Use of Clinical Pathways Integrated into the Electronic Health Record to Address the COVID-19 Pandemic

Infect Control Hosp Epidemiol. 2022 Mar 22;1-27. doi: 10.1017/ice.2022.64. Online ahead of print.


Background: The COVID-19 pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)-integrated Clinical Pathways (E-ICPs), easily-understood care algorithms accessible at the point-of-care.

Objective: To describe the institution's creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools.

Setting: Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices.

Methods: Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19 specific E-ICPs along with a process for frequent re-assessment and updating. We examined the development and use of our COVID-19 specific pathways for a six-month period (March 1 to September 1, 2020), and describe their impact using case studies.

Results: Forty-five COVID-19 specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders placed. Case studies describe the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting.

Conclusion: E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and non-urgent clinical conditions.

Keywords: COVID-19; Clinical Pathways; Decision Support Systems, Clinical; Electronic Health Record; Information Dissemination.