Zika virus outbreak makes disease surveillance a critical healthcare IT tool, expert says

To lessen the damage of Zika or any virus, electronic communication between hospitals and health departments is key.
By Mike Miliard
11:35 AM
Zika virus could be following in the footsteps of dengue and chikungunya, which are also transmitted by the Aedes aegypti mosquito.

As the Zika virus spreads from South America to the United States, epidemiologist and public health expert Christine Hockett says disease surveillance technology is key to protecting against it.

Keeping open lines of electronic communication between hospitals and their state and local health agencies is critical as those departments "collect and analyze disease counts and monitor how disease spreads throughout a community or geographic location," said Hockett, who works for Xerox-owned Consilience.

[Also: Experts warn of Zika epidemic as hospitals, health departments prepare]

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Zika, spread to people through mosquito bites, is currently most prevalent in South America. In response, the U.S. Centers for Disease Control and Prevention issued a travel alert for U.S. citizens traveling to regions where virus transmission is ongoing.

But Hockett says she expects the virus to increasingly move into the United States. She points to a recent article in The Lancet, which argued that, "with an estimated 440,000 – 1.3 million cases currently in Brazil alone, Zika virus could be following in the footsteps of dengue and chikungunya, which are also transmitted by the Aedes aegypti mosquito.

"Given that an outbreak anywhere is potentially a threat everywhere," the authors argued, "now is the time to step up all efforts to prevent, detect, and respond to Zika virus."

"I don't think 'scared' is the right word," said Hockett. "But we need to be aware of what's happening. And definitely, I think there are certain areas of the U.S. that are more vulnerable than others."

Robust electronic surveillance – data collection and reporting – is essential to keeping that spread as limited as possible.

Syndromic surveillance has been a key part of meaningful use since the very beginning, of course, with the government requiring providers to prove their ability to use "timely pre-diagnostic data and statistical tools to detect and characterize unusual activity for further public health investigation."

The Maven Outbreak Management Software offers Web-based case management tools that can help local and state health systems do disease surveillance, enabling them to analyze the health data from specific diseases.

Rather than a siloed database, the Maven tool is accessible across jurisdictions to local and state public health departments, and can integrate electronic reporting. Outbreaks can be assessed and triaged as confirmed cases emerge or patients at risk present themselves, with updates shared electronically or via its secure Web portal, according to the company.

It can also be updated as new disease threats emerge. That happened in 2014 during the Ebola crisis, and it did again earlier this month as Zika started to spread.

"With the configurability of Maven, you're able to adapt to these new emerging diseases," she said. "The CDC on Jan. 15 said, 'You need to be able to do this in your disease surveillance systems.' A couple weeks later, all of our deployments have this Zika-enabled data module."

Here’s how it would work from hospital's perspective. "Say I recently just traveled to Brazil," she said. "And I come back to the U.S. I go and see my primary care provider and say, 'Please test me for the Zika virus, just to make sure I don't have it.'" (Zika symptoms are very mild, and could be easy to miss.)

"So I get tested, that then gets entered into the EHR system. That lab report, once the lab processes that, not only does the doctor report it to the state health department, but the lab does too. That reporting is done through the connections into Maven, which is hosted within the local and state health departments – a case is created, the epidemiologist can see that I am a potential case of Zika. They would call me and do the necessary follow up and data collection needed, specific to the virus. Once that case is confirmed, the system is able to report it to CDC."

If technology is critical in the fight against Zika, however, people and process are even more so.

[Also: Questions raised about EHR workflow in Ebola case]

As seen in the 2014 Ebola outbreak – when a patient at Dallas-based Texas Health Resources first appeared with Ebola symptoms, but the fact that he had recently traveled from Africa, while logged in his EHR, was still missed by subsequent members of his care team – the balance between IT and clinical workflow can be a challenge.

"It's definitely a collaborative effort," said Hockett.

She pointed to the One Health concept, which holds that the health of humans is inextricably connected to the health of animals and the environment.

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That holistic approach means there's a deep need for collaboration, she said. "Use of effective surveillance systems is essential: knowing the symptoms of the diseases that are going on, talking with your provider community and epidemiologists and local and state health departments. The communications between hospitals and local and state health departments are critical."

Twitter: @MikeMiliardHITN