Reporting and Research on COVID-19

Since the COVID-19 outbreak began in New York, the Bronx RHIO has quickly adapted its resources to serve public health agencies and its diverse membership. Bronx RHIO has integrated the State-provided Electronic Clinical Lab Reporting System (ECLRS) data into its Virtual Health Record, including a prominent COVID-19 flag displayed along the top of the screen.

In addition to the ECLRS data, Bronx RHIO has identified a range of clinical indicators of COVID-19 infection and related factors. As knowledge develops about COVID-19 treatments, risk factors, and complications, Bronx RHIO is continuously working to find clinical data elements to track these factors. Bronx RHIO has also worked with its large data contributors to expand and refine the clinical data they provide, such as respiratory flow sheets, which provide richer ventilation use data. By analyzing real-time member data, including labs, medications, observations, progress notes, diagnoses, and procedures, Bronx RHIO is now tracking and reporting.

• Confirmed COVID-19 infections and antibodies

• COVID-19 deaths

• Comorbidities, with special attention on lupus and HIV patients and the potential for their management medications providing protection from COVID-19

• COVID-19 treatment medication use (remdesivir, hydroxychloroquine)

• Social determinants: race, ethnicity, age, sex, housing status, UHF neighborhood data (poverty)

• Hospitalization and ICU use

• Intubation, ventilator, and ECMO use

• Stroke and Pediatric Multisystem Inflammatory Syndrome in COVID-19 patients

• Smoking status and BMI

COVID-19 alerts and reports are available to all Bronx RHIO members. The COVID-19 Participant Report allows Bronx RHIO members to view their patients who have been identified as positive for COVID-19. It provides patient identity and contact info, COVID-19 lab test details, current hospitalization, relevant high-risk comorbidities (such as hypertension, diabetes, and pulmonary disease), and recent emergency department and inpatient encounter details including discharge disposition. The report is available both as a self-service report and as an automated report for regular delivery to a secure location. Per New York State, patient consent requirements have been waived for delivery of COVID-19 data, though at present relaxed consent restrictions are only possible for the automated version of the report.

While efficiency remains a priority in this evolving health crisis, Bronx RHIO has focused on workflow integration when it comes to providing alerts and reporting on COVID-19. Before alerts or reports are turned on, the population included is reviewed with the member organization to ensure all alerts are wanted and the organization has capacity to follow up on the data they are provided. Likewise, the method of delivery of both alerts and reports is tailored to the specific capabilities and limitations of the member organization, especially now that more workplaces are operating remotely.

Bronx RHIO is working with a group of researchers at Montefiore and the Albert Einstein College of Medicine to develop a research study investigating factors related to the high rate of COVID-19 infection and disease severity in the Bronx, especially social determinants of health. This research study is undergoing expedited IRB approval and will be presented to Bronx RHIO’s Subcommittee on Research and Quality Improvement in May 2020. In addition to member-generated research projects, the Bronx RHIO has begun preliminary internal analyses on COVID-19 risk factors, complications, and outcomes, which are intended to be made publicly available as de-identified analyses in the future.