US doctors use medical records to fight the measles epidemic

CHICAGO (Reuters) – US doctors are consulting their electronic health record to identify unvaccinated patients and potentially infected people to contain the worst measles outbreak in the US in 25 years.

New York NYU Langone Health Hospital and Practice Network welcomes patients from Rockland and Brooklyn counties, two epicenters of the epidemic. He has integrated alerts into his electronic health record system to inform doctors and nurses that the patient lives in an epidemic area, based on his postal code.

"It identifies incoming patients who may have been exposed to measles and need to be evaluated," said Dr. Michael Phillips, chief epidemiologist at NYU Langone Health.

Alerts in a patient's medical record also encourage conversations with visitors – who may also have been exposed to the virus – about their own health, past exposure to measles, and vaccination history.

The Mount Sinai Health System in New York launched a similar program last week, said Dr. Bruce Darrow, its head of medical information.

Darrow said it was important because, although a patient from a postal code affected by measles passed the screening test, family members who visited him may have been exposed.

He added that the alert system makes doctors and nurses "watch not only our patients, but everyone entering the building".

The US authorities have reported more than 700 confirmed cases of measles, the highest level since the announcement of the elimination of the virus in 2000. The measles virus is highly contagious and can cause blindness, deafness, brain damage or death.

At NYU Langone, alerts were developed using Epic Medical Systems software, based in Madison, Wisconsin. Epic, whose medical records software is used by thousands of US hospitals and clinics, said other clients have begun to seek help to cope with the epidemic.

In response, Epic released a practical guide last month incorporating many of its clients' best ideas to fight the epidemic. The guide explains to health systems how to use medical records to identify and touch unvaccinated patients and inform doctors about how to screen, track and treat patients with measles.

"For example, we can find all patients missing MMR vaccine and send a message to patients or providers," said Jordan Tucker, a member of the Epic Implementation Team, who helps oversee the project.

Until now, Epic customers from New York, Illinois, Texas and California are using the system to fight the epidemic.

Illinois has confirmed seven cases of measles this year. In response to information pointing to a potential case in the Chicago area, two suburban hospitals last month sent hundreds of letters to parents urging them to make sure their children get vaccinated against measles.

"We wanted to do everything we could before it would happen," said Dr. Michael Caplan, medical co-director of a pediatric partnership between Advocate Children's Hospital and North University HealthSystem.

Sutter Health, which serves 1.7 million patients in Northern California, launched a measles risk screening questionnaire last month for each patient who attempts to make an appointment online.

Dr. Jeffrey Silvers, Medical Director of Infectious Diseases at Sutter Health, said people with measles often seek treatment for symptoms such as coughs, runny noses, or fever before developing the tell-tale rash. The screening program aims to quickly identify if they represent a measles case.

"If a person has a fever and any of these symptoms, or a rash, she has to answer the following question, which is:" Have you been outside the United States in the last three weeks? or have you been exposed to a person with measles? & # 39; & # 39; Silvers said.

Those who answer in the affirmative must phone to schedule their appointments so that staff can take precautions to protect themselves and other patients.

Until now, California has had 40 cases of measles, most in the south of the state. Sutter plans to use Epic software to develop a program to increase immunization coverage against measles, Silver said.

According to the World Health Organization, 95% of the population needs to be vaccinated to provide "collective immunity", a form of indirect protection that prevents infection in people too young or sick to be vaccinated. CDC officials said increasing rates of vaccine skepticism are creating under – vaccinated populations and weakening the herd 's immunity.

If herd immunity is not sufficient and exposures continue, the outbreak could take off, said Caplan, the Illinois pediatrician. "Everyone is a little concerned about this."