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Learning Centre: Ideas

Measuring the impact of COVID-19

Globally, every organization’s focus, both private and public, has turned to dealing with the COVID-19 pandemic.  Providers of healthcare services, federal governments, and state/provincial health and human services organizations have directed all resources towards treating those who have fallen ill and preventing the spread of the coronavirus through all means possible.

This means:

  • Rapidly creating temporary healthcare facilities for treatment of the rapidly growing number of infected citizens
  • Deploying every possible healthcare resource, whether currently active or retired, to provide care
  • Establishing programs for individual financial relief for those ill or who have become unemployed, or underemployed due to the pandemic
  • Accelerated rollout of telemedicine and at home monitoring programs to alleviate the most at-risk people from traveling to see their physicians

To address this global crisis, services are being rolled out rapidly, no matter the expense.  Now is not a time to worry about who is entitled to which healthcare services or financial relief.  No one knows when COVID-19 will be considered “under control”, but we all hold hope that it will be not too far in the future.

When “normalcy” returns, all organizations will be called upon to report on what services were provided that are attributable to the virus.  It will be time for reporting and accounting on which services were given, what costs were accrued and who will be eligible for further economic funding and relief.  This will require a massive and complex reporting initiative that spans the boundaries of private and publicly funded healthcare, government economic and social programs for citizens and businesses.  Without this, it will be impossible to know who in fact was directly (and indirectly) impacted by COVID-19.  Adding to the complexity in the US, hospitals and the government will need to determine which fees will be covered for uninsured patients and how an individual’s employment status and income were directly impacted to receive further social and economic assistance.    I myself wish this “true-up” did not need to occur, but I cannot imagine a world where this day does not eventually come.

I worry about the chaos that will ensue particularly as it relates to reporting the true number of patients who were ill or died due to COVID-19.  Clinical diagnosis codes for COVID-19 did not exist until mid-March, and many health systems have been instructed to use the codes reflecting the patient’s condition such as flu, pneumonia and COPD instead of the more specific code.  One reason for this is that it will take some time for the new codes to be fully set up across public and private payer and hospital systems.  Using new codes would break downstream operations and billing processes.

Many health information exchange protocols (HL7, FHIR) and EMRs do support multiple diagnoses, but oftentimes only the primary one is shared between systems, leaving partial and inconsistent data across the end points.

As temporary healthcare facilities are miraculously setup in convention centers and hotels and are equipped to have what they need to provide care, they may not be equipped with access to integrated EHRs to track and eventually report on the patients they treated.

It will be critical to bring together all the heath data sets across all the locations where patients are treated, whether permanent and temporary, to assess who was specifically impacted by COVID-19, both living and deceased.

Those patients may be eligible for funds for to help them and their families with their healthcare costs and loss of income.  It will critical to provide a singular trusted list, to share, link and merge with other health systems, payers and government entities with clear evidence of all treatment provided and collected diagnoses, whether at time of admission or in later care, everywhere the patient was seen.  Otherwise, we face the chaotic and regrettable experience of “lack of evidence” with human beings caught in the middle of incomplete reporting and their relief processes held in the balance.

How will health systems and payers deal with the providers, those who have previously retired or specialists who are assisting in general or emergency care, generously risking their own safety to redeploy their skills and time to care for those sick with COVID-19? It’s very likely that the healthcare providers credentials and billing identifiers/NPI are not currently active across the wide range of systems required to account for care given and subsequent billing and claims processing.

Treatment and prevention are the current priority at hand, not active data management and appropriately so.  When the pandemic subsides, active data management and massive scale patient data linking will be critical to produce the reports needed to help provide some relief to the citizens of the world.   When that time comes, IMT can help with the data management tools and processes to combine massive sets of patient and provider data to help you understand the impact and report it with confidence.  This is not something health systems should have to deal with, IMT can help with the clean-up so our valued healthcare system can go on providing the care we all need right now.