As the Zika outbreak continues to spread in the continental United States and territories, electronic health records are going to be essential to tracking the virus within patient populations, according to Laurie Garrett, senior fellow for global health at the Council on Foreign Relations.
“One of the huge problems we have with Zika is that we don’t have great diagnostics, and so we have to be able to scour for symptoms,” Garrett told an audience during Monday’s general session at the AHIMA conference in Baltimore. “We need some kind of record keeping that keeps track of mobile populations that move around from place to place.”
That’s where EHRs come into play by helping public health officials and providers identify patients who might be at risk of infection, said Garrett.
“We are already collaborating with our colleagues in CDC, just like we did with Ebola,” Andrew Gettinger, MD, ONC’s chief medical information officer and executive director of the Office of Clinical Quality and Safety, told AHIMA conference attendees.
“We want to alert clinicians to risk factors and have the EHR systems say, ‘Oh, by the way, with this constellation of signs and symptoms you put into the record, you want to think about whether or not your patient could have Zika,’ ” he said.
According to Gettinger, the collaboration between ONC and CDC is very strong, with the health IT agency actively supporting CDC’s Emergency Operations Center, which is monitoring and coordinating the Zika response.
Nonetheless, Garrett added that most people with the disease are asymptomatic, and even those with symptoms probably would not normally go to the doctor and get diagnosed because the symptoms can be mistaken for the flu. At the same time, collecting and sharing travel information in EHRs is critical for diagnosing and tracking Zika cases.
“We desperately need to be able to track the outcomes of all these infections, and keep in mind we’ve had thousands of individuals exposed to Zika living in the United States,” she said, noting that most of these people have acquired the virus during international travel. “We need to track these people and know what happens to them.”
The 2014 misdiagnosis of Thomas Duncan, America’s first Ebola patient, drove home that point. Duncan was initially treated and released by Texas Health Presbyterian Hospital’s emergency department in Dallas—only to return to the hospital’s ED where he was admitted for treatment of Ebola and later died.
Although Duncan’s travel from Africa was collected by a nurse as part of the influenza screening process and entered into the EHR, data was not in a place where the attending physician would typically see the information.
In the case of Zika, the mosquito-borne virus was first identified in 1947 in Uganda courtesy of an infected monkey, recounted Garrett. From Africa, it spread to French Polynesia and Brazil, and ultimately Zika became a global phenomenon after a “perfect storm” between 2014 and 2015, with the World Health Organization earlier this year declaring a worldwide state of emergency—because of microcephaly and other birth defects—and the U.S. reporting its first cases.
As of October 12, 3,936 cases of Zika have been reported in the continental U.S. and Hawaii—those cases include 878 pregnant women with laboratory evidence of possible Zika infection, according to the CDC. Last week, the Florida Department of Health announced a new area of active Zika transmission—the third such zone—in an area of about one square mile in Miami-Dade County, which has become ground zero for combating the outbreak domestically.
However, Zika is spreading most rapidly in the U.S. Territories where 25,955 cases have been reported. Puerto Rico in particular has been ravaged by the virus. According to the CDC, if current trends continue, at least 1 in 4 people—including women who become pregnant—may become infected.
Garrett contends that with Zika in the mosquito populations and spread to more than 60 countries “we are facing a long-term challenge.” And given the fact that it can be transmitted sexually, she asked: “Could this virus begin to take on attributes of a classic STD and transmit independently of mosquitos?”
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