Ebola is no longer a disease of distant shores and movie thrillers. It is a disease found on three continents, killing thousands of people, and challenging researchers, healthcare workers, and even information technologists worldwide.
As the disease moves from country to country and person to person, information and misinformation about where it comes from, how it spreads, and how to avoid it or treat it scatters along the way.
The Nidus, or “Where Does Ebola Come From?”
Ebola is a disease of humans and other primates that was first identified in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. There are five different strains of the virus and four of those are known to cause the infection in humans.
The long-term host for this pathogen is still unknown. Evidence seems to show that Ebola, like similar viruses, is animal-borne and is most likely carried by bats. The natural reservoir hosts of such diseases often do not ever get the disease or it is carried as a non-lethal infection.
Outbreaks have appeared sporadically in Africa over the past decades. The first recognized outbreak in Zaire in 1976 saw slightly fewer than three hundred deaths from the disease and was the largest outbreak on record until now.
According to the World Health Organization (WHO), as of mid-October the number of deaths attributed to the current Ebola outbreak is 4,033 with the total number of confirmed, probable and suspected cases totaling 8, 400. These numbers include cases of the disease reported in Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain and the United States.
IT for Outbreak Prevention
The WHO, other international health organizations, the Centers for Disease Control and Prevention (CDC) and everyone down to local hospitals and doctors offices are collecting data, reading statistics and implementing protocols in an effort to understand the disease – including how it spreads, its signs and symptoms, and how to diagnose and treat those who have fallen victim. This is where health information technologists and technologies come into play.
In the past few years the U.S., the Department of Health and Human Services (HHS) recently updated its plan for fighting healthcare-associated infections (HAIs) such as Ebola.
“Monitoring and measuring HAIs is a critical component of the overall strategy to prevent and reduce HAIs,” the plan reads.” Advances in information technology (IT), harmonization of disparate data standards, incentive programs designed to promote the meaningful use of electronic health records (EHRs), and capabilities to connect with and integrate multiple data types and sources all provide opportunities to enhance national capacity to monitor, measure, and prevent the occurrence of HAIs.”
Key terms in healthcare IT such as “interoperability’, “workflow”, and “meaningful use” particularly come into play when discussing how making data available worldwide can help prevent continued spread of viral outbreaks like Ebola.
A perfect – and unfortunate – example is the miscommunication that led to Texas Ebola patient Thomas Duncan being sent home after his initial emergency room visit. Despite stating he had recently traveled from Liberia, the information did not automatically populate an area of the EHR routinely seen by both physicians and nurses.
In response, the hospital has had its EHR provider relocate the travel history documentation to a portion of the record that is part of both workflows. The idea being that a doctor seeing Duncan’s information on his recent return from Africa might have kept him in the hospital instead of letting him leave infected.
Information systems for data entry and retrieval, analysis and safer care are available and starting to be used more widely in the wake of this health crisis. Some of these applications include:
Using electronic communications ranging from email and smart phones to two-way video conferencing and other advanced forms is quickly proving to be some of the safest and most efficient ways to exchange diagnosis and treatment information during the current Ebola outbreak. Real time reporting of new cases, whether in Africa or here in the US, along with the ability to keep watch over patients and even improve their health status without endangering healthcare providers by unnecessary personal exposure is evolving rapidly.
For the second time since September The Nebraska Medical Center is using its Biocontainment Patient Care Unit to help treat an Ebola victim. A network television cameraman who contracted the disease while working in Liberia is receiving treatment and is able to interact with his physicians and nurses via video conference and is even able to visit with family members. Using real-time syndrome surveillance, even abroad, can help identify at-risk patients including contacts and travel data. This allows for earlier diagnosis and faster public health response.
Telemedicine allows health care professionals world wide to interact, even brainstorm, for new ideas and methods of treating viral outbreaks like this one in the moment, losing no valuable time or jeopardizing their safety.
2. Infection Control Software
Real time is also the key to successfully using Infection Control Programs (ICP) and other electronic surveillance systems (ESS) to combat the spread of illnesses such as Ebola.
“Electronic surveillance methodologies are a significant improvement over traditional manual surveillance due to one key factor,” nursing researchers Patti G. Grota, PhD, RN, CNS-M-S, CIC and Rhonda Unruh, RN, BSN told Infection Control Today. “It is concurrent, real-time data versus retrospective data. ESS is particularly effective in preventing potential outbreaks by identifying unusual or important pathogens in real time.”
“Customized ESS reports can be programmed to automatically alert the infection preventionist of specific pathogens as soon as they are entered into the laboratory electronic database. ESS can produce an automated map to troublesome pathogens in minutes compared to manual surveillance that can consume hours, often days. These reports include data fields needed to quickly complete a risk assessment and respond with actions needed to minimize transmissions.”
The problem right now, at least in the United States, is that many hospitals have not yet invested in infection control software. According to one survey, many hospital administrators have been concerned with getting EHRs up and running and making sure that electronic security is in place yet not interfering with information interoperability. However, as the Center’s for Medicare and Medicaid Services (CMS) put more pressure on hospitals for not preventing HAIs, especially in light of the current Ebola crisis, it is likely more significant financial penalties will be enforced.
The medical classification list developed by the WHO is in its 10th revision and will be adopted in the U.S. by October 2015. However, many healthcare providers around the world have already adopted it and its more precise method for coding diseases, signs, symptoms, abnormal findings and other relevant health information. Use of this newest coding structure is a bit more challenging since it has grown from 14, 000 codes to approximately 69,000. However, its specificity can provide better data and will allow the US to move from a number of codes describing hemorrhagic fever to one specific code, A98.4, for Ebola.
What this means is more accurate data allowing public health officials to move more quickly tracking and cataloguing information. Approximately 25 different countries currently use the ICD system and most have already adopted ICD-10. This international system allows for much easier sharing of data internationally and means more researchers and providers are on the same page searching for methods to slow and even stop the spread of diseases like Ebola.
Common Sense Complements High Technology
There is clearly a place for technology in the prevention and of diseases such as Ebola. However, it is not all high tech; some prevention methods are more straightforward and based in common sense. Since there is no vaccine available for Ebola and currently hospitals and healthcare providers spend their time treating the symptoms here are some guidelines provided by the CDC:
- Hygiene – Like every other virus, you cannot wash your hands too much. Practice careful hygiene and avoid contact with blood and body fluids, including not handling other items that may have come in contact with an infected person.
- If you travel to an area affected by an Ebola outbreak avoid funeral or burial rituals that require handling the body of someone who has died from the disease.
- Also, if traveling to an affected area avoid contact with bats and non-human primates or blood, fluids, or raw meat prepared from these animals.
- While in an infected area avoid hospitals where Ebola patients are being treated and when you return home make sure to monitor your own health for 21 days, the known incubation period.
- If you are a healthcare worker wear protective clothing, including masks, gloves, gowns and eye protection and follow all protocols for donning and removing that clothing.
Ebola is a disease of bodily contact. If there is any reason to believe there has been direct contact with blood or body fluids of someone sick with Ebola health officials should be notified immediately. The virus enters the body through broken skin or unprotected mucous membranes such as the eyes, nose, and mouth.
Sharing this kind of information across the continuum of care and around the world by providers and systems is really the future of prevention.