About EHRN

EHRN is a journal for the 21st century, designed for rapid sharing of knowledge to help solve medical problems. We make this information available with internal peer review, but without third-party peer review, to expedite sharing. It’s important that good data be available sooner, rather than perfect data be available too late. Submissions are welcome.

Briefs
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Recent EHR data show that immunization administrations for pediatric patients have decreased by 42% in the spring of 2020 compared to prior years. It is estimated that 260,000 immunizations expected for March 8-May 9 were missed or delayed across all age groups at sampled organizations. Patients under 6 months of age showed the smallest reduction in immunization volume, but these patients still missed or delayed an estimated 29,000 immunizations this spring. 

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Figure 1: Weekly immunization volume over time for each age group. White capsules show the average weekly volume from January 1, 2017-Dec 28, 2019, and colored capsules show the lowest volumes for 2020 and the most recent volumes as of May 9, 2020.
Briefs
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As the COVID-19 pandemic continues, there are growing concerns that patients with urgent conditions are not seeking the care they need for fear of exposure to COVID-19. Recent EHR data show that the weekly incidence of acute myocardial infarctions (AMI), commonly known as heart attacks, has decreased by 45% since the United States declared a national emergency for COVID-19 on March 13, 2020. Similarly, the weekly incidence of strokes decreased by 38% relative to the average number of strokes prior to March 13, 2020.

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Briefs
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Briefs
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Severe obesity, defined as having a body mass index (BMI) of 40 kg/m2 or higher, has been identified by the CDC as a risk factor for more severe COVID-19 illness.1 This brief examines the relationship between obesity and severity of illness for adult COVID-19 positive patients.

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Figure 1. COVID-19 severity by obesity class and age group
Briefs
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There has been recent conversation about the role that smoking status may play in severity of COVID-19 disease. To investigate this role, we examined the relationship between smoking status, as documented in the electronic health record, and general outcome severity of COVID-19 in a large national cohort of adult COVID-19 positive patients.

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Figure 1. COVID-19 worst severity by smoking status and age group. Some rows may not add to 100% due to rounding.
Research UpdatesMount Sinai
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A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19.

Physicians at Mount Sinai are exploring new avenues of clinical investigation, based on the beneficial response of patients to tPA in a small, preliminary case series. Use of tPA, short for tissue plasminogen activator, is common in emergencies such as ischemic stroke, pulmonary embolism, and other dangerous situations where its clot-busting clinical benefits outweigh the risks.

Briefs
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On March 13, 2020, a United States national emergency was declared due to COVID-19. With many states issuing stay-at-home orders, healthcare organizations have decreased in-person office visits and increased telehealth visits.

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COVID-19 hospitalization and mortality information were assessed in a sample of 36 million active patients.1 Nearly 10 million of those patients have documented hypertension, diabetes, chronic obstructive pulmonary disease (COPD), or moderate/severe asthma as of April 30, 2020. The summarized data were contributed by 31 health systems (300 hospitals) across 18 states. Table 1 shows the prevalence of these conditions in the sample data set as compared to national baselines for adults.

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Table 1. Prevalence of examined conditions in adults in the active patient population as compared to national baselines.