OHSU spearheads a data-sharing initiative that quickly scaled across 60 hospitals by surmounting EMR challenges and avoiding sensitive patient data to deliver an automated snapshot of bed and ventilator availability across the state.
On Saturday, March 14, a Mission Control executive at Oregon Health & Science University (OHSU) woke up with an ambitious idea. As the coronavirus pandemic was gaining a foothold in the U.S., he imagined the benefits of having a shared data system that automatically tracked real-time bed and ventilator capacity for every hospital in the state.
By that evening, OHSU's Mission Control consulting team at GE Healthcare Command Centers had outlined a plan. Within two weeks, 90% of hospitals in the state were live on the system, sharing near real-time data in a way never before achieved. "Oregon is the first U.S. state to have this specific system in place across an entire state," according to an article published in the June 2020 Critical Care Explorations.
The compelling aspect of this success story is not only how quickly such a complex initiative scaled across multiple hospitals and healthcare systems, says Matthias Johannes Merkel, MD, PhD, senior associate chief medical officer of Capacity Management & Patient Flow at OHSU, but also how competing health systems came together to share data with each other for a greater good. Others have taken note. Following Oregon's example, the state of Florida is preparing to roll out a similar program, according to GE Healthcare.
COVID-19 Ignites Innovation
The Oregon Capacity System, which OHSU created in concert with the Oregon Health Authority, tracks 7,368 beds and about 800 ventilators at 60 hospitals, processing 4.2 million data points each day, according to Jeff Terry, MBA, FACHE, global CEO of GE Clinical Command Centers, GE Healthcare. Bed data is updated every five minutes.
Like every other state, Oregon previously tracked hospital capacity information manually, says Merkel. Manual processes produce "outdated" data, he says, which is useful for reporting purposes, but not meaningful in a crisis when a patient may need an immediate transfer.
The Challenge: Convincing Healthcare Systems to Share Data
While clinicians immediately saw the advantages such a system would offer, Merkel says convincing hospitals administrators to share such data might have presented an issue.
"The biggest challenge was to create a common narrative around why we were doing this," he says. Even within OHSU, it was essential to consider why the Portland, Oregon–based academic healthcare system would be willing to participate. Leaders pondered whether, "Is this really a good idea?" he says.
"The idea that health systems will be so transparent with their peers is revolutionary," Terry says. "On a day-to-day basis, big health systems are sort of 'frenemies;' they all collaborate a bit, but they also all compete a bit. The fact that everyone came together in Oregon and did this was a big deal, and it also created a North Star.
"In the end, we all agreed the benefit of having this available outperformed any of historical concerns [about sharing information]," Merkel says.
Addressing the IT Challenge
The next barrier to overcome was the IT challenge.
"The reason nothing is automated today except outside of Oregon, is it's hard to get the data out of the EMRs [electronic medical record], and everybody's on a different system," says Terry. The 60 participating hospitals in Oregon involve about 40 different IT systems, he says. "We were able to create a method to extract that data … that is fast to set up and does not include any PHI [patient health information). It's low risk, which was very important to getting the hospitals on board."
According to the Critical Care Explorations article, the first key steps only require about an hour of time from an organization's IT team.
Data from each facility is fed into OHSU's Mission Control center, which serves as the Oregon Capacity System's information hub. While OHSU did not share the cost involved, funds secured through the OHSU Foundation were used to offer the appropriate technology to other hospitals in Oregon to facilitate the connection.
"It was really about optimizing the technology we use every day in a way that actually helps us in the pandemic," Merkel says. "That's how this idea came together."
How the Data-Sharing Works
Information is available to all participating organizations via a website that can be accessed through smartphones or any device, or projected onto an electronic wallboard as it is at OHSU's Mission Control. Like an airport electronic arrival-departure board, the display is not static and updates constantly as the user views it. Within each five-minute window throughout the day, all data is refreshed.
The display posts availability of 13 types of hospital beds (such as adult and pediatric ICU, negative pressure, behavioral health, etc.) at all participating facilities. Ventilator data is included as well. Plans include adding emergency department beds to the mix.
Information is organized by region, Merkel says, mimicking the strategy Oregon already had in place for trauma care.
Every facility uses the system differently. Many review it a part of their daily executive team or emergency operations meetings. Some examine it throughout the day for updates about their own capacity. Others refer to it when they begin reaching capacity to determine what other options may be available.
"In the case of an extreme COVID surge, which Oregon doesn't have right now," says Terry, "there would be a switchboard where advanced care practitioners and physicians like Dr. Merkel would use this tool to inform the allocation of patients between hospitals and perhaps temporary hospitals that are set up." That same system could also be activated during another type of disaster, he says.
In fact, “The unprecedented wildfire situation in Oregon has highlighted another use case for the benefit of real-time tracking of available beds within the state," Merkel says. "We are using the Oregon Capacity System today and continue to learn how to incorporate it into our emergency operations.”
Potential Expansion Beyond the Pandemic
Beyond COVID-19, OHSU is exploring other potential uses for the tool, particularly in specialized areas, such as pediatric critical-care burn units and behavioral health, Merkel says. "I think these things will outlive the pandemic [because] it allows us to serve patients very effectively across multiple health systems."
Meanwhile, use of the tool has spawned increased collaboration, says Merkel, who reports that regular calls among CMOs now occur several times a week. "This was not possible before," he says. "I hope that the lessons learned survive a long time so that we build a more robust health system and health response across various components."
Oregon's initiative has inspired at least one other state to take similar action to build a statewide capacity reporting system, says Terry. GE Healthcare Partners was approached by AdventHealth, HCA Healthcare, and Tampa General Hospital, which all have command center facilities in Florida, to develop a similar data sharing system under the auspices of the Florida Agency for Health Care Administration. He says it should go live by the end of the month. Terry predicts other states are likely to follow, and eventually, a national system may emerge.
"The pressure of COVID broke down cultural barriers and inspired revolutionary new technology," Terry says. "Oregon has a first-of-a-kind automated bed traffic control. Everybody wants that."
“The idea that health systems will be so transparent with their peers is revolutionary, On a day-to-day basis, big health systems are sort of 'frenemies;' they all collaborate a bit, but they also all compete a bit. The fact that everyone came together in Oregon and did this was a big deal, and it also created a North Star.”
Jeff Terry, MBA, FACHE, global CEO, GE Clinical Command Centers
Mandy Roth is the innovations editor at HealthLeaders.
Within two weeks of ideation, the solution scaled to 90% of Oregon hospitals.
Onboarding hospitals across the state required creating a "common narrative" about the greater need to share data to better serve patients.
Shared data from about 40 EMRs includes no PHI, so it circumvents issues related to HIPAA.