• Large Print

Utilizing informatics to standardize and streamline Zika testing requests and case investigation

State: DC Type: Promising Practice Year: 2017

:
Fairfax County Health Department
:
Utilizing informatics to standardize and streamline Zika testing requests and case investigation
The Fairfax County Health Department (FCHD) is located in Northern Virginia (VA) in the suburbs of Washington, D.C. and serves the 36th largest county in the United States. The population of Fairfax County in 2014 was estimated at 1,137,538, accounting for 13.7% of the population of the Commonwealth of VA. Given that Fairfax County is the largest health district in the National Capital Region, its large immigrant population makes the County more susceptible to emerging infections compared to more rural areas of the country. The Zika virus epidemic offered unique challenges to public health. In Virginia, local health departments were asked to facilitate the Zika testing request process as all Zika testing was done through public health laboratories. Over the course of 2016, approximately 48% (1009) of all test requests in Virginia were routed through FCHD and 25% (26) of cases resided in Fairfax County. The disproportionate percentage of work related to emerging infections when compared to Fairfax County and Virginia population is typical given the large subset of population with recent foreign travel. The burden of human surveillance Zika related work fell to the Communicable Disease/Epidemiology Unit (CD/Epi Unit) at the Fairfax County Health Department. With already full caseloads and unfilled positions, adequately accomplishing this new workload was extremely difficult. As the number of requests and questions about Zika increased, a small group at FCHD convened to develop and implement a more productive process for Zika response. The goal of this work was to create a system to electronically automate the vast majority of testing requests, procedural paperwork, and communication (internal and external) of information related to Zika virus, hence allowing our Unit to focus on areas of more pressing public health concern such as Zika case investigation and patient/clinician education. The proposed new system would include the following features: A secure (HIPPA compliant) website on FCHD's website where clinicians could request Zika testing through the state lab. The request form would ensure collection of all pertinent information to the approval process. Once a request was made on the website, a notification would be sent to the CD/Epi Unit of the request available for review (via secure email). The CD/Epi Unit would review the request and approve or reject on the system. This process would result in a secure email to the requester informing them of this decision. Approved emails would contain collection and submission instructions for the requesting provider as well as Zika education. Rejected emails would contain testing algorithm and Zika education. Internal notifications would also automatically occur among key staff members at FCHD to ensure efficient notification (Lab, vector control, HD leadership) when new and pertinent information is entered into the system. This system would also allow FCHD to quickly collect and analyze information (generate reports) on Zika testing requests and case information. The system would also send reminders to providers who are entering information on the pregnancy registry. The informatics team at FCHD developed a data system in SharePoint that achieved all of the goals listed above. The system was implemented on 03/22/2016. The link to the request site can be found here: https://www.fairfaxcounty.gov/webforms/?form=TVpOdkR5Qm5wY3locTA0TUpENjFKRkRjN29jaHJoK3hnZ1QzbDBvTGJQbDd1SmhRZG94bjN1djI2amFBSGhTbDlyd1dIU2w1NEYxZnIwRkUzM2FKc2c9PQ==. As of 12/08/2016, 1,009 requests have gone through the SharePoint system. The FCHD CD/Epi Unit was able to limit Zika coverage from a team of CD Nurses to one nurse that covers Zika requests/education/follow-up full-time, which greatly enhanced our ability to respond to communicable disease threats in our community.
The Zika virus epidemic offered unique challenges to public health. In Virginia, local health departments were asked to facilitate the Zika testing request process as all Zika testing was done through the state lab. The burden of human surveillance Zika related work fell to the Communicable Disease/Epidemiology Unit (CD/Epi Unit) at the Fairfax County Health Department. With already full caseloads and unfilled positions, adequately accomplishing this new workload was extremely difficult. With implementation of the system and workload management, on average, providers received a response to their testing request within a one hour time period or less during normal business hours. As Zika Virus is a new concern for public health in the U.S., a completely novel system was needed to ensure completion of all required investigations (not just including Zika Virus). An automated electronic system would handle the vast majority of testing requests, procedural paperwork, and communication (internal and external) of information related to Zika virus, hence allowing our Unit to focus on areas of more pressing public health concern such as Zika case investigation and patient/clinician education. The target population for this work was internal FCHD staff and external providers requesting testing. All providers in Fairfax County were shared the request link and direct consultation was made available to any provider needing technical support.
None
The goal of this project was to create a system to electronically automate the vast majority of testing requests, procedural paperwork, and communication (internal and external) of information related to Zika virus, hence allowing our Unit to focus on areas of more pressing public health concern such as Zika case investigation and patient/clinician education. Numerous meetings were held between epidemiology and informatics staff at FCHD to ensure the successful completion of this process. Stakeholders (OBGYN providers) feedback was also solicited to ensure the tool meets their needs as well as the system's ease of use. From start to finish, this project took approximately two months. Although no cost analysis was completed, FCHD utilized their existing contract with SharePoint, therefore the only costs associated with this project were work hours, which we can estimate was significantly lower than if the system did not exist.
Limited evaluation was done as this is such a recent/new process. FCHD's SharePoint Zika request system has accepted 1,009 requests for testing, 848 were approved for testing and 161 requests were denied with Zika testing and education provided. The unit's goal was to respond to requests within 24 hours, however, with implementation of the system, during normal business hours providers received a response in one hour or less. Actionable internal notifications were given on 849 Fairfax Zika cases or suspected cases. 53 electronic referrals to vector control were made immediately upon lab results received, shortening the response time for vector abatement actions in Fairfax County. The system was also used internally to notify the Fairfax County Health Department lab of incoming specimens/approvals, notify the incident management team of confirmed cases and to notify the mosquito control program of suspected or confirmed cases that required follow-up. The FCHD Zika request system was the first of its kind in Fairfax County and the Commonwealth of Virginia. Based on the success of the FCHD's Zika Testing Online Request Form and process, Virginia Department of Health (VDH) developed an online requesting for Zika process and database to be used statewide.
As this project yields no more costs and only saves FCHD work hours, we will continue to utilize this tool as long as it is needed. The long-term goals of this project are to facilitate as much of the Zika process as possible to limit the amount of man hours spent on testing requests, procedural paperwork, and communication (internal and external) of information related to Zika virus. Given uncertain financial futures and constant budget shortfalls, the development of this system has also fostered future project proposals in this mold to help electronically automate other communicable disease processes that can further streamline FCHD's work. As emerging infections are a continual source of concern in public health, we can expect to utilize this model for future large scale public health responses to securely collect and transmit information electronically.
E-Mail from NACCHO
 
Processing...


Driving Walking/Biking Public Transit  Get Directions