Canadian Journal of Nursing Informatics

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This article was written on 21 Mar 2020, and is filled under Current Issue, Volume 15 2020, Volume 15 No 1.

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Informatics in the time of COVID-19

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by June Kaminski, RN MSN PhD(c)
Editor in Chief

June Kaminski CJNI was initiated by June Kaminski in 2006 when she was President-Elect of CNIA. She is currently Curriculum Coordinator of a BSN Advanced Entry nursing program at Kwantlen Polytechnic University; Past President of the Canadian Nurses for Health and the Environment and Editor in Chief of the Online Journal of Nursing Informatics In 2012, June was honored to receive the CASN and Canada Health Infoway’s inaugural Nursing Faculty E-Health Award 2012 in Ottawa Canada. She also won the Distinguished Teaching Award from Kwantlen Polytechnic University in 2016. She offers the Nursing Informatics Learning Centre for nurses.

EDITORIAL

Informatics in the time of COVID-19

2020 has proven to be an unprecedented year in modern history, and it has barely begun! The emergence of the COVID-19 pandemic has caused major impacts on global society, including huge challenges for health care. No one on this planet is immune to these sweeping changes, as many join in the efforts to contain this virus. Informatics teams are a critical part of these efforts, serving as support, facilitating new methods of delivering care, and aiding in tracking and forecasting the related impact data. Let’s look at some of the major ways informatics shines during this critical time and some resources to aid in these processes.

Supporting the Day to Day

Information Technology (IT) and informatics specialists (IS) are integral to all emergency actions taken by health care organizations during a pandemic. This includes addressing supply chain and labour shortages, business partner considerations, telecommuting, enhanced physical and technological security, continuity and disaster recovery planning, and monitoring supplies of personal protective equipment (PPE) (AEHIS Incident Response Committee, 2020). Specific attention is also required from IT and IS to organize the following:

  • Mass Notifications – digital experts often spearhead innovations in mass notifications to ensure staff are updated immediately as the crisis evolves. “Healthcare systems may want to ensure that they test their mass communications systems and procedures to ensure that they can get critical information into the hands of staff as quickly and efficiently as possible” (AEHIS Incident Response Committee, 2020, p. 4).
  • Client Information – IS experts have found innovative ways to provide COVID-19 support to clients in some health organizations. For instance, Siwicki (2020) described how the Montefiore Health System in New York City harnessed chatbot AI technology to support client information. “Staff wanted to offer patients the ability to be directed to Montefiore information, but also be in a position to get answers to key questions they had about COVID-19. Being in New York City, they were facing an increasing volume of calls coming into doctors’ offices, an increased demand for services, and worried patients coming into emergency rooms and hospitals. Chatbot technology was meant to be an offering to provide value to patients and direct them to the care they needed” (p. 1).
  • Client Teaching– IS experts may also be involved with the development of client health promotion and prevention teaching materials that target COVID-19, such as brochures, infographics, handouts, videos, games, and other interactive and engaging productions. For instance, IS may work with organizations such as the Public Health Agency of Canada to produce infographics to educate the public on Social Distancing.
  • Privacy of Health Data– IS and IT also dedicate a lot of energy to ensure staff and clients stay safe: this includes protecting their personal health information (PHI) as well as employee data. It also entails securing organizational systems and educating staff about potential COVID-19 inspired scam and malware attempts. As well, policies related to PIH in the time of a pandemic should be reviewed and revised as necessary. One example of potential policy tips are available through the US system, as a bulletin: HIPAA Privacy and Novel Coronavirus.
  • Equipment Disinfection– all equipment used within health organizations must be protected and disinfected if used more than once, including electronics. “Particular attention is needed to address sanitation of mobile devices that are handed off by workers between shifts or handed from patient to patient” (AEHIS Incident Response Committee, 2020, p. 5).
  • System Interoperability– EHR based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19 are all supported by system interoperability. A great paper addressing these functions is available from Reeves et al.(2020). 

Digital Health Canada offers a comprehensive collection of resources to support informatics specialists as they work to connect and protect front-line workers. This includes links to important contacts, recorded COVID-19 webinars, and a dynamic Forum “for Canadian digital health professionals to support each another during the COVID-19 outbreak” (Digital Health Canada, 2020, p. 1). 

