As Korea’s fourth confirmed patient with China-originated novel coronavirus was found to have been freely moving during multiple visits to a nearby clinic, local medical institutions faced criticism.
These hospitals have come under fire for missing the opportunity for early diagnosis because of their failures to check patients’ travel history through the “Drug Utilization Review” (DUR).
The fourth confirmed patient visited Wuhan, Hubei Province, China, and came back to Korea on Jan. 20. On the following day, the patient visited a local clinic due to cold symptoms, but the clinic failed to screen out the patient.
Four days later, the patient reported symptoms of a high fever of 38 degrees and muscle pain to the public health center. The authorities’ active monitoring of the patient began on Jan. 25.
As the patient was out of the monitoring system for four days, the public criticism against the clinic intensified because it did not use the DUR to check the patient’s China travel record.
In a news conference, however, the Korea Medical Association said physicians need to check patients’ overseas trip records through the DUR system. However, the DUR system mainly aims to check the patient’s drug use information, and doctors are not obligated to check the patient’s travel history, KMA said.
“People are unfairly blaming medical institutions as if the institutions are entirely responsible for spreading the disease,” the KMA said. “This will only discourage physicians who are on the front lines to prevent the spread of infectious disease.”
The Health Insurance Review and Assessment Service (HIRA) expressed somewhat different views. In normal situations, it said, medical institutions may not be obliged to check with the DUR and the International Traveler Information System (ITS). To stop an epidemic under an emergency like now, it is best to use them to ask whether a patient visited a contaminated site, HIRA added.
The DUR program provides doctors and pharmacists with information about drugs and contraindications. The program also offers patients’ ITS information. When a traveler entering Korea from an overseas infectious area visits a clinic or a pharmacy, the DUR program alerts the user about the patient’s foreign travel record through a pop-up window on the computer for 14 days from the date of entry.
The Korea Centers for Disease Control and Prevention (KCDC) developed ITS in 2015 to respond quickly to the Middle East Respiratory Syndrome (MERS) outbreak. Synchronized with the Electronic Medical Record (EMR) system, ITS information appears on a pop-up window once the patient registers for medical care, and it can help doctors make an early diagnosis.
More specifically, the ITS program informs physicians about visitors to China, where the new coronavirus was first identified in the reception or treatment stage through a pop-up window. It also alerts when a person who contacted the confirmed patient with the new coronavirus visits the institution. In the prescription stage, when a doctor checks with the DUR program, ITS also notifies such information.
For example, if a traveler entering Korea from a country where the novel coronavirus case was confirmed visits a medical institution, the DUR program notifies a physician to report the patient through the hotline 1339 or to the public health center in red letters on the monitor.
If the institution needs to report to the authorities, it should not let the patient move to another hospital or go home. Instead, the doctor should ask the patient to wait in a separate room and ask the patient, medical staff, and employees to wear masks.
Physicians must report a patient to the authorities in following cases: When a patient has a fever or respiratory symptoms within the last 14 days; when a patient had a close contact with a confirmed patient within the last 14 days and has fever or respiratory symptoms; or when a patient who shows pneumonia symptoms within 14 days after a visit to China.
On Jan. 21, HIRA asked hospitals and pharmacies to install DUR and ITS programs as the new coronavirus showed signs of spreading. Again, on Tuesday, the state agency asked institutions to install or run the ITS program.
“Most medical institutions are equipped with both DUR and ITS programs. But as the programs are optional, some institutions don’t seem to use them actively,” an official at HIRA said. “To prevent the spread of the infectious disease, however, I hope medical institutions will actively use DUR and ITS.”
To curtail the novel coronavirus from spreading, hospitals should isolate patients who visited the contaminated site from the reception stage through the ITS program, the HIRA official emphasized.
“While DUR enables a physician to check the patient’s travel record at the prescription stage, ITS allows it at the reception stage, he said. “To prevent the new coronavirus from spreading, it is important to use ITS at the reception stage to sort out patients coming from the contaminated area.”