remote go-live at MercyAscot<\/a>.<\/p>\nA Brave but Crucial Implementation for Chinese Hospital Group<\/h2>\n
In the early days of the COVID-19 pandemic, many people in China did whatever they could to avoid hospitals. But as the outbreak grew and communities enacted stay-at-home restrictions, one team from InterSystems ran to the frontlines.<\/p>\n
Six employees set up camp at Amcare\u2019s Women\u2019s and Children\u2019s Hospital\u2019s Baodao campus, in Beijing, to execute a TrakCare implementation. Their work had never been so important. Amid the emerging pandemic, clinicians still needed to perform the specialized
\nhospital group\u2019s key function: safely marshalling women through pregnancy. After all, nothing would stop babies from being born. And that task required easier access to the information that matters.<\/p>\n
\u201cWe have seen medical workers who are sticking to their posts to fight the virus,\u201d says Luciano Brustia, regional managing director for Asia Pacific at InterSystems. \u201cThanks to them, the medical needs of the Chinese people are being met.\u201d<\/p>\n
The employees, including technical and application specialists and a project manager, executed the implementation alongside three remote technicians in February. They wore face masks and avoided public transportation to safely get the job done. TrakCare went live in the hospital later that month, empowering physicians to provide uninterrupted pregnancy tests and other gynecological, obstetrical, pediatric, and reproductive care throughout the pandemic. The project, it turned out, brought vital IT tools to clinicians whose duty to serve patients had never been so imperative and imperiled.<\/p>\n
In the following months, InterSystems employees remained connected to customers in Chinese healthcare organizations. TrakCare experts provided round-the-clock technical support, remote coordination, and on-site services. The implementation at Amcare\u2019s Baodao campus stemmed from a 2016 partnership between the private hospital group and InterSystems. By this February, TrakCare had already gone live in three facilities and one clinic in Beijing. Amcare and InterSystems understood that the company\u2019s newest acquisition, the Baodao facility, couldn\u2019t wait for the unified healthcare information system. Once launched, TrakCare would establish a single source of truth for clinical, administrative, and financial information, with the insights to fuel stronger clinical decision making and support care collaboration.<\/p>\n
While the implementation occurred at the height of China\u2019s struggle with COVID-19, its implications will span far beyond the pandemic, helping the next generation of children enter the post-pandemic world unharmed.<\/p>\n
Rome Wasn\u2019t Built in a Day. But Its COVID Hospitals Went Live in Weeks.<\/h2>\n
By March, when the Italian region of Lazio directed Gemelli Hospital to lead its clinical response to COVID-19, the pandemic had turned the world\u2019s attention to the nation. Italy instituted a strict lockdown as the death toll climbed, chiefly in the northern regions. Rome, where Gemelli is based, was bracing for impact. Hospital leaders had to build up the city\u2019s defenses, and they had to do it quickly.<\/p>\n
So, Gemelli got to work. In mere weeks, the organization opened the Columbus COVID-2 Hospital in its polyclinic, providing 21 intensive care units and 32 beds, and turned a nearby Marriott hotel into an 80-bed hospital where COVID-positive patients could quarantine after discharge. Suddenly, international media focused not on Italy\u2019s struggles, but Gemelli\u2019s successes.<\/p>\n
What received less attention were the rapid-fire remote technology implementations that fortified the work of Gemelli\u2019s dedicated physicians and nurses. Gemelli IT staff and InterSystems, for instance, took a single week to launch InterSystems TrakCare at Columbus. The Marriott followed weeks later, going online April 1. The prestigious university hospital\u2019s mobilization went on to underpin Italy\u2019s remarkable turnaround in its fight against COVID-19, which saw new case and death counts fall and an entire society reemerge from a panicked slumber.<\/p>\n
Gemelli\u2019s speedy implementation of TrakCare in both hospitals aided clinicians in a sprawling effort to screen all patients, connecting COVID-19 testing data in a central location. Physicians and nurses received alerts the moment the laboratory identified a positive patient. The technology empowered the hospital to locate COVID patients and separate them from others. Clinical decision support tools and visualizations illuminated trends in prescribing data, helping Gemelli execute medication management, and develop standards of care. The launch had several factors working in its favor. For one, Gemelli and InterSystems teammates moved decisively on the remote go-live, a new approach for each organization. They used automation tools to transfer data and virtual programs to train users. IT specialists remained available to guide and troubleshoot for Gemelli employees. Then there was TrakCare itself, whose regional edition drew on previously established workflows, security groups, and localized compliance mechanisms.<\/p>\n
The personalized system also came ready with favorites and simplified configurations for physicians. And they were familiar with TrakCare, which went live in Gemelli just months before, in late 2019.<\/p>\n