Although novel, some organizations are taking advantage of robotics to protect both staff and clients. An example is the Wegree robot. “Wegree, a company based in Poland, makes humanoid robots that are typically designed to greet people at stores, malls, and other consumer-facing businesses, and to answer their questions. Now, Wegree has adapted its robots to serve as check-in staff for hospitals and clinics, alleviating the need for humans to interact with potentially infected individuals. The robots can greet those presenting with symptoms, guide them to sanitize their hands and put on a face mask, and ask relevant questions that can be used to triage those that should receive medical attention” (Medgadget Editors, 2020, p 1). View a video of this process on the Weagree YouTube channel. 

Supporting Virtual and Telehealth Care

Informatics specialists (IS) may well work with physicians, nurse practitioners, and other professionals to provide virtual and/or telehealth care. Most provinces now have specific virtual and telehealth care codes for physicians to use with clients. IT and informatics experts can help support physicians and others to choose the best technology and to  “consider how easy the technology is for you to use, how easy it is for patients to use, how the technology can help you keep patient information private and secure, and that you must record the work in your medical record” (OntarioMD, 2020). This includes integrating COVID-19 specific tools into existing electronic medical and health records. 

“We need well defined and easy-to-understand guidelines for the day-to-day use of telehealth technologies in the context of COVID-19. We need these to be adjusted to the most vulnerable (e.g. different age groups) and their needs. Such guidelines need to keep the expectations of users, be it patients or healthcare providers, realistic. They need to convey the message that eHealth solutions are a viable alternative in times of this pandemic and beyond; however, probably not suitable for all problems that arise and certainly not a full replacement of traditional care” (Nittas, 2020, p. 1). 

However, telehealth can also facilitate the direct care of COVID-19 clients being isolated within their own homes. “Community paramedicine or mobile integrated health care programs allow patients to be treated in their homes, with higher-level medical support provided virtually” (Hollander & Carr, 2020, p. 1). Unless caregivers are equipped with virtual diagnostic tools, telehealth does have it limits for general practice. “The biggest benefit of telehealth may be preventing people who have been exposed to the coronavirus from leaving their homes and spreading it to a physician’s practice or an entire emergency department, putting patients at risk and potentially putting health care workers out of commission for 14 days of quarantine” (Ostherr, 2020, p. 1). 

Some health professionals and organizations have resorted to using mass market software and platforms to facilitate virtual and telehealth care during the pandemic. These include platforms like Zoom, Skype, Apple Facetime, Google Hangouts, Microsoft Teams, Facebook Messenger, and others. IS can facilitate private and secure access and utilization of these platforms to support client virtual care. “Yet these platforms are not embedded into electronic medical records (EMRs). As a result, physicians find themselves toggling between their EMR — holding important lab results and consultation notes — and their video screens. The time spent moving between two separate programs adds up and places an extra layer of effort to an already exhausting overhaul” (The Conversation, 2020, p. 1). 

Canada Health Infoway have released guidelines to facilitate this process through their guide, Videoconference and Teleconference Tools to Support Virtual Care

OntarioMD also offers practical tips and links to supporting virtual and telehealth care in Canada. 

Tracking and Forecasting

IS have been instrumental in finding ways to track COVID-19 and forecast future events related to the outbreak. For instance, informatics experts at the University of Alberta’s Centre for Health Informatics explained, “Our experts at CHI (data scientists, academics, clinicians, statisticians, epidemiologists, and visualization specialists) teamed up and developed an interactive and comprehensible dashboard. We want to help all Albertans and Canadians stay informed on the current COVID-19 situation, with the best data that is available” (University of Calgary, Centre for Health Informatics (CHI), 2020, p. 2).

The CHI COVID-19 Tracker from “The Centre for Health Informatics, working collaboratively with the province of Alberta and the City of Calgary in partnership with Alberta Health Services (AHS) and Alberta Health (AH) to create a data visualization dashboard with up-to-date information tracking the progression of the COVID-19 across the province and the country at large” (University of Calgary, Centre for Health Informatics (CHI), 2020, p. 1). 

The importance of informatics in global tracking of this pandemic has been strongly emphasized at the highest levels. “It is critical to emphasize the use of health informatics methodology and information and communication technology to combat the current pandemic COVID-19 and future outbreaks. The essential role of biomedical and health informatics in pandemic surveillance, notification and continued delivery of evidence-based best practices” (International Academy for Health Sciences Informatics (IAHSI), 2020, p. 1). 

