BACKGROUND: In Virginia, local health departments facilitated Zika test requests through public health laboratories. Fairfax County is the largest health district in the National Capital Region and its large immigrant population makes the County more susceptible to emerging infections. During 2016, approximately 48% of all Zika test requests statewide were routed through the Fairfax County Health Department (FCHD) and 25% of cases resided in Fairfax County. With limited resources, adequately accomplishing this new workload was challenging. To address this issue, FCHD developed a web-based system to automate the vast majority of testing requests, procedural paperwork, and communication (internal and external) of information related to Zika virus.
METHODS: The new SharePoint system allows providers to request testing via a secure (HIPPA compliant) website while ensuring collection of all required information, sends approval or rejection emails with detailed instructions on specimen collection and public health guidance to requesting providers, allows timely and efficient automated notification to key internal staff members (Lab, vector control, FCHD leadership), sends automated reminders to providers who are entering information for the pregnancy registry, and allows FCHD to analyze information on Zika testing requests and case information. Provider feedback was also solicited to ensure the system’s usability. The FCHD informatics team developed and implemented the SharePoint system on 03/22/2016. An access link was distributed to all Fairfax County providers and direct consultation was made available to any provider needing technical support.
RESULTS: As of 12/08/2016, 1,009 requests have been processed through the SharePoint system. FCHD was able to reduce Zika coverage from a team of CD Nurses to one full-time nurse who manages Zika requests/education/follow-up, thereby greatly enhancing our ability to respond to communicable disease threats in our community. FCHD investigated 28 cases of non-congenital Zika and 1 case of congenital Zika and enrolled 22 infected pregnant women into the US Zika Pregnancy Registry.
CONCLUSIONS: The goal of this project was to create an electronic system to automate the majority of Zika-related work, allowing FCHD to focus on areas of more pressing public health concern such as Zika case investigation and patient/clinician education. Based on FCHD’s success with this novel system, the Virginia Department of Health (VDH) developed a similar platform for statewide use. Given uncertain financial futures and constant budget shortfalls, the development of this system has also fostered future project proposals in this mold to electronically automate other communicable disease processes thereby further streamlining FCHD’s work.