The first article in this three-part series criticized the conditions of COVID-19 treatment in the United States. Now let’s look toward the future: what we do ideally if we had an epidemic and a treatment we wanted to administer quickly to patients?
The ideas in this article combine observations of mine over several years with conversations I held during the past two weeks with industry experts, especially Dr. Steve Mok, Manager of Pharmacy Services and Fellowship Director for Clinical Surveillance and Compliance at Wolters Kluwer, Health.
The Prescription Stage
The first element would be a simple and quick way to connect a patient to someone who can issue a prescription. Next, the clinician needs access to patient records. Amber Glauser, RN, Cloudticity director of customer success, said that we are making progress gradually on information sharing. The 21st Century Cures Act helps by requiring providers to give patients access to their personal health records. Physicians were required to comply by April 2021.
OK—how many of you readers have a complete record of your diagnoses and medications? I admit that I don’t. My Epic portal doesn’t offer access to everything in my record. And it takes time to share it with another provider, such as my dentist.
I posed questions about “information blocking” (the term seen in laws and federal documents about barriers to data sharing) to Shannah Koss, a long-time health IT policy consultant and consumer health IT advocate.
Koss told me of three factors that will delay the ban on information blocking. First, there is no single on-ramp for patients and families, so the average Medicare patient would still have to go to their 7 different clinicians and 4 practices to get their data. Second, there are 8 exceptions to the ban that are broad and vague. Third, we need to put more attention and resources toward consumer outreach, education, and IT support at the community level so people have access to records regardless of their sophistication in health issues, technology, and regulations.
Thus, the experts say that we are making progress, but we haven’t reached our goals. (Check a recent panel on interoperability or a written summary, where leaders of health care organizations discuss how to measure impacts and progress.) Today, if you had a telehealth visit with a doctor who didn’t happen to work for a corporation that has your data (that is, if you weren’t as lucky as Dr. Richard Dion), you’d probably be delayed getting a prescription.
The Fulfillment Stage
Many further concerns go into access to the medication itself.
The urgent question is how to bring medications close to the people who need them. If one county has a particularly high incidence of COVID-19, it needs a lot of the medication. Assessing this public need is a responsibility shared by many organizations. Glauser said that ideally, municipalities would collect information about infection rates and feed them to state agencies. The two levels of government would cooperate to direct treatments to the places that need them most. However, broad decisions about medication distribution are made at the federal level, as we’ll see.
So responsibility is widely distributed among different levels of government, which are often underfunded and use incompatible systems. Data may have to be sent manually and input manually into another system. The data distributed by the CDC, for instance, always lags a week or more behind its collection.
Suppose that the public health system has surmounted the problems of determining where medicines are needed, and has gotten the drugs to the right places. All pharmacies receiving the medicines should be part of a unified network so that a clinician prescribing the medication can simultaneously inform the patient of the most convenient pharmacy that has the medication.
Let’s not end this section without considering drug delivery. You can get a taco delivered to your door, but not a life-saving medication. Granted, a valuable and fragile medication needs to be handled with care. But it should be possible to arrange trusted delivery services. Some of the experts I talked to for this article even mentioned a hope for drone delivery, which is already in use in some critical regions of the world.
Surveillance and Response
The urgent public health requirement to manage infection rates also creates new demands on a wide range of actors. When all COVID-19 testing was done through institutions such as pharmacies and schools, the government could collect fairly accurate information on infection rates. Home tests were an invaluable addition to the public health effort, long called for, but they had a paradoxical effect: Most people didn’t report test results. (I’ve taken several home tests, and I have no idea who would be interested in my results and how to get them to the relevant parties.)
An ideal testing system would be no-cost and easy to perform, and would include a convenient way to report both positive and negative results (if the patient chooses to do so). In the meantime, governments can use known data on hospital admissions, waste water testing, and statistical models to determine where COVID-19 treatments are most needed.
The last article in this series hones in on some aspects of health care that need to improve, so that next time we’re in better shape to treat patients during epidemics.
