Call for Collaboration from Health Care Leaders to the EHR Vendor Community to Fight COVID-19

If you are interested in endorsing this Call for Collaboration, please click here.

Update: Two weeks ago, we penned a Call for Collaboration from Health Care Leaders to the EHR Vendor Community to Fight COVID-19 which has now been endorsed by over 50 leaders representing a diverse cross-section of the global health care delivery community. Overwhelmingly, this call for collaboration has been met with encouragement and a sense of shared agreement around the potential to improve clinical outcomes in a time of otherwise sweeping uncertainty.

We have engaged in dialog with a number of colleagues surfacing platforms, networks, and new initiatives intended to advance data sharing for research, clinical care, and population health management prior to the COVID-19 crisis. There is tremendous promise in the collaborations that have resulted in alliances and exchanges such as CommonWell, COVID-19 Evidence Accelerator, Carequality, and even a new international effort, The 4CE Consortium, surfacing in preprint just this week. Despite the gains in data sharing cooperation and coordination, we remain steadfast in the assertion that the COVID-19 crisis requires that all health systems, regardless of their vendor affiliations, have timely access to democratized data, the workload to extract data is swift, and data is pooled from an expanded, international set of sources for all to access when and where they need it today.

Finally, thank you to the many providers, vendors, clinicians, and researchers that have contacted us over the past two weeks, and a special note of gratitude to colleagues that have added their signatures in support. We will continue to advance this call for speed, ease, and scale in dialog with vendor colleagues and network facilitators in the days ahead.

Original Print: Providing the right care, for the right patient, at the right time in the context of a new pandemic infection with a variable clinical picture requires a level of collaboration not yet seen in modern heath care. We, the undersigned clinicians and health system leaders, are inviting the electronic health record (EHR) vendor community to join us in mobilizing our collective assets and expertise to meet this unprecedented moment by April 23, 2020.

EHR vendors, most notably Epic and Cerner, collectively have access to clinical data for the vast majority of all hospitals and health systems in the United States. This data is vital for us to understand the full nature of COVID-19 disease as it is presenting in our population, and to make rational therapeutic choices in patients with differing presentations and courses of disease. Understanding what factors may signal better or worse prognosis, and greater or lesser response to specific therapies, as well as what combinations of co-morbidities portend non-survivability are crucially important, not only to understand what therapies may be beneficial, but also to allow for informed ethical allocation decisions in situations where crisis standards of care become operative. Without analyzed data, health care practitioners are left working in the proverbial dark.

Here is what we think it will take.

The major EHR vendors voluntarily extract and upload an agreed-upon data set of deidentified clinical and demographic data to a neutral third-party data warehouse. The elements of the data set will be specified by expert clinicians at the frontlines of treating COVID-19 patients. The initial data upload will be updated on an ongoing basis, so that the clinical course of patients is included. Data sets will include clinically relevant parameters not only for understanding the characteristics of the COVID-19 pandemic within the United States from an epidemiologic standpoint, but also to enable the detection of patterns of presentation, clinical course, and response to various therapeutic interventions.

Access to this data set must be democratized. Clinicians should be able to easily “slice and dice” data and perform analyses to understand mortality rates under specific conditions (e.g. combinations of different severities of COVID-19-associated severe lung injury by age, BMI, etc.) or with specific therapeutics. This would better enable clinicians to make therapeutic decisions at the point of care while awaiting controlled trials. We anticipate that machine learning/AI may also be used to detect patterns otherwise not apparent that could aid in clinical decision-making.

Standing up such a system in the midst of a growing and evolving pandemic requires three core design principles:

• Speed: In order to significantly impact mortality and the course of the pandemic in the US, this system should be up and running within two weeks. Every day that passes without access to this information means hundreds of potentially preventable deaths. Waiting months for such a system will provide the answers too late to be of help.
• Ease: Data extraction should be performed by the EHR vendors, and not require any additional workload for treating clinicians or facilities.
• Scale: The more comprehensive the coverage of facilities with this data set, the more helpful it will be. A goal of 80% of facilities across the US would ensure a sample that is representative of a mix of types of hospitals and demographics.

The COVID-19 pandemic represents a unique opportunity to make use of the vast repository of EHR data in a way we never have before, and to answer a need never before encountered at this magnitude. Let us, together, meet this moment of shared humanity.

If you are interested in endorsing this Call for Collaboration, please click here. An updated list of signatories will be uploaded daily. Please email the IHI Leadership Alliance (IHIAllianceTeam@IHI.org)for any questions.

