EHR v Covid-19. Follow the data: Visits, Testing, Symptoms, Codes?

It is time we looked back at the past month to update our data. Since we initiated social distancing in mid March, and then the Colorado Stay-at-Home order in late March and subsequent mask use, what has happened to Covid-19, and what about symptoms? other viruses, the geographic spread? Hold on to your hats. This is all UCHealth data from our Slicer de-identified data tool.

  1. Virtual visits are up, and stable at about 4000 visits a day. In person visits are way down from baseline in early March. Overall visit volume is way down, as it is for most health organizations right now. As Colorado starts to ease restrictions from “Stay at Home” to “Safer at Home”, we will see what comes next. Regardless, there will be repercussions from this some time to come.

2. Covid RNA testing is up (not enough), supplies for testing are short nationally, and unlikely to change quickly. The state is ramping up, and we all agree that widespread community testing is critical to safely opening up restrictions. Furthermore, antibody testing, although everyone’s working hard on this, is still not ready for prime time; the accuracy of the tests (false positive, false negative rates) are still too high to be trusted.

3. Cough, Fever, Shortness of Breath, Diarrhea is all decreasing as we reach the end of the worst virus seasons. What does this mean about Covid? Of course, mixed in, is the decrease in visits overall. This curve is worth watching over time as the state “opens up.”

4. Where is the spread across 12 hospitals. University of Colorado Hospital on the far right, Greeley Medical Center on the far left. The higher bumps in the middle are for Poudre Valley, Medical Center of the Rockies, Memorial North, Memorial Central. Some of our hospitals are seeing very little. Interesting regional variation. We are also intentionally protecting some of our hospitals to be Covid-free as much as possible, in case of future surge demand.

5. What about ICD10 diagnoses by docs? You may know that CMS published an new set of ICD10 codes (international classification of disease, version 10) that contain Covid-19: including: Confirmed Covid, Suspected Covid, Exposure to Covid, etc. Grouping them into Confirmed versus Suspected, here’s what you get in our visits since March (orange: suspected, blue: confirmed). This is a reflection of the scarcity of testing. Again, interesting to see where this goes. NOTE: The last down-tick on the orange may be due to counting a partial-week in the data.

So what do we learn?

A. We need more testing to figure out what the community prevalence is.

B. Virtual visits, even scalable at 20x previous volume, will not save the day.

C. Social distancing and stay-at-home are followed quickly by a dramatic reduction of Covid-like symptoms seen in clinics. BUT, be careful of conclusions: social distancing could also have affected the USUAL winter virus spread, OR patients are not choosing to be seen, OR the virus is mutating into a less severe form, OR distancing policies might really be working. Wouldn’t you like to know which it is?

D. ICD10 codes are being used in our clinics! But the trends don’t mean anything yet. It might be promising that “suspect Covid” codes are growing more slowly.

F. Covid is going strong into the late Spring (wasn’t it supposed to evaporate magically likes SARS CoV-1? That outbreak in 2003 largely evaporated by late May, early June). Covid-19 (more accurately, SARS CoV-2) is going strong and is likely to behave quite differently, not a good sign for us humans.

PREVIEW OF NEXT POST: How does testing for OTHER VIRUSES compare to COVID testing results in the late winter/spring? and what does Hemoglobin testing teach us about Covid-19?

CMIO’s take? The lessons from Pandemic are numerous and they just keep coming. Be sure to take a break, and take care of yourself. Don’t worry, I’ll be back soon.

Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

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