion Forum (https://connect.amia.org/communities1/viewcommunities/groupdetails?Commu…)

Speaker Information

Jeffery Smith, MPP
Vice President of Public Policy
AMIA

Joseph Kannry, MD
Lead Technical Informaticist
Mount Sinai Health System
Chair, AMIA Public Policy Committee

Susan Hull MSN, RN-BC, NEA, FAMIA
Chief Health Information Officer
CareLoop, Inc.
Member, AMIA Public Policy Committee
Co-Chair, Alliance for Nursing Informatics

Welcome: About these resources

Clinical and nursing informatics personnel are working hard and fast to prepare and manage health IT resources in relation to the 2020 COVID-19 pandemic. This site was developed by leadership of the Informatics and Technology Expert Panel, American Academy of Nursing, with collaboration and sponsorship of the American Nursing Informatics Association. We are passing along publicly available information, and sharing informal reports and documents with the permission of the authors. This material is being passed quickly, in the interest of providing resources, and we do not assure the accuracy or legitimacy of the material. Please contact us if you’d like to share some helpful tips/ information, a field report describing the problems that you are encountering, examples of strategies or SOP that have been successful, necessary workarounds, etc… or any other item directly relevant to the clinical/ nursing informatics community.