Sincerely,

James D. Leo, MD, FACP, FCCP
Chief Medical Officer
MemorialCare

Stephen A. Mette, MD
Chief Executive Officer
University of Arkansas for Medical Sciences Medical Center

Nnaemeka Okafor, MD, MS
Chief Health Informatics Officer
Memorial Hermann Health System

Amanda Hammel
SVP Chief Information Officer
Memorial Hermann Health System

Georgia Thomas, RN, MBA, FACHE
AVP Quality and Patient Safety
Memorial Hermann Health System

Ryan Walsh MD, MMM
Chief Medical Information Officer
Memorial Hermann Health System

Pinckney McIlwain, MD
Chief Medical Officer
Charleston Area Medical Center

Anthony R. Uy, MD
Associate Chief Medical Officer
Charleston Area Medical Center

Helen Macfie, PharmD
Chief Transformation Officer
MemorialCare Health System

Jared M Nunes
Executive Director, Informatics and Analytics
MemorialCare Health System

Ann M Lewis
Chief Executive Officer
CareSouth Carolina

Al Kurose, MD
Chief Executive Officer
Coastal Medical

Edward McGookin, MD, MHCDS
Chief Medical Officer
Coastal Medical

Steve Tierney, MD
Senior Medical Director & Chief Medical Informatics Officer
Southcentral Foundation (SCF)

Thomas J. Bader, MD, MBA
Vice President, Medical Quality
Hackensack Meridian Health

Johanna Martinez, MD, MS
GME Director of Diversity & Health Equity
Northwell Health

Rusha Modi, MD, MPH
Assistant Professor of Medicine
Keck Medical Center of USC

Anjali Mahoney, MD, MPH
Vice Chair of Clinical Affairs, Associate Professor of Family Medicine
USC Keck School of Medicine, Keck Medicine of USC

Sandy Nesin, Esq.
Vice President, Accountable Care Operations and Population Health Strategy
St. Joseph Healthcare

Eric Nelson, RN, MHA
President — Primary Care
MHealth Fairview

Scott Revoir
Process Improvement Specialist
Bellin Health

Chris Mertes, MD
Carilion Clinic

Scott Fields, MD
Chief Medical Officer
OCHIN

Kim Schwartz, MA, NBCC
Chief Executive Officer
Roanoke Chowan Community Health Center

Laura Burke, MD, MPH
Assistant Professor of Emergency Medicine
Harvard Medical School

Andrew P. Loehrer, MD, MPH
Assistant Professor of Surgery and The Dartmouth Institute
Dartmouth-Hitchcock Medical Center

Patrick J. Loehrer Sr., MD
Director
Indiana University Melvin and Bren Simon Cancer Center

Elizabeth Krebs, MD
Assistant Professor of Emergency Medicine
Thomas Jefferson University

M. Kit Delgado, MD, MS
Assistant Professor of Emergency Medicine & Epidemiology
University of Pennsylvania, Perelman School of Medicine

Nicholas Gavin, MD, MBA, MS
Vice Chair of Clinical Operations, Department of Emergency Medicine
Columbia University Vagelos College of Physicians and Surgeons

Ali Khan, MD, MPP, FACP
Executive Medical Director
Oak Street Health

Seth Trueger, MD, MPH, FACEP
Assistant Professor of Emergency Medicine; Digital Media Editor
Northwestern University; JAMA Network Open

Alyssa Burgart, MD, MA
Clinical Assistant Professor
Stanford University

Donald Chi, DDS, PhD
Professor
University of Washington

Ishani Ganguli, MD, MPH
Assistant Professor of Medicine
Harvard Medical School

Peter DeBalli, MD
Envision Physician Services

George Molina, MD
Clinical Fellow
Ariadne Labs

Alex Harsha Bangura, MD
Lakewood Health System

Anica Law, MD
ICU Staff Physician
Beth Israel Deaconess Medical Center

Nathan Bahr, MD
Assistant Professor of Infectious Diseases, Department of Medicine
University of Kansas Medical Center

Savita Srivastava, MD
Augusta Health

Andrea Wolffing, MD, FACS
Assistant Professor of Surgery
Dartmouth-Hitchcock Medical Center

R. Carter Clements MD, FACEP
Member-Section for Emergency Medicine Informatics
ACEP/CalACEP

Rachel Solnick, MD
Clinical Lecturer, Emergency Medicine Physician
University of Michigan

Shih-chuan Chou, MD, MPH
Attending Physician
Brigham and Women’s Hospital

Almaz Dessie, MD
Assistant Professor of Emergency Medicine
Columbia University Medical Center and New York Presbyterian Hospital

Anubodh Varshney, MD
Cardiovascular Medicine Fellow
Brigham and Women’s Hospital / Harvard Medical School

Adam Overberg, PharmD
Director
Indiana Poison Center

Reuben J. Strayer, MD
Associated Medical Director, Department of Emergency Medicine
Maimonides Medical Center

Michelle Lin, MD, MPH
Assistant Professor of Emergency Medicine
Icahn School of Medicine at Mount Sinai, NY

I Gede Juanamasta, MSN
Chulalongkorn University

Nirav S. Patel, MD
Vice President
Southland Neurologic Institute

Katharine Gatto
Talent Acquisition, Recognition and Workforce Planning Specialist
Women’s College Hospital

Giammarco Ceppi
King’s College Hospital NHS Trust

Michael Oravec, MPH
Research Program Director
Summa Health

Lisa B. Nguyen, DDS
Assoc. Director for Community-Based Clinical Education
UCLA School of Dentistry

Innocent Mugume
Executive Director
Family Health Resource Center — Uganda

Fatima Chagani
Medical student
University of Miami Miller School of Medicine

Ryan Matos
Epic Lab/Reporting/Orders Expert
Honeydew Consulting

Mostapha Benhenda
Data scientist
Melwy

Lynn Johnson, PhD
Professor and Associate Dean
University of Michigan

Charlene Gaw, MPH
MD Candidate 2020
Mayo Clinic Alix School of Medicine

Header illustration by BrianAJackson/ iStock