Epic leader talks EHRs, and how they're helping with COVID-19 vaccination efforts
So far, the U.S. healthcare system has vaccinated half of the country with the various COVID-19 vaccines. It’s been a tremendous feat in only a matter of eight months. Now comes the hard part: trying to convince those who are hesitant to take the vaccine, or outright refuse to do so, in an effort to reach herd immunity.
But in the effort so far, one of the important tools helping U.S. caregivers has been the electronic health record. It’s been crucial to document who has received the vaccine. What’s more, there are aspects of the technology that assist physicians, nurses and pharmacists in their tasks.
EHR giant Epic was hard at work last year preparing its tools for administering the vaccine. Now it’s had the experience of wide-scale vaccination in the middle of a worldwide pandemic.
Healthcare IT News sat down with Nick Frenzer, an implementation executive at Epic, to discuss the part EHRs have played to date with COVID-19 vaccination, some of the non-traditional vaccination settings where Epic has helped, the role of data modernization, and how QR codes have come into play with Epic and vaccinations.
Q. What role has the electronic health record played in the United States’ vaccination efforts?
A. Documenting vaccinations starts as simply as identifying the patient, recording the logistical information around the vaccine and how it was administered, and providing follow-up instructions for a second dose and proof of vaccination.
In and of itself, this was accomplished through a variety of electronic means. Many were documented in EHRs in physician clinics, mass vaccination sites and employee health drives. Many still were administered within the walls of grocery stores and pharmacies through a variety of electronic means.
Where the EHR became critical is the connection of vaccine information to the patient’s medical record, communication with their primary care or acute care provider, and integration back to the patient for record keeping.
What we have found during the pandemic is that the most critical part of the EHR is ensuring it can receive and process the vaccination in real time, in a way that makes sense to patients and providers.
Soon after vaccination started, businesses and venues started to request proof of vaccination, and very quickly the paper CDC cards became insufficient. The patient-facing portion of EHRs in the form of web or app-based patient portals became critical to everyday life, and this is all backed by the EHR – supported by the thousands of healthcare organizations relying on them for safe patient recordkeeping.
As we progress toward 2022, EHRs must engage patients directly on their vaccination status – it is no longer something done early in childhood and at 10-year intervals, but something each person has to decide and empower themselves to act upon.
EHRs provide the conduit for people to review their medical history and vaccination status and act on it through a variety of methods. Our responsibility is to ensure that however the patient received that vaccination, the EHR can receive and face it in real time for population health monitoring, regulatory requirements and, most important, direct patient care.
Q. Vaccinations are in the forefront with states that are again facing COVID-19 surges. What are some of the non-traditional vaccination settings where Epic software is being used, and how does having software in these settings help?
A. There are two main areas Epic is being used in non-traditional settings: mass vaccination clinics and community outreach clinics. The former was more prolific earlier in the year when we saw sites administering up to 15,000 vaccinations a day through drive-through sites and other venues focused solely on delivering shots in arms as quickly as possible.
As the year has progressed, as expected we saw that mass vaccination clinics reached their maximum threshold of patients and we had to go out into the community to reach the rest of the population.
Community outreach clinics can take many forms. Some are in church basements where our healthcare partners have provided vaccine and electronic documentation methods (often our phone app, Rover) for documentation in the community.
In other places, we’ve seen Epic used in jails and homeless shelters where vaccine administrators are focusing on populations who often move and do not have reliable access to healthcare or an EHR. These were cases where it was especially important to use interoperability networks to ensure once a patient in this group was documented, we had a consistent way to identify them if they presented in another setting.
Having one patient record for that person that can be referenced, even if the patient is unable to clearly identify themselves, makes the difference down the road when we are trying to shore up vaccination gaps around the globe.
Q. How can data modernization help vaccination efforts?
A. The pandemic shined a light on the lack of investment in healthcare data standards in the United States. The information immunization systems (IIS), of which there are more than 60, by and large do not talk to each other, and in many cases do not meet modern data needs.
This isn’t a lack of effort on the part of the states, but a lack of investment in server architecture and staff to service those systems. While EHRs can transmit vaccine information between each other and to the state, we found many cases where the state IIS was unable to intake data on a real-time basis, or in some cases at all.
There was a rapid catch-up effort to ensure we had at least basic electronic transmission, but in some cases it still is not as effective as it should be. In addition, the multiple layers of regulation that sometimes directly conflict in terms of what data should and shouldn’t be collected make designing data streams between these systems extremely challenging.
As this is unlikely to be our last pandemic, we need to invest in state registry reporting in two ways. First, bring the state IIS and other regulatory reporting systems up to a level where they can receive data in real time based on the current industry (FHIR) standards. Maintain these systems so they continue to keep pace as the healthcare technology industry evolves.
Second, we need to invest time in a standard method of data reporting across states. The healthcare industry needs to understand across the board when race, for example, should be collected and what are the expected values that the state and federal government expect to ingest.
Population health reporting will be disjointed until this is resolved, and it is less about any one group dictating a standard as it is the need for a collaborative meeting, led by the appropriate regulatory agency, to facilitate a shared agreement that can be implemented.
Outside of the IIS challenges, the healthcare industry made quick strides during the pandemic to agree across EHRs and organizations on expectations around vaccine record transmission. Interoperability of vaccine records spans across EHRs, and we see a high level of anticipation of the next round of booster shots or potentially net new immunizations.
Q. Please talk a bit about the vaccination QR codes being used in Epic’s MyChart and how they help provider organizations.
A. First, the key to the vaccination codes is that they are not EHR-specific. They need to be readable by stadiums, airlines and other businesses, which require a safe method of confirming vaccination status. If we see organizations develop their own standards, we’ll be in the same boat as electronic device chargers – in isolation each one works fine, but you’re going to end up with a drawer full of wires and codes.
To prevent that, we want to support a single standard that is shared across EHRs and businesses and can be verified in real time. We’re supporting the Vaccine Credentialing Initiative in this effort, which we expect to be widely adopted by large technology providers, including Epic.
Today, I can open MyChart on my phone and in one click arrive at my vaccination status. I’ve had to do this in New York to prove my vaccination status a few times. It’s human readable and you can clearly see when I was vaccinated and how.
Now, we’ll provide a QR code, which an airline gate agent, for example, can scan and receive confirmation in their app that this is a secure and accurate vaccination status. We need both – the human readable portion, which can be shown in the app, on a laptop or printed, as well as a secure digital method. This is portable, and can be downloaded to stand alone or transmitted as the person needs for travel or job hunting, for example.
Provider organizations already receive vaccination status by interoperability standards, both at Epic organizations and non-Epic. Where the QR code helps them is a consistent way to provide the patient with means to show their vaccine status – it reduces the overhead of printing codes, replacing CDC cards and inquiries.
In addition, in the event a provider was on a lower-tech solution that did not support interoperability, they could scan the code and have a secure confirmation the patient is vaccinated. It provides a consistent experience for the patient – I show my screen to the requester – and a consistent experience for the recipient – I scan and confirm. This ties together interoperability between systems, and how the patient experiences and acts upon their vaccination status.
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