Utilizing a health information exchange to facilitate COVID-19 VA primary care follow-up for Veterans diagnosed in the community

Abstract

The use of alerts from the Bronx RHIO, a health information exchange (HIE) to identify James J. Peters VAMC patients diagnosed with COVID-19 in the community was described to facilitate COVID-19 VA primary care follow-up. COVID-19 hospitalization and testing alerts were delivered on a Bronx RHIO facility report. VA COVID-19 follow-up care by telephone and video was guided by local COVID-19 clinical pathways, electronic health record (EHR) templates, and tracking through a database. VA received 180 RHIO alerts for 111 unique patients, and 88 had positive non-VA testing from March to June 2020. 41% of the 88 had non-VA admissions and 23% died. 63% received VA primary care follow-up of COVID-19 symptoms documented by custom EHR templates. The HIE identified 11% of the facility COVID-19 patients. HIE alerts can be used to identify facility COVID-19 patients diagnosed in the community and facilitate follow-up by their VA primary care teams.

The Primary Care COVID-19 Integrated Pathway: A Rapid Response to Health and Social Impacts of COVID-19

“…Literature evaluating community-based COVID-19 care pathways in the United States demonstrates similar ndings 5,10 . Patel et al evaluated a remote monitoring pathway for high-risk COVID-19 patients discharged home in Colorado 5 .…”

“…Between April and June 2020, 422 patients were monitored through the pathway, with only 4% re-admitted to the hospital and 3% visiting the emergency department within 30 days 5 . Sherman et al described a health information exchange pathway in the United States which alerts PC teams when veterans are diagnosed with COVID-19 in community facilities 10 . The health information exchange system integrated COVID-19 results from state reporting systems to identify and note COVID-19 diagnoses on patients' electronic medical records, notifying their PC team for follow-up 10 .…”

“…Novel pathways incorporating PC have been developed to provide COVID-19 care following hospital discharge 5,6 . There are studies describing community-based PC pathways for COVID-19 care within a North American context [7][8][9][10] . For example, in United States, a remote monitoring pathway for high-risk COVID-19 patients discharged home was used by new and established PC physicians, medical students, and nurses who conducted daily phone calls to patients and regularly monitored vital signs over eight days, or as needed 5 .…”

“…For example, in United States, a remote monitoring pathway for high-risk COVID-19 patients discharged home was used by new and established PC physicians, medical students, and nurses who conducted daily phone calls to patients and regularly monitored vital signs over eight days, or as needed 5 . Another study used a health information exchange pathway to alert PC teams when veterans were diagnosed with COVID-19 in community facilities 10 . Thus, this model of communication facilitated follow-up care from established PC teams for patients that may not have been identi ed otherwise 5,10 .…”

“…Another study used a health information exchange pathway to alert PC teams when veterans were diagnosed with COVID-19 in community facilities 10 . Thus, this model of communication facilitated follow-up care from established PC teams for patients that may not have been identi ed otherwise 5,10 . However, there is no literature evaluating COVID-19 care models as developed and executed in Canada.…”