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 New York's NYU Langone Health network of hospitals and medical
offices treats patients from both Rockland County and Brooklyn, two
epicenters of the outbreak. It has built alerts into its electronic
medical records system to notify doctors and nurses that a patient
lives in an outbreak area, based on their Zip code.
"It identifies incoming patients who may have been exposed to
measles and need to be assessed," said Dr. Michael Phillips, chief
epidemiologist at NYU Langone Health.
Alerts in a patient's medical record also prompt conversations with
their visitors - who may also have been exposed to the virus - about
their own health, prior exposure to measles and vaccination history.
Mount Sinai Health System in New York rolled out a similar program
last week, said Dr. Bruce Darrow, its chief medical information
officer.
Darrow said it was important because although a patient who comes
from a measles-affected Zip code may have passed the screening,
family members who visit may have been exposed.
He said the alert system raises awareness for doctors and nurses "to
be on lookout not just for our patients, but anybody who comes into
the building."
U.S. officials have reported more than 700 confirmed cases of
measles, the highest level since the virus was deemed eliminated in
2000. The measles virus is highly contagious and can cause
blindness, deafness, brain damage or death.
At NYU Langone, the alerts were developed using software from
Madison, Wisconsin-based Epic Medical Systems. Epic, whose medical
records software is used by thousands of U.S. hospitals and clinics,
said other customers began requesting their help to address the
outbreak.
In response, Epic released a how-to guide last month that
incorporated many of the best ideas from its customers fighting the
outbreak. The guide walks health systems through ways to use medical
records to identify and reach out to patients who are unvaccinated
and helps inform doctors on how to screen, track and treat measles
patients.
"For example, we can find all those patients missing the MMR vaccine
and send out a message to patients or providers," said Jordan
Tucker, a member of the Epic implementation team, who is helping
oversee the project.
So far, Epic clients in New York, Illinois, Texas and California are
using the system to fight the outbreak.
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Illinois has confirmed seven measles cases this year. In response to
reports of a potential case in the Chicago area, two hospitals in
the suburbs last month sent hundreds of letters to parents urging
them to ensure their kids get their measles shots.
"We wanted to do everything we could before it got to us," said Dr.
Michael Caplan, co-medical director of a pediatric partnership
between Advocate Children's Hospital and North University
HealthSystem.
Northern California's Sutter Health, which serves 1.7 million
patients, last month introduced a screening questionnaire about
potential measles risk for every patient who tries to book their
appointment online.
Dr. Jeffrey Silvers, Sutter Health's medical director of infectious
diseases, said people with measles often seek treatment for symptoms
such as cough, runny nose or fever before they develop the tell-tale
rash. The screening program aims to identify early whether they
represent a measles case.
"If a person has a fever plus one of those symptoms, or a rash, they
have to answer the next question, which is, 'Have you been outside
of the United States in the last three weeks or been exposed to
anybody with measles?'" Silvers said.
Those who answer yes must call to schedule their appointment so that
staff can take precautions to protect themselves and other patients.
California so far has had 40 measles cases, most of them in the
southern part of the state. Sutter plans to use Epic's software to
develop a program to increase measles vaccination coverage, Silver
said.
According to the World Health Organization, 95 percent of a
population needs to be vaccinated to provide "herd immunity," a form
of indirect protection that prevents infection in people too young
or sick to be vaccinated. CDC officials have said rising rates of
vaccine skepticism are creating undervaccinated populations,
weakening herd immunity.
If herd immunity is not sufficient and exposures continue, the
outbreak could take off, said Caplan, the Illinois pediatrician.
"Everybody is a little concerned about that."
(Reporting by Julie Steenhuysen; Editing by Daniel Wallis)
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