COVID-19: A Tale of Two Hospitals

COVID-19: A Tale of Two Hospitals

By Mary Butler

The governors of both New York and Washington state have declared a state of emergency in an effort to mount an effective response to outbreaks of the novel coronavirus COVID-19 in their respective states.

To get a sense of how COVID-19 is impacting providers in those states, the Journal of AHIMA spoke with two health information management (HIM) professionals in New York City and Seattle.

Their organizations are currently treating patients who have tested positive for COVID-19. The differences in day-to-day life for staff in these two places are stark.

Treating COVID-19 in Seattle

Seattle, WA is the epicenter of the biggest known outbreak in the United States, with 162 confirmed cases and 23 deaths as of Tuesday.

Sally Beahan, MHA, RHIA, senior director of enterprise records and health information at the University of Washington Medicine (UW Medicine) in Seattle, says she is “truly swamped” by the demands of making sure that patients and UW Medicine’s healthcare workers are protected.

According to Beahan, HIM staff who can perform their duties from home and have a computer that allows VPN access into their office computer are being allowed and encouraged to work remotely.

Beahan also noted that the hospital’s compliance department is fielding many questions about privacy and what types of patient information can be shared with state and local officials.

UW Medicine also has enacted the following precautions for healthcare staff:

  • UW Medicine has set up a drive-thru screening clinic specifically for staff who have symptoms. According to Beahan, UW Medicine staff have to consult the employee health department before showing up, but they can get tested for influenza A and B, RSV, and COVID-19 from the comfort of their cars, and get results within a day or two.
  • UW Medicine set up a command center to support clinical areas (hospital, primary care, and specialty care clinics) that need supplies (masks, gowns, gloves, etc.) and to report issues and concerns.
  • Travel abroad has been banned for all students and staff across UW.
  • Non-essential business travel has been suspended.
  • Health system leaders are encouraging staff who have to enter the clinical areas to pick up paper for scanning to wear masks and gloves.
  • UW Medicine also is allowing administrative leave for staff who test positive for COVID-19 who were exposed while at work. Staff who do not test positive or contracted it from outside work can use sick leave time.

Beahan is unconcerned about the risks to her own health as she deals with response to the outbreak.

“Everyone is on high alert, but we also recognize we have work to do to support UW Med so we are doing what we can,” she says. “I’m truly not worried for me but for those who have underlying health conditions, this is fatal. Keeping them out of the public is critical right now.”

To that end, UW is taking the following measures to protect patients and the community:

  • UW Medicine is encouraging staff and patients to use its virtual clinic if they feel sick, rather than coming into the clinic or emergency room (ER). The fee for the virtual clinic has been waived and, where possible, providers are using telemedicine for clinic appointments so patients can stay home.
  • Entrances to the hospitals have been closed, with the exception of a few key entrances where anyone entering is screened for fever and asked travel questions.
  • Non-essential clinic appointments are being rescheduled for a later date to make room for patients who need more immediate access and to protect healthy patients from being exposed in clinics. High-risk populations cared for in the health system’s oncology and transplant departments, are being treated remotely if possible.
  • UW Medicine has created a mobile unit that goes out to homes to screen patients who feel ill and exhibit signs of the virus to keep them out of the ER.
Treating COVID-19 in New York City

Dianne M. Chappelle, MPA, RHIA, director of HIM operations, New York–Presbyterian Hospital, is no stranger to high-profile public health events. Her facility, which has more than 40,000 employees, has treated patients during 9/11 and during the SARS, MERS, and Ebola outbreaks. As of last Thursday, NY–Presbyterian was treating two people who tested positive for COVID-19, though the situation in New York has been evolving.

While the outbreak is a constant topic of conversation around the office, the impact on staff and patients has been minimal thus far.

“Our leadership is reminding us that this is no different than any other infection. We’ve handled these types of things before,” Chappelle says.

The biggest change so far for Chappelle is the cancellation of large meetings. She says it is strongly recommended that meetings not be held in person, with conference calls and video conferences being preferred.

“We cannot assemble more than 50 individuals in the same room. The recommendation, too, is that most meetings have under 20 people and that we wash down the tables and the keyboards and things that we use during those sessions,” Chappelle says.

As for other HIM operations, Chappelle noted that a “break the glass” procedure is being explored to be in place to protect the records of patients who test positive for COVID-19. This is standard for large and small facilities treating VIPs to ensure that only authorized personnel are looking at the records.

Additionally, while many healthcare organizations have added travel screening questions to their EHRs to help track patients who have been to China, Italy, and other COVID-19 outbreak zones, Chappelle says this has long been standard at NY–Presbyterian.

“That’s already part of our readiness program. Since Ebola, the travel question has always been asked. If you call any doctor in the New York–Presbyterian network they will ask you, even on the phone, ‘Please let us know if you’ve traveled outside the US,’” Chappelle says.

 

Mary Butler (mary.butler@ahima.org) is associate editor at the Journal of AHIMA.

To read about the CDC’s interim coding guidance for coronavirus, click here.