It’s been almost nine months since Florida became the first U.S. state to confirm local mosquito transmission of the Zika virus. In the public health battle that ensued, Miami-Dade County became ground zero in the war against the mosquito-borne illness.
In late 2016, the Centers for Disease Control and Prevention removed the “red area” designation for the county, meaning it is no longer a geographic area where local, state and CDC officials have determined that the intensity of Zika transmission presents a significant risk to pregnant women. Zika infection during pregnancy has the potential to cause serious fetal birth defects.
However, according to Diego Shmuels, MD, director of quality and clinical practice management at Borinquen Health Care Center of Miami-Dade County, it would be a mistake to become complacent about the Zika threat now that the county has been downgraded to a cautionary “yellow area” and think that the worst is behind South Florida.
“We have a large influx of patients that travel to and from the Caribbean and Latin America, and obviously with the warm weather there, they are always exposed to the virus,” says Shmuels, who notes that Borinquen Health Care Center constantly screens for Zika regardless of when mosquito season begins and ends.
A federally qualified health center with 10 clinical sites, Borinquen has been leveraging electronic health record vendor athenahealth’s network to help combat Zika by identifying patients who might be at risk for infection by taking the CDC guidelines and running EHR queries.
In addition to mosquito bite transmission, the virus can be sexually transmitted to partners. As a result, where patients live, their travel history and the travel history of their sexual partners can affect their chances of getting Zika.
“I believe that most of our cases are basically imported,” observes Shmuels. “Currently, there are no local cases.”
He contends that it’s important for clinicians to ask patients if they have themselves travelled to areas with active local Zika transmission or if they have had sex with partners who have travelled to those areas, and to document those facts in the EHR.
“When Miami’s Wynwood neighborhood became the hot zone for Zika last year, athenahealth allowed us to implement a call campaign to all our patients that were at risk living in specific ZIP codes,” he adds, which was based on an athenahealth network query that looked for women of reproductive age that could be sexually active or are pregnant, as well as men of the same age group that could be sexually active with those women.
“If we have another outbreak of local cases in Zika-infected areas, we would do the same again—activate athenahealth to expedite the process,” Shmuels concludes. “We’ll have to wait and see what happens once the hot weather returns.”
Nonetheless, he emphasizes that the EHR is a “platform that supports decision making—but, at the end of the day, the clinician is the one that determines how to properly utilize diagnostic testing.”
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