Of course, tracking can become a cause for concern, especially if human rights for privacy and confidentiality are breached. During a pandemic, these rights might come into question. Thus, all IT and IS experts are encouraged to consider the following recommendations from Informatics Europe (2020, p. 1):

  • Track individuals with their consent and under their direct control, allowing them to freely and easily switch tracking on and off even during the same day. To achieve this goal, we recommend technical experts to develop software which is not only GDPR-ready, but also dynamically reconfigurable by the end users within the limits defined by the current jurisdiction.
  • Track only aggregated data that cannot be traced back to particular individuals if they have not given their explicit consent.
  • Keep the tracking process transparent and open to the scrutiny of public opinion from the beginning of its use and rely on the evaluation by independent scientific advisors to assess the impact of security measures taken.
  • Make any software and hardware used open to examination by the civil society.
  • Specify the time limit for tracking without allowing for any extension in absence of an independent evaluation of the motivations

Some IT and IS experts have harnessed the power of artificial intelligence (AI) to create screening tools that anyone can use to decide if their symptoms are positive for COVID-19 and whether further treatment is necessary. Whittbold et al. (2020) described how the Partners Healthcare team in Boston used AI bots to create the Partners Covid-19 Screener, that “provides a simple, straightforward chat interface, presenting patients with a series of questions based on content from the U.S. Centers for Disease Control and Prevention (CDC) and Partners HealthCare experts. In this way, it too can screen enormous numbers of people and rapidly differentiate between those who might really be sick with Covid-19 and those who are likely to be suffering from less threatening ailments. We anticipate this AI bot will alleviate high volumes of patient traffic to the hotline and extend and stratify the system’s care in ways that would have been unimaginable until recently” (p. 1). 

HIMSS Media offers a great collection of tracking and forecasting innovations in their article, Roundup: Tech’s role in tracking, testing, treating COVID-19. “As the cases of COVID-19 increase we are seeing a rise in digital epidemiology tools, chatbot helpers, EHR guidance tools and rapid-response test kits” (HIMSS Media, 2020, p. 1). 

AI is also being used to forecast the trajectory and future of the COVID-19 pandemic. “Few would argue that AI is causing a paradigm shift in health care and there might be value in the application of AI to the current COVID-19 outbreak, for example, in predicting the location of the next outbreak” (McCall, 2020, p. e166). Unfortunately, in order for this to occur, high quality data must be available, and the AI system must be programmed to this data. “As a result of a lack of data, too much outlier data and noisy social media, big data hubris, and algorithmic dynamics, AI forecasts of the spread of COVID-19 are not yet very accurate or reliable. Hence, so far, most models used for tracking and forecasting do not use AI methods. Instead, most forecasters prefer established epidemiological models, so-called SIR models, the abbreviation standing for the population of an area that is Susceptible, Infected, and Removed” (Naude, 2020, p. 1).

IT and IS can work together to harness the benefits of AI during this pandemic in a number of ways. According to Naude (2020), “There are six areas where AI can contribute to the fight against COVID-19: i) early warnings and alerts, ii) tracking and prediction, iii) data dashboards, iv) diagnosis and prognosis, v) treatments, and cures, and vi) social control” (p. 1). 

Experts emphasis the importance of the humans – the IT and IS experts who work with AI that make all the difference. “Efforts to leverage AI tools in the time of COVID-19 will be most effective when they involve the input and collaboration of humans in several different roles. The data scientists who code AI systems play an important role because they know what AI can do and, just as importantly, what it can’t. We also need domain experts who understand the nature of the problem and can identify where past training data might still be relevant today. Finally, we need out-of-the-box thinkers who push us to move beyond our assumptions and can see surprising connections” (Hollister, 2020, p. 1). 

All in all, informatics is critical to the successful abatement of the COVID-19 pandemic, and informatics specialists are the heart of this support and innovation. We salute all of our tireless peers who are spearheading these initiatives that support the hard work and dedication of our front-line health care professionals. May we all come through this crisis with strength, vision, and collaborative success!!

References

AEHIS Incident Response Committee. (2020). Information Technology Considerations for a Disease Outbreakhttps://digitalhealthcanada.com/wp-content/uploads/2020/03/CoronavirusAEHISFinal.031120.pdf

Canada Health Infoway. (2020). Videoconference and Teleconference Tools to Support Virtual Carehttps://digitalhealthcanada.com/wp-content/uploads/2020/04/Video-Conferencing-Tools-for-Virtual-Care-with-Privacy-Tips-2020-04-072.pdf

Digital Health Canada. (2020). COVID-19 Information Resources. https://digitalhealthcanada.com/covid-19-resources/

HIMSS Media. (2020, April 10). Roundup: Tech’s role in tracking, testing, treating COVID-19. Mobihealthnews. https://www.mobihealthnews.com/news/roundup-techs-role-tracking-testing-treating-covid-19

