Consolidate findings and observations from Year 1 COVID to create final report.
867-02 Final Report
870-01 Harvest Meeting Slides
870-01 Harvest Meeting Transcript
Challenges and Lessons Learned
Alaska - Final Report
x1. We have buy-in from our health centers but found that most of them were unable to provide data in a timely manner due to being overwhelmed and competing priorities related to the pandemic.
x2. The learning curve for data needs and collection was very steep, but not insurmountable. Since
dashboards and procedures have been developed, data reporting should be much easier during the
remainder of this project.
x3. With the amount of data needed, we found it very important to have a shared data platform and
Health Centered Controlled Network. We started the project with trying to obtain data from
multiple sources and try to verify and collate the data. Having multiple Health Centers on Azara did make the task easier. We have further partnered with Azara to have any future monthly data pulls
x4. Even with a shared data platform it is difficult to verify data in the health centers’ EHR since we do not have access to them, so we had to find other ways to verify the data.
x5. One way is that we partnered with the State of Alaska and people with their Immunization
Information System (VacTrak) to assist in verifying the immunization data provided in Azara.
x6. The importance of the Human-Centered Design Approach - Remembering there are real people
behind the data and making sure to tell their stories.
Alaska - Harvest Slides
Alliance/HCN - Final Report
xReflecting on health center experiences and workflows, HCN and AllianceChicago would have liked to have had health centers document their workflows and grouped them into similar categories to assist in hardwiring data capture. Another option would have been to understand the needed data elements across all reporting entities and support health centers in streamlining reporting requirements from those requesting data on a regular basis.
Alliance/HCN - Slides
- xHaving health centers document their workflows and grouping them into similar categories to assist in hardwiring data capture.
- xTo understand the needed data elements across all reporting entities and support health centers in streamlining reporting requirements from those requesting data on a regular basis.
CHCN Final Report
|what went well?||did not go well||how addresses/follow up|
xSymptoms not easily identified in the database
Could not identify the correct field to capture symptom information recorded during patient encounters
We connected with OCHIN to learn more about how this data is typically recorded and where it is located in the database. Engage Epic for access to data elements.
Identify the smartdata element IDs related to each type of symptom for improved data collection
|Health Efficient challenge||xWhile we were able to provide our participating health centers with valuable insights on the Covid-19 related data reflected in their operations, we were not able to pull in data from other sources. Most of our participating health centers are using the eClinicalworks EMR. eClinicalworks does not currently allow users to pull in testing or vaccination information from other registries. With this limitation we were only able to provide health centers with a fraction of the testing and vaccination information on their patients. We were not able to mitigate this challenge during the project period but will hope to work with health centers address it in the future.|
xLab testing for COVID had to repeatedly switch systems due to funding, availability, and wait times
xDocumentation of "non-patients" served (testing, vaccines)
To avoid collection and documentation of unnecessary PHI for people who were community members (and not regular patients), external systems were used and tests and vaccine totals became difficult to track. Different workflow processes were used for patients and community members.
Identify workflows that allow "quick registration" or something similar that allows all people served to be recorded in the same system, without conflating other record keeping or collecting more PHI than is essential for the provided services.
|xTracking tests and vaccinations for individuals who were not attributed patients of the health center presented an ongoing challenge. These patients did not have previous, basic, required information previously captured (e.g., race, ethnicity) which increased the burden of documentation. Also, health centers wanted to avoid having these patients be counted for UDS reporting, and struggled with the decision to either enter patient data into the EMR or to track tests and vaccinations in a separate location (often an Excel file). We did attempt to mitigate this through suggestions for using specific visit types or structured data to distinguish non-attributed patients. (HE Final Report)|
xAutomation of data extract
All data extracts and saving to files was automated and scheduled successfully
The extract process is slow and still requires a final manual upload to share to NACHC
Establish an SFTP or other system that does not require manual upload (and can be regularly scheduled)
xDeveloped SQL scripts for views and stored procedures to automate the extraction process
We were able to identify the database fields for all of the essential data elements and many that were not prioritized
Unable to identify good data points for some of the main priorities, such as COVID exposure source. Some lab tests missing critical elements (results, test type)
Establish norms with clinical partners around documentation expectations for improved tracking of patients who are potentially infected or sick.
Health Efficient - Slides
- xIn a public health emergency, FQHCs need a "local" partner like an HCCN to translate guidance and mandates from the federal government, state, and local health authorities into easily actionable guides, resources, and tools
Health Efficient - final report
xExtracting data centrally worked well to allow PHC to focus on serving patients.
AllianceChicago/HCN from slides
- Modified our integration engine to accommodate quickly emerging CDC CVX codes and other requirements.
- Installed codes and database queries to insure reporting of race and ethnicity.
- Performed daily audits to insure timeliness of COVID vaccine reporting and accuracy.
- Modified interfaces per Registry requirements on custom reporting of vaccine given “in house” versus given elsewhere (mass vaccination clinics) to ensure accurate counts and avoid double reporting to public health departments.
- Increased reporting and segregated COVID vaccine reporting by working with State registries to ensure timely reporting
- Modified patient consent requirements where applicable and State sanctioned. Initiated emergency authorization for adults to be submitted unconsented where governance accommodated this exception
xNACHC All Partners Call- the project helped us gain insight into what others around the country are doing with regards to COVID-19 data and how it has been translated into meaningful outcomes
CHCN from slides
Public xPublic health Department engagement was enhanced
Data xData gathering and integration was substantially expanded
Proof xProof that CHCs were vital for early pandemic intervention
CHCN from final report
We have ultimately improved our data access and knowledge, convened and collaborated more effectively, and gained valuable insights about how to approach any future unexpected health events.HealthEfficient
xHealthEfficient from slides and final report
- Development of best practice guidelines presented to health centers for vaccination coding & EMR configuration
- Using data to understand changes in in person visits helped us research and vet telehealth vendors and provide access to demonstrations to our health centers
This helped our health centers select the right vendor for their situation and led to fast and steep implementation of telehealth visits
- The support we provided allowed organizations to rapidly transition to seeing patients virtually, send communications to patients about testing availability at their organizations, workflows to minimize patient contact, and configure/use their EHR and other HIT technology to support their patients.
- Positive impacts of this work included improvements in documentation of COVID-19 diagnosis, and some improvement in data capture of testing and vaccination. We expect that these improvements will be sustainable as a variety of national and local institutions are requiring these data elements be captured reliably for reimbursement and compliance.
Unexpected - health efficient final report
Unexpected xUnexpected impacts this project included the need for translation of national and state guidelines for clinical, operational, and data capture responses to a pandemic at a direct, one-to-one, or on a small peer group level. Health enters were overwhelmed with patient care and other pandemic related challenges, HealthEfficient was able to simplify and share relevant state and federal guidance in practical, actionable ways. (HE Final Report)
Health efficient final report We developed best practices guides for vaccination coding/EMR configuration. We also developed visualizations of COVID-19 testing and indirect effects of the pandemic on patient care and health center operations.
CHCN Final report - Training efforts related (but not specific) to this project included clear guidance on documentation of telehealth encounters, encouraging improved documentation of vaccinations in the EHR, retrieving records from the database via SQL, utilizing OCHIN-developed reports that can be accessed directly within the EHR system, and utilizing CHCN-developed Tableau reports. CHCN responds to the needs of the clinics in the consortium to provide ongoing training, regardless of the current health emergency -