Use of Remote Desktop Access to Electronic Medical Records to Assist in a Contaminated Compounded Pharmaceutical Outbreak Investigation in Florida

BACKGROUND:  Medical record abstraction is a common practice for investigating healthcare-associated outbreaks but typically requires on-site abstraction or specific medical records to be requested for abstraction. The Florida Department of Health was granted remote access to a local healthcare facility’s medical records to assist in an investigation of adverse effects caused by an injection of an intrinsically contaminated compounded pharmaceutical product (preservative-free methylprednisolone acetate or pf-MPA). We describe the benefits and challenges from utilizing remote desktop access to electronic health records in an outbreak setting.

METHODS:  Remote desktop access to electronic medical records was used for active case finding and to identify the background rate of adverse events from this procedure by utilizing ICD-9 CM queries for codes 682.5 (abscess of the buttocks) and 680.5 (carbuncle of the buttocks) from July 2006 to August 2013. In addition, medical records were queried for individuals exposed to pf-MPA lots: 011413dan and 120612dan from December 1, 2012 to February 28, 2013 to identify any additional cases and potentially identify any risks associated with these cases.

RESULTS:  Remote desktop access queries identified 96 patients with the above-mentioned ICD-9 CM codes. Fifteen were previously identified cases, one was a newly identified case, and two additional patients had an injection-site abscess identified outside of the outbreak study period. The other 78 individuals were unrelated to the investigation. Remote medical record abstraction was performed for patients exposed to the two specific lots of pf-MPA. Remote access to the electronic health record allowed for abstraction of past, current, and follow-up visits as well as other significant patient medical history, including laboratory test results, data on other injections and immunizations, and co-morbidities. 

CONCLUSIONS:  Remote desktop access to electronic medical records can be a resource-friendly tool in outbreak investigations by shortening or eliminating travel expenses for investigation staff. Moreover, it saves time and further expenses in requesting, shipping, and receiving records for both the investigative staff and the healthcare-providing staff. Remote data access to health records allows for greater flexibility during an investigation as queries can be adjusted as the investigation evolves and new queries can be conducted as additional hypotheses are generated.  Assistance from facility IT staff may be needed to obtain remote desktop access and provide guidance on utilizing the electronic medical record system.