The way to prevent asthma symptoms being misread for Covid-19

In the UAE, over 14 per cent of residents have asthma and up to one fifth of the population is allergic to something. Adding to which, in what can be a frightening reality for many patients, healthcare providers acknowledge the similarities between the symptoms of allergies, asthma and Covid-19. This early uncertainty can mislead and cause critical delays in diagnosis and treatment. The Mayo Clinic highlights that Covid-19 causes fever, shortness of breath, difficulty in breathing and a potentially upset stomach. Seasonal allergies do not cause those symptoms, and typically present with itching, watery eyes, a runny nose and sneezing. It is, however, very important to be able to determine the often subtle differences and overlapping symptoms between allergies and asthma from those of Covid-19 in order to diagnose and treat patients. The health information exchange platform, Malaffi, is one way to ensure this. Launched officially in the beginning of 2019 it connected its first providers only a year ago and already the database houses over 49 million unique clinical records for more than 3 million patients and provides access to around 25,000 users. To date, Malaffi has procured more than 500 facilities, including 38 hospitals and 23 healthcare groups. As a health information exchange (HIE) platform, Malaffi is the region’s first such initiative and is a part of the Department of Health – Abu Dhabi. Its mandate is to connect all public and private healthcare providers in Abu Dhabi and allow them in real time to exchange information about a patient's health. In the future, it can be connected to a national platform that will cover all Emirates. The access to patients’ unified medical records in Malaffi is hugely significant. It equips doctors to make better clinical decisions based on the patient’s history of, say, allergies or asthma or lack thereof, in addition to information about prescriptions, laboratory and radiology results, previous procedures and past medical interactions, from consultation to emergency treatment. This allows the attending doctor to make the most rapid and informed diagnosis and treatment decisions, which can be critical in determining whether a patient is presenting symptoms of an allergy or has potentially contracted the coronavirus, also by being able to access the Covid-19 laboratory tests results performed by a different provider. The allergy information in Malaffi also heightens patient safety and enables doctors to prescribe adequate medication, and avoid a possible allergic reaction. This access notwithstanding, p atient privacy and the security of digital health information are top priorities for Malaffi and the Department of Health – Abu Dhabi. Malaffi ensures that patient care and patient privacy go hand in hand by enabling the safe and secure exchange of data. Only authorised users from facilities that have a legal contract with Malaffi can access a patient's file. Those healthcare facilities have to abide by Malaffi’s strict privacy and security policies and comply with the relevant Abu Dhabi laws. The platform also has different physical, technical and administrative measures in place to protect the security of patient information. For example, all patient information is encrypted and shared over a secure electronic network. Some might ask why patients cannot themselves tell the doctor their medical history and past ailments. But it is not easy for patients to accurately remember details. Nor is it always possible to retrieve records from previous visits to other medical providers and carry them along on every visit to a doctor. For example, some patients recall only the medication pill or colour of the container but cannot provide the correct name of the medicine. Knowing the generic name of the drug or the correct allergen name is essential for the healthcare provider to correctly manage the patient’s condition. While we are on high alert for Covid-19 symptoms, according to the Harvard Medical School , many people may just be experiencing usual springtime pollen allergies from trees or plants or a common cold. We need to manage incidences of allergic emergencies during the pandemic and this is where data exchange really comes into play. A co-ordinated and emirate-wide exchange of allergy information can empower healthcare practitioners with the right information at the right time. Before Malaffi, data between different EMR systems could not be exchanged. For example, if the patient visited a hospital or clinic outside of the Seha system, we could not access the recorded information. In this scenario, clinicians would waste valuable time in retrieving the records by emailing referral departments and having to delay care, sometimes having to ask the patient to come back with the reports and discharge summaries. This, along with the fact that test might be unnecessarily duplicated, seriously affects the efficiency and quality of care, and the experience of patients within the healthcare system. It is important to note that each EMR system is unique and is differently structured to capture various types of data and details of medical histories, often in different formats. This is where HIEs connect different EMR systems and allow the exchange of information. While some healthcare organisations provide patients with access to their EMR records from that organisation, very soon, patients in Abu Dhabi will also be able to access their unified patient record through the Malaffi patient portal and mobile application. When it comes to recording allergies in EMRs, the standardisation of how EMR systems capture allergies has immeasurable value for how it will be exchanged and presented in a unified patient file. It can make all the difference between prescribing a medication that will cause an allergic reaction and one that won’t. This can be lifesaving, especially in an emergency. There is a pressing need to use standardised terminology in EMR systems, which could be in the form of a drop-down menu which doctors can choose from to simplify the data inputting process and facilitate the exchange of critical patient information. This will allow doctors to provide specific and detailed information about the reaction the patient has experienced and record the allergens or trigger that caused the reaction in a structured format, rather than using a free text field that allows for any value to be entered, that is currently standard in some EMR systems. This type of coding and information recording will significantly improve data quality and support patient diagnoses and medical decision-making. It will also allow for the information to be interoperable across EMRs, not to mention, easily accessible. With the establishment of Malaffi within Abu Dhabi, healthcare providers have embraced digital transformation through the recording, access and exchange of important patient information from multiple EMRs. And the pandemic has accelerated these efforts. We are now in an even better position to reap the benefits of technology to improve healthcare, especially when it comes to empowering healthcare providers to utilise data to make more informed choices, in times when speed and accuracy are critical and can help save lives. Dr Bakr Sadoon Ismael is acting health informatics director at Ambulatory Healthcare Services Co, a Seha system facility and a member of the clinical advisory committee of Malaffi

The way to prevent asthma symptoms being misread for Covid-19

Doctors speaking the same language of diagnoses and data exchange can help save lives