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Attending to a Public Health Crisis in an Underserved Area


Facing something like the Zika epidemic is challenging for any healthcare organization, but especially when they lack significant resources.

Welcome to the latest edition of the Physicians Practice Pearls Podcast. In this podcast, we'll bring you some of the most interesting and influential guests in healthcare. If you have any ideas for podcast guests or topics, email us at

The area Borinquen Medical Centers of Miami-Dade serves was a hot spot for last year's Zika epidemic in the U.S.

In fact, the Centers for Disease and Control (CDC) advised pregnant women to avoid the Wynwood area of Miami, which is home to the organization's main community health center. Diego Shmuels, MD, director of quality and clinical practice management at Borinquen Health Care Center of Miami Dade, talked with Physicians Practice in the most recent edition of the Pearls podcast about his organization's efforts to identify patients at high risk for Zika using a limited amount of resources.

At the start of the podcast, Shmuels talked about the challenges in caring for a low health-literate, low income, Spanish speaking patient population. "Eighty percent of our patients are below the poverty line, 40 percent are uninsured, [and] a large percentage are Medicaid. We serve the underserved," said Shmuels at this year's Health Information and Management Systems Society (HIMSS) conference, held in Orlando.

Giving these patients proper care is challenging in the first place, but when something like Zika hits, it's even harder. That's where technology came into play. To identify people who may have contracted Zika, the health organization integrated clinical guidelines from the CDC into the EHR.

"We started finding out how could we consistently ask questions about where [patients] have traveled, where they've been; to screen them properly. And so, we had to go to our EHR … we asked [our vendor] about including a questionnaire for Zika so we could at least … screen patients and be able to track that," Shmuels said.

Once their EHR vendor was able to help implement a questionnaire and later, CDC guidelines, into the system, Borinquen Medical Centers had to figure out a way to pay for the $400 Zika test for these low-income patients. In the case of pregnant women, the Florida Department of Health in Miami-Dade provided free testing. In other cases, the patients were either covered by insurance and workarounds, or just out of luck. This is the harsh reality, Shmuels says, of serving the underserved.

Later in the podcast, Shmuels explained some of the ongoing obstacles his organization continues to face with the Zika epidemic and dispensed advice to practices who care for underserved patients with limited resources.

"Create a partnership with anyone and everyone who is willing to give you help," he advised.

Click above to play the entire podcast.

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