Fighting Zika With Network Medicine

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On Monday, the medical establishment and the general public were put on alert by an emergency notification from the Centers for Disease Control and Prevention: Florida’s Miami-Dade County had 14 confirmed cases of the Zika virus, the infectious disease which causes birth defects, and was at risk of continued active transmission.  In the following days, the CDC has advised pregnant women and their partners to avoid Wynwood, a small community north of downtown Miami–the first time it has ever issued a travel alert in the United States for an infectious disease. It has also issued specific Zika guidelines for the Wynwood region for patients who have traveled to the area on or after June 15th.

Moments like these test our healthcare system and reveal its weaknesses.  We’ve spoken often on this blog about healthcare’s connectivity problem: islands of information and data siloes that don’t talk to one another, sometimes to lethal effect. Public health crises demand that health information flow freely and that healthcare providers have the latest clinical guidelines at their fingertips.

Unfortunately, this isn’t the first time that athenahealth has had to overcome information barriers to respond to concerns about infectious disease.  Last year, at the height of the ebola crisis in Texas, athenahealth rapidly deployed an updated CDC guideline in our EHR to provide content and alerts to assess for Ebola symptoms, travel history, and risk of exposure.

This is what we call Network Medicine: activating the latest, most evidence-based clinical guidelines to deliver them rapidly to our clients for activation—no software update required.

In the days since the CDC’s Zika guidance, athenahealth has assembled a Network Medicine task force once again to help Florida providers affected by the Zika outbreak.  We’re using the power of our network to knit together islands of information—in this case, individual practices in Florida with unidentified patients at-risk of infection—and help our providers activate the CDC’s updated guideline to screen, educate, and protect their patients.  Our strategy is two-fold: identify patients living in the affected region and treated by providers on the athenahealth network; then, equip providers with the tools to perform outreach to those patients and bring them in for treatment.

On Tuesday, we ran a query across athenaNet to identify patients with addresses in the affected area.  The results were astonishing: More than 1800 men and women living in or near the Wynwood area, spanning 94 providers at 24 different practices on the network, fit the CDC’s criteria and may require testing.

We’ve partnered with clinical leadership at the two most affected client sites–a prominent OB/GYN group, and Borinquen Health Care Center of Miami Dade, the largest Federally Qualified Health Center in the Wynwood region–to develop customized, direct-to-patient campaigns to deploy via email and phone.  Today and tomorrow, these clients will be contacting targeted patients with our help.  When they bring those patients in for screening, they’ll find the CDC’s clinical guideline directly embedded in their EHR.  It’s a compelling example of the power of our network, and of what the right information—at the right time, in the right place—can do.

In the coming days, we will continue to partner with other affected client sites in Florida to replicate this process.  We’ll also be using the power of our network to study the volume and age distribution of Zika testing across the US.  You can find that and other coverage at athenaInsight.

With a heat map of potentially vulnerable patients in the Wynwood area, the race is on to connect providers to the information they need to turn insight into action.

Brian Anderson, MD is senior manager, clinical effectiveness athenahealth.

Categories: Uncategorized

11 replies »

  1. So you’d say what they’re doing is “reckless?” “Irresponsible” even?

    That’s strange, I’d argue the opposite.

  2. Yes, I am against what athenahealth is doing. They started as a technology-enhanced billing business followed by a typical EHR data management role. Now they have crossed the line into clinical decision support or public health.

  3. Not all aspects of human society are meant to be privatized and made secret for profit. Law is generally not a private affair and when we let it drift in that direction we end up with gangs, militias, and private prisons. Public health has never been a private affair and gets a pass in most societies for exactly that reason.

    Until the introduction of EHRs, medicine had absolutely no secret components. Yes, we have intellectual property in the form of patents and trademarks but they still allow open peer review.

    When it comes to health IT, how far will society go to abide secrecy? Will we abide secret decision support AI as well as secret EHRs?

    Where do we draw the line on open medicine?

  4. Oh and one last thing ..

    You’re against what athenahealth is doing? As in, you oppose it? Or you’re just not taking a position?

    Just checking : )

  5. Adrian,

    Please see this post for more detail on some of the more creative things that some technology companies are talking about doing in this area …


    Question: do we equate open source with the word “responsible?”

    If we believe that code = democracy, than perhaps we do.

    But hate to break it to you ..

    There are irresponsible open source developers, just as there are irresponsible vendors

    Where do we draw the lines .. ?

    An interesting one

  6. This post is interesting on many levels but HIPAA is not one of them. Network Medicine as a title is a Rorsachach test for all sorts of commercial and strategic interests that drive medical information technology.

    For example,
    – How centralized do we want our health IT to be – one Epic or athenahealth for the entire country?
    – Is it good to have different versions of an EHR in different hospital systems like Epic or is it better to have a cloud EHR like athenahealth where everyone is using the same version?
    – Who at athenahealth decides to deploy clinical guidelines or is this more or less automatically wired to the CDC?

    There’s no limit to how much deep personal information would be useful in a public health context. With Zika or Ebola or opioid overdoses for that matter, we could make good use of a detailed travel history and plans, a sexual history, the genome, family and occupational exposure, for a start. Are we to collect this information into regional and national EHRs combined with prescription drug monitoring programs just so it’s available for public health emergencies or do we continue the tradition of keeping public health relatively separate from clinical medicine?

    As a physician, I’m used to getting advisories directly from the CDC. People are directly informed by public health authorities through the media. Government occasionally bypasses the media and sends a child endangerment or weather alert directly to my phone.

    The current crop of EHRs, be they like Epic or athenahealth, are hardly an open source and publicly responsible commodity. They are not regulated as “common carriers” the way out telecommunications networks are. Are you looking forward to a world where the separation between clinical, public health, and law enforcement data is eliminated in favor of privatized and secret Big Data algorithms euphemistically called Network Medicine?

  7. This is the poster girl for making any changes to HIPAA and other so-called privacy laws that threaten this sort of positive outreach. I’m sure there are some at athenahealth (i.e., attorneys of which I am one) that counselled, “no, no, it’s too risky.” To have done this shows vision and some courage.

    Now the issue is how do we change laws and regulations to take a more sensible approach to sharing healthcare information WITHIN the delivery system???

    Good work.

  8. I TOTALLY agree with you, which is why I asked the question.

    I think what athena is doing is awesome

    Go Jonathan!!! Let’s see more Network medicine in action, Dude!!

    I have a feeling there are those who disagree, however.

    Speculating a little … there may be parents who may have potentially ZIKA-affected pregnancies who do not wish the fact to be public knowledge.

    Remember there has been resistance to this kind of data monitoring in the past. I believe this kind of medicine should be standard across the board. This is exactly the kind of thing that EHRs are designed for.

    What other kinds of Networked medicine can we think of?

  9. This gives me hope for the EHR, which has been a source of considerable despair in my several years of using Epic.
    There is absolutely no question of any HIPAA violation in contacting patients who are already enrolled in a healthcare system and registered with their health records in the EHR. It would be irresponsible NOT to do so; we’ve just never had the technology to connect the dots.
    HIPAA rules chiefly concern disclosure of information to an outside party without the patient’s consent. And, as the recent Orlando shootings illustrated, even those rules can be waived legitimately in emergency situations when family members are desperately seeking information.

  10. IMHO This is a great use of EHR technology. I’m surprised we haven’t heard from the privacy folks yet… Opinions? Is this an acceptable use of EHR data? Does anybody see HIPAA issues?