Patient Characteristics Gender Age Pregnancy Status, sexual activity Exposure Where were you? When were you there? Examples: travel history, lived in Flint MI, known down wind of a radiation incident Symptoms What the patient says E.g. chief complaint – “I have the worst headache ever” Physical findings What the provider measures, e.g. temperature What the provider observes, eg. Patient appears sensitive to light Assessment and Plans Tests Orders (pregnancy) Results The patient profile – in general

The patient profile – Workflow Patients who have traveled to areas at risk (e.g., known Zika Virus transmission, lead exposure or radiation) TRIGGER Identify patients with risk, e.g., All patients presenting to clinic All pregnant female patients EXPOSURESYMPTOMS Patient history / symptoms based on the suspected exposure FINDINGS - EXAMINATIONTESTING TREATMENT ISOLATION REFERRAL Findings on examination consistent with the condition or exposure Studies appropriate to help define if the condition is present Recommendations regarding how to manage a)The patient b)Healthcare workers c)The patient’s exposures

Building blocks Don’t worry about the sequence now. The order of the building blocks may change, or be of no importance. Just capture all the factors you will need. Later you may be concerned about order, to optimize workflow (i.e. move individuals out of the queue, drive reflective questioning) Think about what is necessary, think about what is sufficient

Reporting to Public Health (eICR) – Electronic Initial Case Report Clinidromes Infection Control Aspect – Rule out measles sitting in waiting room – Identify contacts; isolate patients appropriately – Access to EHR for other staff Clinical Quality Framework – Include providing decision support – Providing care; not generating reports

Swim lanes and flow charts helpful to build workflows; simpler the better; eliminate color Maintenance (for example updated locations, risk history questions) Wary of alert fatigue Information for patients – Patient Portals/Pull and push information – Pharmacies – Care navigators

Follow up Reporting Improved communications with PH Systems requirements for sending samples to PH Criteria for sending in a sample with limitations for testing (changes on a daily basis) Everyday situations at the local level (eg meningitis in homeless population)

Access to data for consumers Grants for community libraries for access to dedicated patient portals Hospital and Pharmacy Kiosks Apps for smartphones