In the end, however, the major reason for success was Gemelli\u2019s leadership. Instead of hesitating, they jumped at the challenge. They set up their clinicians to succeed with two new COVID-19 hospitals, running on an integrated source of information that allowed physicians to focus on what mattered most: patients<\/p>\n
Life on the Frontlines of a \u2018Nightmare\u2019 Pandemic<\/h2>\n
For Callum Cox, the hardest part of working in United Kingdom hospital during the COVID-19 pandemic was consoling his intensive care unit patients\u2019 distraught family members. Restricted from entering the hospital,
\nloved ones received updates on a patient\u2019s condition only through a daily text message and phone call. Horror stories on the evening news filled in the blanks. Only when a patient was dying was a single visitor allowed to risk infection to come say goodbye. \u201cPatients had a tube in everywhere. Machines were beeping and screaming all day,\u201d Cox, who worked three long nursing shifts per week this past spring, says. \u201cFamilies didn\u2019t know what was going on. They were scared.\u201d<\/p>\n
But when patients came off ventilators, Cox was there, cellphone in hand, ready to reunite families that had spent days, if not weeks, in distress. Before the pandemic, it would\u2019ve been inconceivable that Cox would be in such a position. He has been out
\nof the hospital for the past two years, working as an application analyst for InterSystems to ensure that his team\u2019s software supports clinicians. When COVID-19 struck, however, he and several other nurses employed by InterSystems heeded the call, faced their fears of infection, and ran to the frontlines when patients and fellow clinicians needed their expertise most. Silvia Marzoli, an application analyst for InterSystems who previously spent nine years as an ICU nurse in Italy, recalls the moment she decided to return to the hospital. When she realized the magnitude of the COVID-19 outbreak, she called former colleagues, who said they were floundering with limited personnel and resources. In two days, she had signed a contract to perform weekend shifts at a nearby hospital, on top of her day job. \u201cI preferred to stay in than stay out of this situation,\u201d Marzoli says.<\/p>\n
Providing care was more challenging than usual. No one knew which treatment to use for the seriously ill, each patient required plenty of time, and patients kept coming in, she notes. In the U.K., Cox and Andrew Seal, an InterSystems application analyst with 15 years of ICU nursing experience, remember sweating through layers of personal protective equipment. They rarely removed the gear, as masks and gloves were scarce. The equipment inflamed once-simple tasks,like speaking with a physician. Seal, who considered the pandemic a \u201cnightmare\u201d and responded by taking two overnight ICU shifts per week, spent his first day caring for a patient of the same age, who had no comorbidities. COVID-19 had devastated the patient, making survival uncertain. Seal saw himself in that patient. \u201cBut in a few weeks, the patient was better,\u201d the nurse says. \u201cI played a part in getting the patient off the ventilator and getting them back on the way home. So that was a proud moment.\u201d Still, the frontlines were fraught with risk. Cox, who has a wife and two babies, partook in a grueling ritual to prevent infecting them. He woke up, showered, drove to work in clean clothes, placed them in a locker and donned his scrubs, and did his shift. Then he showered at the hospital, left
\nthe scrubs behind, wore his commuting clothes, and disinfected his car upon arriving home. Finally, he changed into new clothes in the yard and cleaned his personal items. When the number of COVID-19 hospitalizations began waning in the U.K. and Italy, the three InterSystems employees returned to their typical routines. But will they charge the frontlines if the pandemic calls for it? \u201cOh, yeah,\u201d Marzoli says, \u201cif they need us again.\u201d<\/p>\n
SARS-CoV-2 Antibody Testing<\/h2>\n
By Russ Leftwich MD, Senior Clinical Advisor, Interoperability<\/strong><\/p>\nSince January there has been much in the news about testing for COVID-19, the disease caused by the Severe Acute Respiratory Syndrome associated Coronavirus 2 (SARS-CoV-2). More recently there has been the appearance of antibody tests, also referred to as serology, for this coronavirus. But what is the difference in these tests and what are antibody tests? The test done \u201cto see if you have COVID-19\u201d is a test that detects genetic material from the virus itself, usually testing a swab from the nasal passages or fluid from the lungs. The antibody test involves a sample of blood to see if your immune system has responded to the virus by producing antibodies.<\/p>\n
What are antibodies? Antibodies are proteins produced by a particular type of cell in the immune system called B-cells. Antibodies are produced in response to a foreign substance in called an antigen; in this case the SARS-CoV-2 virus. Antibodies, also called immunoglobulins, are Y-shaped protein molecules. The tip of each arm of the Y is an area which binds to a specific area of an antigen and fits like a piece of a jigsaw puzzle only to that area. The SARS-CoV-2 virus may have dozens, even hundreds of such distinct areas each recognized by a different antibody molecule. When there is an antibody response the immune system produces a family of antibodies recognizing different specific areas on the virus. This is called a polyclonal response, because each member of the family of antibodies is produced by a different clone of B-cells. And, two different individuals will produce two different families of antibodies based on their own genetics. When the immune system encounters an infectious agent for the first time, whether it is a bacterium or a virus, it first produces Immunoglobulin M (IgM). IgM starts to appear several days after the infection starts. A few days later, a second type of antibody, Immunoglobulin G (IgG), starts to appear. Both IgM and IgG are families of antibodies to the SARS-CoV-2 virus. The IgM produced usually starts to disappear within a few weeks. The IgG antibodies in the blood continue to increase for several weeks and may remain for months before they disappear<\/p>\n
