Use of clinical pathways integrated into the electronic health record to address the coronavirus disease 2019 (COVID-19) pandemic

摘要

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)–integrated clinical pathways (E-ICPs), which are easily understood care algorithms accessible at the point of care.Objective: To describe our institution’s creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools.Setting: Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices.Methods: Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19–specific E-ICPs along with a process for frequent reassessment and updating. We examined the development and use of our COVID-19–specific pathways for a 6-month period (March 1–September 1, 2020), and we have described their impact using case studies.Results: In total, 45 COVID-19–specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions, and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders were placed. Case studies demonstrate the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting.Conclusions: E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and they continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and nonurgent clinical conditions.