Hollander, J., & Carr, B. (2020, March 11). Perspective. Virtually Perfect? Telemedicine for Covid-19. The New England Journal of Medicine, DOI: 10.1056/NEJMp2003539 https://www.nejm.org/doi/full/10.1056/NEJMp2003539

Hollister, M. (2020, March 30). AI can help with the COVID-19 crisis – but the right human input is key. World Economic Forumhttps://www.weforum.org/agenda/2020/03/covid-19-crisis-artificial-intelligence-creativity/

Informatics Europe. (2020, April 3). Recommendation on the Use of IT for COVID-19 Infection Mitigation. Informatics Europe Newshttps://www.informatics-europe.org/news/541-policy-recommendation-covid19.html

International Academy for Health Sciences Informatics (IAHSI). (2020). IAHSI Statement to WHO on the Use of Informatics in Pandemic Situations. https://imia-medinfo.org/wp/statement-from-the-international-academy-for-health-sciences-informatics-iahsi-the-academy-of-the-international-medical-informatics-association-imia-to-the-director-general-of-the-who-on-the-use/

McCall, B. (2020, Feb. 20). COVID-19 and artificial intelligence: protecting health-care workers and curbing the spread.The Lancet Digital Health, 2(4), e166-167. DOI:https://doi.org/10.1016/S2589-7500(20)30054-6 https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30054-6/fulltext

Medgadget Editors. (2020, March 20). Robots to Greet, Triage Incoming Coronavirus Patients. Medgadget. https://www.medgadget.com/2020/03/robots-to-greet-triage-incoming-coronavirus-patients.html

Naude, W. (2020, April 1). Artificial Intelligence against COVID-19: An Early Review. Medium – towards Data Science. https://towardsdatascience.com/artificial-intelligence-against-covid-19-an-early-review-92a8360edaba

Nittas, V. (2020, April 7). When eHealth goes viral: The strengths and weaknesses of health tech during COVID-19.  Mobihealthnews.  https://www.mobihealthnews.com/news/europe/when-ehealth-goes-viral-strengths-and-weaknesses-health-tech-during-covid-19

Office for Civil Rights, U.S. Department of Health and Human Services. (2020). HIPAA Privacy and Novel Coronavirus Bulletin. https://www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf

OntarioMD. (2020). Virtual care and the 2019 Novel Coronovirus (COVID-19). https://ontariomd.news

Ostherr, K. (2020, March 19). Telehealth overpromises during the Covid-19 pandemic. STAT News. https://www.statnews.com/2020/03/19/telehealth-overpromises-during-the-covid-19-pandemic/

Public Health Agency of Canada. (2020). Social Distancing Infographic.  https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/social-distancing-infograph/social-distancing-infograph-eng.pdf

Reeves, J. J., Hollandsworth, H. M., Torriani, F. J., Taplitz, R., Abeles, S., Tai-Seale, M., Millen, M., Clay, B. J., & Longhurst, C. A. (2020). Rapid Response to COVID-19: Health Informatics Support for Outbreak Management in an Academic Health System. Journal of the American Medical Informatics Association (JAMIA). https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocaa037/5811358

Siwicki, B. (2020, April 10). How Montefiore uses chatbots to guide patients in a COVID-19 hotspot. HealthITNews. https://www.healthcareitnews.com/news/how-montefiore-uses-chatbots-guide-patients-covid-19-hotspot

The Conversation. (2020, April 11). How COVID-19 has helped advance telemedicine. Kitchener Today. https://www.kitchenertoday.com/coronavirus-covid-19-local-news/how-covid-19-has-helped-advance-telemedicine-2243118

University of Calgary, Centre for Health Informatics (CHI). (2020). The CHI COVID-19 Tracker. https://cumming.ucalgary.ca/centres/centre-health-informatics/research/chi_covid-19_tracker

Weagree. (2020a). Robot that has a real impact on protection against coronavirus. See this solution. https://www.medgadget.com/wp-content/uploads/2015/07/Wegree-1.pdf

Weagree. (2020b). This robot has a real impact on people’s safety. [Video file]. https://www.youtube.com/watch?v=qgCwOpZoeF0&feature=youtu.be

Wittbold, K.,  Carroll, C., Iansiti, M., Zhang, H. M. & Landman, A. (2020, April 3). How Hospitals Are Using AI to Battle Covid-19. Harvard Business Review.  https://hbr.org/2020/04/how-hospitals-are-using-ai-to-battle-covid-19

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