On the front lines of the COVID-19 outbreak, clinicians and health administrators are burdened with completing a 100 field form for laboratory-confirmed cases and Persons Under Investigation (PUIs) for COVID-19. To combat this latency and improve standardization, Palantir has created an application to pre-populate information into the form by automatically and securely connecting to the clinician’s Electronic Medical Record (EMR) system. The de-identified case report data is then sent to participating local, state, and federal systems in real time, with the originating organization retaining full control and ownership over their data.
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The challenge: Fighting the COVID-19 pandemic with data
Outbreaks like COVID-19, now officially classed as a pandemic, are at their most dangerous when they are least known and understood. While shrouded by confusion and misinformation, a virus can spread voraciously. It is only when a virus becomes traceable that it can be slowed, cordoned off, and stopped. However, traceability is dependent upon data.
Only by gathering meticulous, real-time records of existing and potential cases and combining that information with other critical data — such as population risk and resource availability — can public health agencies effectively combat a virus. This data collection becomes challenging when it must take place in the overly-complex, fragmented infrastructures that make up modern healthcare. In order to take action and help contain this outbreak, healthcare professionals need an efficient and secure way to capture and collaborate on the same data.
Currently, the burden of creating and sharing this information rests with the clinician and local public health agencies. For each patient, public health agencies ask clinicians to complete a detailed case report that not only captures how the patient was exposed to the virus, but also information on medical history, symptoms, and demographics. These reports provide invaluable signal into the nature and spread of viruses like COVID-19; but, clinicians’ time is limited, particularly during a crisis.
To make matters even more complicated, there are substantial reporting variations across jurisdictions. While federal agencies like the CDC have published a template with guidance on how to capture this information, it’s ultimately the prerogative of state and local health officials to decide how they will capture and monitor conditions like COVID-19. Some states have invested in their own systems for data entry and will hard-code a version of the CDC template into their own systems. Others will use the CDC’s web-based forms like Epi Info, RedCAP, and the Data Collation and Integration for Public Health Event Response (DCIPHER) platform.
It’s ultimately a burden on the local agencies to report up, but the lack of standardized mechanisms for doing so creates a situation where data is captured in a highly inconsistent, fragmented way. Hospitals lack visibility into what lies beyond their own systems; local agencies lack visibility into how the virus is spreading outside of their communities; and federal agencies have to integrate heterogenous incoming data in order to coordinate an effective response. Worst of all, this amount of friction may discourage clinicians from taking the time to fill out a case report in the first place.
A solution: FHIR case report application
Our approach, demonstrated here, builds on growing momentum across the healthcare industry to leverage open data standards, like the FHIR (Fast Healthcare Interoperability Resources) specification. Initiatives like the Argonaut Project and further enhancements to the FHIR API led by SMART Health IT have created a foundation for technology companies, hospital systems, and government health agencies to innovate and create applications that make effective use of the rich data in Electronic Medical Record (EMR) systems.
Recognizing that clinicians often already have access to many elements of a patient’s case report in their EMR system, our team created a new FHIR-based case report form that hospital systems can register with their EMR systems to be able to securely query data using the FHIR API. This allows clinicians to pre-populate de-identified patient data into a CDC-compliant case report template to more easily comply with public health authority regulations to report notifiable conditions. Granular access controls ensure that only data the clinician is authorized to access via the hospital’s EMR system is transferred into the case report template; this data is not retained or housed within the case report platform. In practice, this alleviates the administrative burden placed on clinicians at the point-of-care, as well as saving local agencies time parsing and packaging the relevant information. Moreover, it homogenizes the data to be more easily collected and monitored by overseeing federal agencies, taking a critical step towards standardized reporting.
While the FHIR specification makes it easy for hospitals to adopt and utilize a new case report form, the true potential of this information emerges when agencies leverage the data in concert with other vital information related to COVID-19 containment efforts. Integrating siloed data sources into a common operating picture, local and federal health agencies could coordinate supply chain logistics for critical equipment like ventilators, identify vulnerable populations in emerging hotspots, and mitigate the economic impact on businesses and employees.
This isn’t just theory — it’s a product. The FHIR Case Report app is ready to launch, deployable quickly to help hospitals, local, state, and federal agencies collaborate and save lives. As more health organizations participate in a standards-compliant data sharing infrastructure, this value only compounds, expediting the identification of emerging diseases by employing passive outbreak monitoring systems tied to EMR data — ultimately making viruses more traceable, and, therefore, easily combated.