ROCHESTER, Minn. -- The Electronic Medical Record has been blamed for creating busywork, but when it comes to COVID-19, it may mean the difference between a functioning hospital working at full capacity within a pandemic and a health system facing internal outbreaks that sideline health care workers and disrupt care.
For Mayo Clinic and its health system, the ability of paperless medicine to quickly call up names behind each newly positive COVID-19 patient's care team is proving invaluable in the work of calling up a digital paper trail to launch rapid-response contact tracing within a sprawling health system.
It works like this: In the preferred scenario, a patient with symptoms of COVID-19 calls in to the clinic, is triaged via nurseline, and if they are to be seen, that patient is greeted at the door by personnel wearing PPE. Every subsequent contact between that patient and Mayo personnel and facilities is then treated as if the patient is contagious.
That's the preferred process. But it doesn't always work that way.
"It's not that common that patients are identified after entry into the hospital," says Dr. Laura Breeher of the Mayo Clinic Department of Occupational Medicine. "Mayo Clinic is doing very detailed screening of patients that are coming in, and we have stringent requirements for personal protective equipment that is used when seeing those patients. But we know COVID-19 is in every state in the U.S. and we are learning more and more about it, like the fact that some patients may not have a fever or a cough. Their first symptoms might be GI (gastrointestinal) distress."
As a result, asymptomatic patients with coronavirus can have unprotected contact within the health care system. When this happens, it becomes imperative for the clinic to quickly identify and pull anyone off the floor who may have been exposed.
"Say we had a health care worker that was exposed to a patient who was ill with COVID-19, and it wasn't identified right away that it might be COVID-19," Breehar says. "The list of employees that interacted with that patient in the electronic health record is one piece of the information, but it wouldn't capture everyone."
"It might not capture the phlebotomist that draws blood. It might not capture the ambulance driver that drops that person off at the hospital. Or the receptionist that checks them in. So we've developed these tools that allow us to go beyond the electronic health record and get information directly from supervisors."
"We have to have very detailed information about each contact -- we're looking for health care workers that have been in close contact with a covid-positive person at less than six feet, for more than five minutes."
The occupational medicine team can send contact logs to supervisors in any given area of the hospital -- for example the emergency department, Breehar says, "and the supervisors in that area can then tell us all of the employees that may have been in contact with that patient."
Breeher estimates the clinic has repurposed over 100 employees strictly for the positive test response program, a personnel investment that she calls "a small army of brilliant people."
Employees can come down with COVID-19 as well, which is why the same internal tracing must also identify all those who worked alongside an employee during their period of likely contagiousness.
And all of it has to happen fast. Very fast.
Even with its own lab, a test for coronavirus can take 24 hours to get a result. That means that once a positive result is returned, the clinic's internal contact tracing is tasked with identifying, interviewing, assessing and if needed, removing from campus all who were exposed within just two hours.
"Anyone at medium or high risk we would take that person off of work on campus," Breeher says. "We write a restriction saying they can't work on campus but that they can telecommute if that is available. We also do twice-daily active symptom monitoring of that person in collaboration with the state, to make sure that over a period of 14 days they don't develop a fever or symptoms."
And for the low risk individuals?
"We have them check their temperature and for symptoms twice daily, and we notify them not to come to work if they develop any symptoms."
Although that's become standard across the health system. In something of a foreshadowing of times to come everywhere, taking your temperature twice a day is now required of everyone who works on the Mayo Clinic campus. "It's because," Breeher says, "we know they could have exposure to someone with COVID in the community as well."
Breeher says that despite the alarm it causes in the community, there's no special art to telling a Mayo Clinic employee that they may have been exposed to COVID-19.
"We explain that we cast the initial net very broadly, just to make sure we capture every single individual that may be exposed. We also say it's possible we may determine from the interview they may not have been exposed," Breeher says.
Breeher didn't have a number for how many employees have been exposed so far, but she says the investigations have been numerous.
"We're using it frequently. Any positive individual we look to see was there a potential exposure that occured. Our institutional leadership has been incredibly supportive to make sure we have the tools we need for these contact tracing efforts."
Minnesota Department of Health COVID-19 hotline: 651-201-3920.
COVID-19 discrimination hotline: 833-454-0148
Minnesota Department of Health COVID-19 website: Coronavirus Disease (COVID-19) website.