Effective working relationships, built on frequent interaction, familiarity and, eventually, trust between health departments and healthcare facilities, are an essential component of an HAI program, and can facilitate timely and reliable access to EHRs, including remote access. Through cultivating contacts, building and maintaining relationships, and communicating clearly and often, you can help ensure that the privacy and security of patient information is protected during outbreak investigations. For example, a memorandum of understanding (MOU), or other agreement to collaborate, established before you need EHR access, will speed investigations in case of outbreaks. Good relationships also help stakeholders find solutions to problems with protecting the privacy and security of patient information.
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In October 2012, an outbreak of fungal meningitis was reported in the United States. The U.S. Centers for Disease Control and Prevention traced the outbreak to fungal contamination in three lots of a medication called methylprednisolone used for epidural (spinal) steroid injections. The medication was packaged and marketed by the New England Compounding Center (NECC), a compounding pharmacy in Framingham, Massachusetts. Doses from these three lots had been distributed to 75 medical facilities in 23 states, and doses had been administered to about 14,000 patients after May 21 and before September 24, 2012. Patients began reporting symptoms in late August, but, because of the unusual nature of the infection, clinicians did not begin to realize the cases had a common cause until late September. Infections other than meningitis were also associated with this outbreak, which spanned 19 states. As of March 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections.
Some health departments lacked ready access to needed patient information in EHRs, in part, because public health staff did not have established relationships with healthcare facilities, which slowed, or in some cases delayed, the outbreak investigation putting the public’s health at risk.
To help improve EHR access for routine public health data needs (e.g., data validation) as well as to respond to future outbreaks, public health departments must cultivate the right contacts and have a designated point of contact in every healthcare facility within your jurisdiction. That healthcare facility point of contact must be empowered to coordinate with other facility staff (e.g., information technology, legal, facility leadership) to respond to your health department’s request for patient information.