I was reading CNN news this morning when having breakfast, Chinese President Xi at the recent G20 Summit is pushing for a global COVID-19 tracking system using QR codes to help fast-track international travel and business.
China has mandated using Health QR Codes from February national wide; in the past nine months, the country has gained huge benefits and confidence in control the pandemic.
I introduced the Healthcare QR codes in July 2020, in an event organized by AHIMA International.
Health QR Code is built on shared and interoperable digital technology platforms. It is applied in identifying individual, tracing individual’s locations, and subsequently empowered contact tracing. It is proven, efficient, convenient and useful. It is comprehensive, time accurate in comparison to the various types of apps.
Privacy is considered necessary, public health is equally or maybe even more important as China has gone through SARS. People are more willing to be disciplined for their safety and society’s protection.
Health QR Codes provide an option to international travellers to enter into China, presumably earlier down the road.
How could china quickly control the pandemic in such a practical way? What are the secrets? One secrete is using digital tools for contact tracing.
Contact tracing is a critical step in controlling COVID-19 pandemic. The coronavirus is highly contagious, spreading so fast, it is so overwhelming and impossible to do contact tracing in traditional ways. China has extensively applied digital technology in contact tracing that includes identifying and following-up with patients, identifying, notifying, and following up with the contact.
The digital tools were applied to help contact tracing for accuracy and efficiency. For example, apps were used for electronic surveillance, and people were informed if they took the same train or plane with suspected or confirmed cases, the doctor was informed if their patients had high risk.
The most crucial contact tracing digital tool is the Health Code.
Health Code is a unique personal code, generated and saved on a personal phone, shows the pandemic risk.
Health Code shows three different colours indicating health status and pandemic risk level: green colour means low risk; yellow colour means medium risk, and red colour means high risk.
Health Code colour is generated based on big data collected from different sources, mobile service vendors, social media, online payment platforms, all information about where the individuals have been to
It is straightforward to apply.
Health Code status is real-time and dynamic.
The 1st version of the Health Code was generated on Feb 5th, 2020, over one billion health codes are generated.
During the pandemic period, every person must show their health code when entering into a public place, such as residential complex (coming back home), shopping malls, train station, airports, office etc.
Health code was not the only measure; temperature check was used together to trace suspected cases.
There are limitations, for people who did not have a phone or did not bring their phone, who did not remember their ID number, whose phones did not support 4G or scanning barcode), the manual process was used for tracing.
We have noticed that the Health Code is beyond contact tracing; it is population tracing. It identifies an individual’s footprints, footprint crosses. It makes contact tracing accurate, compressive, more efficient and more effective.
How could China so quickly build and implement such big health code systems nationwide almost within 1 month, the reasons behind include:
Mobile phone and internet is popular (i.e. 900 million people have internet access, internet access is over 64.5%)
Big Data ecosystems are ready
Unique ID for every citizen every individual is available
The most important is that people’s acceptance of link ID to register for a phone number, social media access and payment platforms.
To summarize China’s experiences of fighting against the coronavirus:
Digital Technology has been applied in identifying individual, tracing individual’s locations, and subsequently empowered contact tracing. It is proved, efficient, and useful.
Privacy is considered necessary, but public health is equally or maybe even more important as China has gone through SARS. People are more willing to be disciplined for their safety and society’s protection.
Over one billion people have been traced during the pandemic period.
Tests are encouraged and available in the major cities.
China’s experiences are of help to the world, the COVID-19 pandemic will be settled down soon worldwide, and we look forward to going back to everyday life.
The world is changing very fast. Big will not beat small anymore. It will be the fast beating the slow. – Rupert Murdoch
During the pandemic, many hospitals have shared their experiences of rapidly improving the existing EHR/EMR systems. Some reported their success stories about fast virtual implementation and go-live. Covid-19 requires rethinking and refocusing on priorities. The decision-making process has been shortened, and the actions have moved faster.
1. WHY need EHR/EMR?
COVID-19 pandemic exposes both strengths and flaws of EHR/EMR systems. However, despite the frustration and disappointment from the front-line clinicians, we must first acknowledge that EHR/EMR architecture and platform have enormous value in controlling the pandemic and other widespread public health emergencies.
Paperless EHR/EMR system is essential and assured for early detection of the risks, report of abnormal conditions, rapid diagnosis, and the appropriate treatment and life support.
Eliminating all the paper and minimizing direct contact is a must in the whole of the caring process. The workflows need to be connected seamlessly and communicate effectively, such as identifying patients, booking appointments, admitting to ward, referring consultation, coordinating MDT review, electronic print, bed-side care, and post-discharge follow-up, etc. Also, the recommended Covid-19 protocols evolve very quickly, and EHR / EMR enables hospitals to implement changes far more uniformly.
