key: cord-275801-cjxuvyh9 authors: Sylvestre, Emmanuelle; Thuny, René-Michel; Cecilia-Joseph, Elsa; Gueye, Papa; Chabartier, Cyrille; Brouste, Yannick; Mehdaoui, Hossein; Najioullah, Fatiha; Pierre-François, Sandrine; Abel, Sylvie; Cabié, André; Dramé, Moustapha title: Health Informatics Support for Outbreak Management: how to respond without an Electronic Health Record? date: 2020-08-06 journal: J Am Med Inform Assoc DOI: 10.1093/jamia/ocaa183 sha: doc_id: 275801 cord_uid: cjxuvyh9 nan To the editor, The world is facing an unprecedented health crisis in 2020 with the COVID-19 pandemic. Reeves et al. paper [1] underlined the importance of the Electronic Health Record (EHR) and health informatics in general to support outbreak management. They proposed several recommendations heavily-based on the EHR to help hospitals improve their response in this unique situation. This article is extremely relevant for the United States, since most American within the healthcare system have their data recorded electronically. According to the Office of the National Coordinator for Health Information Technology (ONC) report, as of 2015, 96% of non-federal acute care hospitals and 78% of office-based physicians had adopted certified health Information Technology (IT). [2] Thus, with a fully functioning EHR, the authors were able to implement screening tools to help proper triage, ordering tools for accelerated biology and imaging exams and even clinical decision support. All of those EHR enhancements followed COVID-19 monitoring guidelines set by institutions and were a major help for outbreak management. The use of EHR as a potential public health tool has been studied for years [3] and with the COVID-19 pandemic, many institutions worldwide have tried to leverage its full potential to accelerate their response. However, some health institutions are still struggling to entirely digitize their health data. In iii) be able to create and distribute real-time reports. We managed to build two databases in less than a week. The first database (COVID-SAMU) is a triage database used for monitoring outpatient cases, with a phone call schedule based on national monitoring guidelines. The database has information on all outpatient cases, including their address, their age, their underlying diseases and their different symptoms. Sociodemographic data from patients with COVID-like symptoms are first automatically integrated from the hospital triage software. Then, we developed a web application where each clinician can fill specific forms to monitor COVID symptoms and their evolution at the time of each phone call. We decided to heavily rely on this form of outpatient monitoring rather than self-reporting (for example, based on a smartphone application) because of our population characteristics (Martinique is one of the oldest French territory). The second database (COVCHUM) is for hospitalized patients. This database also integrates the few digitized data available (administrative data, reimbursement claims and laboratory test reports). As for the COVID-SAMU database, we developed a web-application and COVIDspecific forms for clinicians. In this case, we needed to be able to integrate quickly the most important data for COVID monitoring despite the lack of interoperability between our different digitized systems. Since our administrative data is fully digitized, we were able to link patients throughout the Both databases are implemented with WINDEV ® , because it allowed us to automatically integrate data from our hospital framework (all of our hospital software rely on Oracle ® database management system). We also used WEBDEV ® to develop the web-based applications, because we wanted to be able to deploy them hospital-wide in a very short time, even with a very small team. Finally, both COVID databases allow to perform queries using Structured Query Language (SQL) and extract structured data in comma-separated values (CSV) form, which helps us create real-time reports. We still wanted to comply as much as possible with health IT guidelines. As a result, we focused on interoperability, standardized terminologies and automatic data collection when possible. We also implemented simple rule-based Natural Language Processing algorithms to be able to extract unstructured data from clinical notes. Despite our limited resources and our lack of an existing adequate informatics framework, we managed to implement relatively simple tools, which helped us improve our ability to rapidly respond to the evolving situation. The electronic health record is an essential tool for COVID-19 management, but even without it, we can still develop alternative solutions that can tremendously help hospitals with limited resources and without state of the-art health IT. We should leverage these solutions to help reduce the impact of the digital divide in healthcare, especially in time of crisis. Report to Congress -Annual Update on the Adoption of a Nationwide System for the Electronic Use and Exchange of Health Information Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health The authors have no competing interests to declare. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.