JAMA
December 17, 2014, Vol 312, No. 23
http://jama.jamanetwork.com/issue.aspx

Viewpoint | December 17, 2014
Ebola Virus Disease and the Need for New Personal Protective Equipment
Michael B. Edmond, MD, MPH, MPA1; Daniel J. Diekema, MD, MS1; Eli N. Perencevich, MD, MS1,2
Author Affiliations
JAMA. 2014;312(23):2495-2496. doi:10.1001/jama.2014.15497.
[Initial text]
Preventing transmission of pathogens in the health care setting with the use of personal protective equipment (PPE) has been an area of longstanding debate in the infection prevention community. Recently, reports of nosocomial transmission of Ebola virus to 2 nurses from the same patient in Texas (despite their use of PPE) has generated great concern and presents new challenges, particularly because there is no postexposure prophylaxis or effective antiviral therapy for Ebola, and approximately half of the cases are fatal…

Viewpoint | December 17, 2014
Is the United States Prepared for Ebola?
Lawrence O. Gostin, JD, LLD1; James G. Hodge Jr, JD, LLM2; Scott Burris, JD3
Author Affiliations
JAMA. 2014;312(23):2497-2498. doi:10.1001/jama.2014.15041
[Concluding text]
Risk Reduction
Only by controlling Ebola in West Africa can lives be saved and the risks of international spread minimized. Domestically, Ebola prompts the recognition that preparedness depends on the core strength of health systems. Not enough has been done to support well-functioning health systems in West Africa, but the United States also needs to invest more in domestic health system capacity. After the country has spent more than a decade developing preparedness programs and laws, isolated Ebola cases reveal the vital need to build a stronger system for detecting and treating infectious diseases, evaluating and improving performance, and committing to the basic institutions and professionals charged with protecting the public’s health.

Viewpoint | December 17, 2014
Ebola in the United States- EHRs as a Public Health Tool at the Point of Care
Kenneth D. Mandl, MD, MPH1,2
Author Affiliations
JAMA. 2014;312(23):2499-2500. doi:10.1001/jama.2014.15064.
[Concluding text]
ADDRESSING EBOLA AND HEALTH IT NOW
Not technical barriers but a pervasive socioadministrative-regulatory inertia slows progress in health IT. Simple actions taken now could advance health IT as the current Ebola epidemic unfolds but also deliver wider value. For example, diagnosis of streptococcal pharyngitis was substantially improved by integrating data about the local incidence of streptococcal disease and calculating disease risk based on prior probability of disease.8 Hundreds of thousands of antibiotic doses per year could potentially be avoided using these epidemiologically adjusted diagnostic models. Electronic health records are not yet capable of delivering those incidence data into a decision support system at the point of care, but the apps model readily allows data “mash-ups” and novel forms of decision support. To facilitate response to enterovirus D-68—a pathogen with a changing case definition now possibly including flaccid paralysis in rare cases9—a common apps interface to EHRs could enable rapid nationwide uptake of a triage and management app, one that could be updated as the epidemic and clinical picture evolves. Such technological feasibility would also be helpful when the next epidemic arrives. Potential next steps should include:
– Standardize on a programming interface between data and apps. The SMART platform specification, created under a $15 million federal investment, is a good place to start.
– Create the necessary apps functionality. Clinicians, informatics experts, and representatives from the CDC, the World Health Organization, the US Agency for International Development, and nongovernmental organizations could collaborate to design workflows and data displays to improve diagnosis and management apps that work for physicians providing care.
– Liberate data for contextualized diagnosis. Using the open.fda.gov initiative as a model, public health data resources could be identified and made available in computable formats so external data sources can be combined with EHR data to provide clinical and public health intelligence to treating physicians.
– Ready the point of care. Institutions with real-time data warehouses could adopt the SMART application programming interfaces and begin running apps. The largest EHR vendors, several of which have invested in SMART and SMART-inspired programming interfaces, could lead the way in responding to Ebola by upgrading as many installations as possible to support public health apps, as a first-use case.
With Ebola moving across the globe, this aggressively paced response may be achievable in a short time frame. Even if it takes more time, the steps outlined could rapidly transform current-stage HIT into a platform that may turn the point of care into a place for innovation, efficiency, and improved outcomes.