In late April and early May the first U.S. case of Middle East Respiratory Syndrome (MERS) coronavirus was reported at Community Hospital in Munster, Ind., and was successfully contained, with much of the credit going to the hospital’s various IT technologies.
The Indiana patient who was diagnosed with MERS was a healthcare worker who had returned from Saudi Arabia four days before he was admitted to Community Hospital on April 28. He has since been discharged from the hospital and, according to the Centers for Disease Control and Prevention (CDC), is fully recovered.
Alan Kumar, MD, Community Hospital’s CMIO, said that the ability to get these various technologies—such as the hospital’s EMR and real-time locating system (RLTS)—to work in combination helped providers identify any potential information gaps that could have made containing MERS more difficult.
“The big advantage we had was having a fairly robust EMR—we use Epic—and we use it in a variety of ways to log interactions with patients at different levels, clinical and non-clinical,” said Kumar. “So, for example, anyone that interacts with the patient medically is going to be in the clinical chart. But, additionally, whenever a tech enters vital signs, or a social worker comes into contact with the patient, or even when housekeeping staff comes into contact with a patient’s room, it is logged in Epic.”
But there are cases in which persons could come into contact with patients without that being logged into the EMR, and that’s where the RTLS comes in. For example, Kumar explained, if a patient hits a call light because he or she needs a glass of water or an extra blanket, that interaction won’t be logged. “But this [the RTLS] is able to keep track of all those other people who interact with the patient,” he said. “Between the two systems we were pretty much able to catch every interaction with that [MERS] patient prior to the full contact and airborne isolation precautions. That also allowed us to pretty easily capture our entire group of at risk employees and isolate them from the rest of the hospital workers, patients and visitors.”
The ability to track all of the caregivers who came into contact with the patient, and the amount of time they spent with them, is also giving the CDC some useful data regarding the amount of exposure to a person infected with MERS it takes for the virus to be transmitted, Kumar said.
This was Kumar’s second interaction with the CDC—the first was a possible SARS (Severe Acute Respiratory Syndrome) case about a decade ago that turned out to be negative. Since this case was confirmed, it involved a lot of collaboration between the CDC, the Indiana Department of Health and the hospital, said Kumar. Six investigators from the CDC were dispatched to Munster, but functioned in an advisory role, he said. “They’re there to collect information from an epidemiological point of view because that’s where their skillset lies.”
As far as lessons learned from a CMIO perspective during the MERS episode, Kumar suggested that depending on the role a CMIO plays in an organization, “there could be times when you are going to have to do a significant amount of medical management.
“I’m not sure how many CMIO’s function in that capacity, but I did, and it worked out well since I was central to all of the processes that were going on,” he said. “I think a good CMIO needs to have various skillsets, and in the past I took some refresher classes in medicine and media relations—what to say, how to say it and how best to present yourself so that you are giving an even, cohesive message. In this case I think it helped prevent any kind of panic because we were able to send out a clean, cohesive message to all parties concerned.”