As physicians and healthcare workers have toiled to treat COVID-19 patients over the past few months of the pandemic, it’s been a continuous struggle and challenge to adapt clinical care methodology as we learn more about the disease pathogenesis and its consequences over time. We have not yet had to deal with a pandemic and virus in this way, and tackling this unknown, but powerful microscopic enemy has been the concerted effort of many dedicated and ingenious minds.
Of these silver-lining efforts are the clinical scores developed by MDCalc and their collaborators and contributors. There are many groups that have raced to put out scores, but the majority are not evidence-based scores that are based on gold standard prospective trials. It’s thus been a challenge to put forward scores that were either validated in a different disease, such as viral pneumonia, or in COVID-19 with less robust studies than would meet the normal threshold.
To best support clinicians and patients during this crisis, knowing that everyone is acting on partial and evolving information, MDCalc has shifted their normal threshold for COVID-related scores to be added to expand utility, while taking care to uphold their usual standard benchmarks.
In addition to adding new clinical tools, MDCalc has also created multiple COVID-19 resources, including a special free toolkit version of their EHR integration that makes accessing relevant scores at the point-of-care and documenting the results even easier.
We interviewed Dr. Joseph Habboushe, a front-line NYC emergency medicine physician and entrepreneur who founded MDCalc, to explain more about how MDCalc is being used in practice to help clinicians treat COVID-19 patients.
Alice Ferng, Medgadget: How is MDCalc helping doctors during this COVID-19 pandemic?
Dr. Joseph Habboushe, Co-Founder of MDCalc: We were thrust into the middle of this!
Clinical decision tools help doctors most when either the disease has a large practice variability or when doctors don’t have enough experience seeing patients with the disease to develop a strong “gestalt” (a sense for the best way to treat based on experience). With a novel disease such as COVID-19, we have BOTH. In addition, the diseases that are related to COVID-19 – pneumonia, ARDS, blood clots, etc. – all already have many well-validated clinical decision tools incorporated into physician practice.
Additionally, Scarce Resource Allocation Protocols – those horrible scenarios we feared we may face where we’re out of ventilators or ICU beds and someone needs to choose how to ration care – very often incorporate a clinical decision tool that’s used on MDCalc, such as the SOFA Score, mSOFA Score, Charlson Comorbidity Index, etc.
So, we really were thrust into the middle of this! Because MDCalc is all about supporting doctors, we were ready and motivated to jump in and help with the COVID-19 response efforts. Docs were coming to us looking for guidance. We immediately focused 100% of our team’s attention toward creating a COVID-19 Resource Center, which highlights clinical scores that may be useful in COVID-19, most of which were developed and validated in other similar diseases, and discusses the pros and cons of applying them to COVID-19 patients. Because clinical decision tools are so useful across many aspects of COVID-19 care, we turned our COVID-19 Resource Center into an EHR integrated toolkit. We’ve also been able to partner with other mission-driven companies, and together we’re working to find innovative ways to support clinicians.
“MDCalc is the most widely used medical reference tool, with 2/3 of physicians using it routinely. Bluestream is excited to partner with MDCalc to bring its lightweight and flexible virtual care tools to a broad base of care providers.” – Sandeep Pullim, MD, Chief Medical Officer, Bluestream Health
Another thing we’re doing for doctors (and NPs and PAs) is giving away free CME credits (AMA PRA Category 1TM). Doctors can earn credits by simply reviewing the content in our COVID-19 Resource Center and on the core COVID calcs. We’re hoping this small token of our appreciation will help reduce the burden of keeping up with CME requirements during this crazy time while also encouraging more COVID-19 learning.
Medgadget: Can you elaborate more on your COVID-19 toolkit with EHR integration? Who can access this resource? Is this open source? Free? And which EHR systems can utilize this toolkit?