Are all the SARS-CoV-2 antibody tests the same? <\/strong><\/p>\nBy early May 2020 well over 100 antibody tests were available. Each test was developed separately. Some of the tests tested for IgM, some for IgG, some for both. Tests determined that antibody was present or absent. Although it is possible to measure the level of an antibody present, the titer, none of these tests actually do so. There is very limited information about the accuracy of the available tests, but it has been observed that some of the tests have a high false positive rate and that two or three different tests done on the same individual may not agree on the presence of antibody. In the US over 20 different SARS-CoV-2 antibody tests were removed from the market because of inaccuracy.<\/p>\n
What do we know about antibody responses to SARS-CoV-2? <\/strong><\/p>\nAs with most infections, IgM to SARS-CoV-2 starts to appear in some individuals about 3-5 days after the start of infection. But, depending on the sensitivity of the antibody test, it may be 3 weeks before some individuals show IgM to SARS-CoV-2. IgG to SARS-CoV-2 begins to appear a few days after IgM. A small percentage of individuals, around 5% who have COVID-19 with symptoms and a positive test for the virus appear not to develop antibodies even when they have recovered from COVID-19. How is this possible? The answer is that antibodies are not the primary function of the immune system which eliminates a current viral infection. Antibodies are however the primary protection from a future viral infection.<\/p>\n
Does the presence of antibodies mean immunity from future COVID-19? The answer is that we do not know the answer. We do not yet know whether the antibodies present will prevent future infection with SARSCoV-2. And if they do, we do not know how long levels of those antibodies will remain high enough to provide protection. Antibodies that protect from future infection are referred to as neutralizing antibodies. There can be some assessment of the neutralizing capability of antibodies by taking antibodies from a recovered COVID-19 patient and using them to block SARS-CoV-2 infection in other animals, but the only absolute evidence is the prevention of re-infection of a human during an outbreak of the SARS-CoV-2 virus. The goal for a vaccination against COVID-19
\nis of course to induce high levels of neutralizing antibodies in a high percentage of individuals who receive the vaccine. Once again, the only absolute evidence that such antibodies are present, and the vaccine is
\neffective is exposure of vaccinated individuals to SARS-CoV-2 in a future outbreak.<\/p>\n
Testing for antibodies to SARS-CoV2 will be of increasing importance as this pandemic evolves. It will be of critical importance to increase the understanding of the antibody response to this coronavirus and to understand what is being measured by the various antibody tests. Of perhaps greatest importance will be the ability to assess the accuracy of different antibody tests and how they compare to one another. The first step in this will be appropriate coding of the various tests to reflect the origin of the specimen tested, the identity of what is being tested, the method used to include the specific device, the encoding of results, and assessment of the predictive value of each test. Only then can we assess the level of protection of individuals by their antibody levels, the effectiveness of vaccines, and develop our knowledge of how to control COVID-19 at a population level. The practices around coding for tests related to COVID-19 including the antibody tests for the virus will be addressed in a future article.<\/p>\n
WRITE A REVIEW AND RECEIVE A $25 VISA GIFT CARD FROM GARTNER<\/h2>\n
Your feedback is valuable to us \u2014 and to peers who may be considering their next technology purchase. Take a few minutes and write your review on InterSystems TrakCare: gtnr.it\/2CzFov<\/a>z Gartner will ask you to sign in with LinkedIn or create a free Gartner account so they can verify your identity. *Quantities are limited, and Gartner must approve the survey to qualify for the gift card. Gartner will not approve reviews from resellers, systems integrators or MSP\/ISV\u2019s of InterSystems. Survey must be completed by Dec. 31, 2020.<\/p>\n","protected":false},"excerpt":{"rendered":"The last introduction I wrote for this newsletter started as so many other articles do these days, with \u201cAs I sit at my desk at home\u2026\u201d This was not so long ago, yet working remotely was enough of a novelty that it warranted a mention. Not quite 8 weeks later, it feels the whole world […]<\/p>\n","protected":false},"author":1,"featured_media":2260,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"spay_email":""},"categories":[8],"tags":[],"jetpack_featured_media_url":"https:\/\/ec-projects.co.uk\/intersystems-uki\/wp-content\/uploads\/2020\/07\/interystenms.jpg","yoast_head":"\n
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