2. What EHR/EMR systems are the choice?
There is a varied range of EHR/EMR products locally and internationally. Robustness, interoperability, organizational feasibility is of choice. The advantages and power of such choice have been proven during the pandemic, ensuring patient care safety and quickly protecting clinical staff at the same time. The capability of information sharing allows hospitals to track and report abnormal conditions faster and accurately.
3. How to rapidly improve and how to fast implement?
Most hospitals already have workable systems of daily huddles in place. A fast virtual implementation during the Covid-19 strengthens a lean approach, i.e., rational use of resources without waste, implementing the necessary changes.
Hospitals are more likely to make fast decisions, consider much less about those concerns that may delay the change progress. For example, before Covid-19, the staff often spend time in scoping requirements and developing and testing solutions before rolling out changes. This process has been modified to implement changes quickly. New EHR/EMR features are constructed to enable quick back-end editing as processes and guidance change frequently.
During the pandemic, social distancing pushed the implementation teamwork online, which makes communication, testing, and system configuration much harder, and almost impossible to maintain the same level of support and security as onsite. However, those success stories show that new needs invariably create and drive new methods. As Amelia Earhart said, the most difficult thing is the decision to act; the rest is merely tenacity.
The Covid-19 pandemic has forced numerous changes in daily clinical practice. Rapid responses in EHR/EMR help beat the virus and defend the patients. Stay lean to go fast.
Electronic Medical record (EMR) and Electronic Health Record (EHR) in hospitals are tested by the Coronavirus Disease 2019 (COVID-19) outbreak. An integrated and mature EMR / EHR can be a powerful tool in early detection, fast reporting, rapid diagnosis, strict isolation, and the right treatment.
In China, COVID-19 is classified as Class B infectious diseases; however, it follows the preventive and control measures for Class A infectious diseases. Pre-examination and triage is the first step in preventing and controlling virus spreads in hospitals.
I observed a 3-level pre-examination and triage screening workflows implemented in a hospital EHR system in a private healthcare setting in Beijing for the pandemic control
The 1st level screening occurs at the entrance to the emergency room and the fever clinic. Every person entering the hospital building must wear a qualified mask and receive preliminary temperature checking. Screening information, including fever, cough, dyspnea, and epidemiological history, is recorded. Suspected patients are guided to the fever clinic for further examinations. Patients with negative screening results can enter into the hospital. The triage nurse put a round and colored sticker designed by the hospital on the patient’s coat. The marked patient then has access to other departments. The color of the round sticker is changed every day in a weekly cycle.
The 2nd level screening is to avoid patient gathering. It is conducted by the patient self with the assistance of the triage nurse when necessary. Patients complete and submit screening information in EMR on an iPad. If patients have negative results, the EMR flags a green icon, and then the patient can move in the hospital after a second temperature checking. If patients have positive results, the EMR flags a red icon indicating a risk of COVID-19. The nurse will verify and re-check the patient’s temperature. If Patients have an unexplained temperature ≥37.3℃ will be transferred to the fever clinic for further investigations. If patients have not completed the COVID-19 screening, a blue icon is displayed in the EHR, indicating that preliminary examinations are required.
The 3rd level screening is conducted by the doctor in the consultation room. The doctor checks epidemiological history, body temperature, clinical symptoms, body signs, blood test results, chest X-ray results, and CT results in the EHR, and make a medical risk assessment. The level of risk again links to the color of flags.
This 3-level screening is a real-time workflow and process, it guilds decision of patient allocation and isolation during outpatient service and inpatient hospitalization.
The hospital EHR / EMR system shows the advantages of fast mobile access, connecting care providers, real-time monitoring, review, and tracing of outpatients and inpatients. COVID-19 data are always analyzed and reported accurately.
It is time to discuss how we can go back to work safely during these unprecedented times. Here what I witnessed in Shanghai, China, we went back to work in the middle of February. It has been three months so far, with no suspected cases identified and no cross-infection reported.
Three simple and effective methods were applied:
1) wash hands
2) wear mask
3) ensure the safety of office and office building.
1. Wash Hands – we formed the habit of washing hands with soap consciously. For example, wash hands before grabbing a coffee, preparing or eating food, rubbing our eyes, and applying lip-sticks. Keep your hands away from your face. Wash hands every time you press the buttons in the lift or the copy machine. Alternatively, put a bottle of hand sanitizer on every office desk, apply it when you see it. Sometimes you may forget to wash hands (that is normal), do NOT panic. A small amount of virus does NOT knock us down.
2. Wear Mask – we wear a mask at work, on the way to work, and in every public place. On the street, taxi, subway, restaurants, shopping malls. I run every morning in the street for 6km – I wear a mask for the first 500 meters.
3. Ensure the safety of office and office building – everyone working in an office building is registered, and every single entry is checked. Each person needs to scan a barcode (generated automatically by a telecommunication or social media platform provider), showing whether they have been to any risky districts, cities, or outside of the country. Everyone has their temperature checked as well.
We fought hard to save lives from January to March; it is now the time to go back to work, to restore the harmony of life, and to protect our wealth. Now we feel safe!