Dr. Habboushe: A few weeks later, we transformed our work with the COVID-19 Resource Center into an EHR integrated Core COVID-19 Toolkit, and we decided to offer it FREE to hospitals (currently works with Epic only) to help support the crisis. We then developed an expanded COVID Toolkit Plus, which includes not just the core 16 calculators for COVID-19, but also over 100 others that treat related diseases, such as blood clots, pneumonia, etc., as well as tools that generally support the COVID crisis response. For example, we’re working on several Telemedicine Toolkits for different types of providers.
We’ve been told by some hospitals that this meets FEMA guidelines for reimbursement. So, hospitals that choose to upgrade to the COVID Toolkit Plus could get most of the cost back from the government.
Medgadget: What are the factors used to calculate the severity score? And what is the intended use case of the Brescia-COVID Severity Score?
Dr. Habboushe: We are constantly adding to and updating the COVID Toolkit. For example, when the disease was first hitting the US hard, we worked with Italian doctors to build out their Brescia COVID Severity Scale – which is what they used to manage patients in their overwhelmed ICUs. For a few weeks, this was by far the most used calculator of the 550+ on MDCalc. However, as more was learned about COVID, new tools came out that can better assess risk, such as the COVID-GRAM calc, which predicts risk of critical illness in hospitalized COVID-19 patients. We’re looking into a few new others as well.
We’re now working with other researchers around the world who have developed tools to best predict which patients with COVID-19 may get sicker. If effective, these tools may provide critical guidance for physicians – letting them know who to safely send home, and who to keep in the hospital. You can imagine not only how critical this decision is in general, but even more so if we get back to a time when hospitals are overwhelmed, and space is limited.
Medgadget: What other tools can/should be used with this severity score to offer better patient/acute care?
Dr. Habboushe: As mentioned, there is a whole new set of calcs coming out that are specific to COVID-19. We’re thankful to the clinician community who have been sending them our way, and we’re especially excited because we won’t have to rely on calcs that were originally developed for non-COVID-19 conditions. We’ll be launching these new COVID-19 tools when they have substantial evidence. So far, this set includes the COVID-GRAM, but we have a few others in our pipeline.
Medgadget: Thank you for all that you and your team does! And of course thanks to the contributors and collaborators as well. Are there other developments and upcoming plans you’d like to share?
Dr. Habboushe: Hospitals and consultants we have been working with, including previous directors of FEMA’s program, have indicated that our COVID-19 Toolkit meets the FEMA requirements for reimbursement. We offer an upgrade that bridges the gap between the Toolkit and our full integration, MDCalc Connect.
MDCalc Connect brings the full suite of MDCalc resources to the EHR. That’s over 550 calculators across 50+ specialties and expert content written by practicing physicians. We use SMART on FHIR standards to connect with patient data and smartly autofill calculators. It’s a cloud-based application so updates and new calcs are pushed seamlessly to the local EHR environment.
We’ve implemented the MDCalc Connect integration at some pilot partner hospitals, including with our development partners at the University of Utah – a group headed by Dr. Ken Kawamoto who are experts in integrations.
“We partnered with MDCalc because there is a great need for tools that save our providers time and allow them to provide the best care possible. The result of this partnership is MDCalc Connect, which is seamlessly integrated with the EHR. Now, relevant data like the patient’s labs, diagnoses, and medications are automatically pulled in and auto-fills relevant data inputs, and the tool even generates needed documentation. MDCalc Connect and its free COVID-19 Toolkit can be integrated with any EHR that supports an interoperability standard known as HL7 SMART on FHIR. It’s very exciting that we are able to help address the COVID-19 pandemic through this cutting-edge partnership with MDCalc.” – Dr. Ken Kawamoto, MD, PhD, MHS, Associate Chief Medical Information Officer, University of Utah
Lastly, we recently launched a new MDCalc Ad Grants initiative where we’re donating $1 million in advertising grants to 10 innovative organizations helping with the COVID-19 response efforts – such as companies directly helping with COVID-19 relief work or simply supporting the healthcare workers themselves. This is our way of recognizing the great work happening behind the scenes to support our healthcare workers and patients.