The COVID-19 pandemic is having a devastating world-wide impact on individuals, their families, the health care systems, and the general economy. In this post, we explore the role technology can play in addressing this crisis and propose a strategic framework for evaluating and pursuing technical solutions that are effective and can be easily deployed and scaled rapidly.
The Nature of the Crisis
COVID-19, the disease caused by the novel coronavirus, has progressed to a world-wide pandemic that is directly affecting the health of millions, wreaking havoc on health care delivery systems, and generating economic dislocation. Given that we are still learning about the epidemiology (how it spreads) and pathophysiology (how it causes disease in humans), and that specific therapies or a vaccine have yet to be developed, it is logical to anticipate a significant and ongoing challenge to health care delivery.
Successful improvement efforts in health care almost always address the role of people, process, and technology. Strategic innovations aimed at the COVID-19 pandemic should account for all three in a holistic manner. Innovation should be pursued as a series of practical experiments that address current gaps, result in near-term improvement, provide insights for future tests of change, and lead to a set of sustainable and scalable solutions that will be essential to ensure long-term success in addressing this enormous problem.
The Strategic View and a Framework for Innovation
When it comes to meeting the challenges of this pandemic, health IT (HIT) has a lot to offer. While there have been real advances in digitizing healthcare over the last decade, there is still much to be done. As this recent Politco article noted, we still rely on faxes and paper records to a significant degree. So, where do we begin? The ONC's Health IT Playbook provides useful examples of how health IT tools can help. Given the many different possibilities, having a method for organizing and prioritizing potential IT innovations is an important starting point. The following framework groups opportunities based on an abstract view of five types of functionality.
A Solid Foundation
There are a set of technologies that solve common problems and support similar needs. In effect, these solutions play a supporting role and are the foundation for all other categories listed above. Of particular importance are interoperability and native cloud computing functionality. This powerful combination provides the data which fuels individual applications, supports interactions between those applications, and facilitates the rapid deployment and hyper-scaling that a global pandemic requires.
Interoperability and Usability. Technology is useless if no one uses it, hence interoperability and ease of use are essential. Technologies like application programming interfaces (APIs) and fields like human factors engineering enable adoption and increase ease-of-use and clinical effectiveness. Taking a “build it and they will come” approach rarely works. Busy clinicians working with complex patient issues need tools that are intuitive and fit their workflow. And, from a technical standpoint, they allow for more rapid prototyping, development, and optimization while simultaneously enhancing the power and usability.
"This pandemic really points out the need to have interoperability. If we'd had this rule a few years ago, we'd be in a far better spot." - Don Rucker, MD, National Coordinator for Health IT
It’s been fascinating to watch the rush to adopt telehealth solutions in the early months of 2020. It seems pretty clear we did more to advance telehealth in two months than the previous two decades. The urgent need has led to many systems being deployed in a minimalistic, quick-and-dirty approach with minimal or no integration between telehealth platforms and electronic health records (EHRs). For now, good enough is good enough. That will change as the crisis wears on. Daily use of non-integrated systems with awkward workflows will wear on clinicians and impede efficiency. It’s possible to delay for a time, but there’s no escaping the need for integration solutions that are robust, easily deployed, and highly scalable.
The Cloud was Built for Pandemics
Addressing global pandemics using IT requires solutions that can safely and securely deploy and scale rapidly. Modern cloud computing offers an ideal platform for these applications by providing powerful services that act like “building blocks” that can be leveraged to create cloud-native applications. By design, these services can scale to meet global demands while remaining stable, responsive, and secure. Applications that are cloud native have a built-in advantage compared with traditional applications, especially in urgent situations like this pandemic. Many industries figured this out years ago and healthcare was increasingly migrating to the cloud as well. The current crisis underlines the need for cloud-based approaches and will likely accelerate this migration.
Building on the Foundation
With a secure foundation of interoperability and cloud-native capabilities in place, we can begin developing applications that meet various needs. The following framework provides a useful way to categorize and think about the different types of applications that could be deployed in response to the pandemic.
Situational Awareness. The concept of situational awareness is often applied to high-risk, high-performance activities. Aerospace, oil refineries, and the military focus on increasing the situational awareness of personnel because it has been proven to improve safety. Core to this idea is ensuring key information is available and both individuals and teams can readily absorb and act upon it. These technologies increase completeness and availability of information about cohorts or specific patients, often in real-time.
Clinical Decision Support. The digitalization of health care via deployment of EHRs sets the stage for clinical decision support (CDS). In the broadest terms, the goal of CDS is to “make it easy to do the right thing, hard to do the wrong thing.” Often this entails real-time interaction with end-users that is integrated into their workflow. CDS can be utilized by both healthcare providers and patients. A classic example is automated checking for interactions or allergies whenever a new medication is prescribed. For newly emerging diseases like COVID-19, CDS can play a critical role in helping clinicians comply the rapidly evolving recommendations for diagnosis and management by “hard wiring” the current best practices and embedding them in the clinical workflow.
Resource Allocation and Access. This includes technologies that guide the allocation of precious resources or facilitate access to services. Given the scale of the pandemic and limited resources, it is imperative that we “make the most of what we have.” This can include deploying resources where they will have the greatest impact and minimizing wasteful or ineffective activities. Examples might include managing the supply chain and distribution of critical items like ventilators, personal protective equipment (PPE), blood and blood products, and medications.
We can also think of access to providers as a resource that needs to be widely and optimally distributed. In this case, we have seen rapid, large-scale adoption of telemedicine in pursuit of creating better, safer, and more efficient means to access care.
Research. Solving the COVID-19 pandemic will require a deeper understanding of its causes and the discovery and validation of new therapies and other interventions. Technologies that support epidemiology, basic medical research, and clinical effectiveness evaluations will be essential on this journey of discovery. Given what we already know about disparities in patient outcomes related to socio-economic status, the emerging field of social determinates of health (SDH) will contribute to this understanding as well.
We are at the start of the beginning in addressing the COVID-19 pandemic. It’s clear that health IT has much to contribute to meeting the challenge. Starting with a solid foundation for interoperability and cloud-based architectures can ensure that applications have a real impact and can scale rapidly to meet the challenge. It is clear that at each stage from “bench to beside,” health IT is going to help us understand the basic science, tract the trajectory of the pandemic, and support us in providing consistent high-quality care at scale.