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.
This is a very clear and thorough workflow process that is easy for patients and families to understand. Too often our medical and healthcare processes are shrouded in secrecy that result in an intimidated patient. This process described here is open and logical and can easily gain patient acceptance.