Use of clinical pathways integrated into the electronic health record to address the coronavirus disease 2019 (COVID-19) pandemic.

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)-integrated clinical pathways (E-ICPs), which are easily understood care algorithms accessible at the point of care.

OBJECTIVE

To describe our institution's creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools.

SETTING

Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices.

METHODS

Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19-specific E-ICPs along with a process for frequent reassessment and updating. We examined the development and use of our COVID-19-specific pathways for a 6-month period (March 1-September 1, 2020), and we have described their impact using case studies.

RESULTS

In total, 45 COVID-19-specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions, and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders were placed. Case studies demonstrate the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting.

CONCLUSIONS

E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and they continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and nonurgent clinical conditions.