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Feds Looking to Standardize Decision Support for Ebola Screening in the EHR

October 16, 2014
by Gabriel Perna
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Representatives from both the Centers for Disease Control (CDC) and the Office of the National Coordinator for Health IT (ONC) co-hosted a special webinar this week on the use of clinical decision support (CDS) tools in the electronic medical record (EMR) to screen potential Ebola patients.

The webinar comes as the Ebola virus has become an international topic of discussion, amid a full-on breakout in Libera, Sierra Leone, and Guinea and a smattering of cases elsewhere. In Texas, where the first case of Ebola in the U.S. was treated, representatives from the treating hospital, Texas Health Presbyterian Hospital, a Texas Health Resources facility, initially blamed workflow issues in its EMR as to why the patient, Thomas Eric Duncan, was prematurely released from the hospital. However, the hospital later recanted that statement and said the travel history workflow was available in both doctor and nurse workflows.

The idea, according to CDC’s deputy lead of the Ebola Medical Care Task Force, Dana Meaney Delman, M.D., was to explore ways in which the EMR could prompt healthcare professionals to identify those at risk for Ebola in a timely manner.

For their part, the ONC—represented by Jon White, M.D. the acting CMO and director of office and quality and safety—said they have worked and will continue to work with the electronic health record association (EHRA) to work on standardizing the CDC guidelines into a CDS tool for EMRs. “We’re looking to see how we can best support health IT developers as you work with your clients and take the guidelines we’ve been discussing and turn those into resources you can use and implement,” Dr. White said.

Later, White specifically said they’ll take the treatment algorithm and work with developers to parse that information into a standardized document that can be shared across systems. “The simplest way to do this is a human readable document. You can get a lot more specific using tools developed for Health eDecisions [ONC’s CDS standards framework] and other standards for decision support. Not everyone can use that level of specification. We’re going to have that conversation with developers to figure out what’s most useful to them,” he added.

Dr. Delman and Phil Peters, M.D., also on the CDC’s Ebola Medical Care Task Force, shared the agency’s algorithm for evaluating and identifying someone with Ebola. The key elements in that algorithm the CDC wants to see as a decisional tool in the EMR are to identify those with a fever of 100.4 degrees Fahrenheit or compatible symptoms to Ebola and those who have traveled to a country with an Ebola outbreak in the last 21 days. With cases of Ebola being confirmed in America, Delman said they would want to include in this query patients who have had any exposure to an Ebola patient.

“Those are the important elements that we’re hoping could be translated into an electronic question that’s prompted in emergency rooms or care facilities around the country,” Delman said. “That’s the first and most important step to identifying patients with Ebola.”

Once those at risk for Ebola are identified, the CDC is seeking a mechanism in the EMR to alert healthcare providers that the patient should be isolated immediately. They were also interested in the EMR helping alert the hospital’s infection control program and the local state health department, while also evaluating risk for exposures. However, she said it was important for any CDS to not be too complex. “If we try to be too complicated, it might not be successful,” Delman noted.

Other elements of the CDC algorithm—such as whether the patient had a high-risk or low-risk exposure to the disease—would be difficult to capture in a structured CDS tool, she said.

However, later in the webinar representatives from Texas Health Resources and Allscripts both attested to CDS products that could screen for Ebola patients in that kind of detailed manner. The representative from Texas Health Resources said they’ve built a screening tool within its Epic EMR that can determine if a patient has had low or high-risk exposure. Their tool screened travel history first and then went into symptoms.

Later, Toby Samo, M.D., the CMO at Allscripts, said the Chicago-based EMR vendor had taken the algorithm from the CDC and created a section that can be put into any note in the EMR. This CDS tool, he said, can explore whether the patient has had high, low, or no exposure to Ebola. He said they posted it on their client connect site and gave end-users the tools necessary to add that function into their EMR systems. Moreover, he said they created two version of the CDS tool: one that goes through the regular algorithm and one that is more complex for patients with high-risk exposure.

Due to the evolving nature of the Ebola outbreak, a discussion was also held on the flexibility of a potential CDS tool for identifying patients. Could there be a way to add into EMR CDS tools updated guidelines for care as well as additional travel history red-flags? Dr. White from the ONC said the first was likely doable and others on the call attested that the latter could also be done.