As coronavirus spreads, should travel history be in your medical records?

Including travel history in patients' medical records could help slow the spread of coronavirus and future infectious outbreaks, two experts say.

Adding travel history to routine information such as temperature, blood pressure, heart rate and respiratory rate in patients' electronic medical records could help put a patient's symptoms in context for health care providers, they explained.

"The current outbreak is an opportune time to consider adding travel history to the routine. The outbreak is clearly moving at a tremendous pace, with new clusters appearing daily," said Dr Trish Perl, chief of infectious diseases and geographic medicine at University of Texas Southwestern Medical Center in Dallas. She wrote a commentary with Dr Connie Savor Price, from the University of Colorado School of Medicine.

"This pace is a signal to us that it is a matter of time before we will see more of these infections in the US," Perl said in a UT Southwestern news release. "What is different with this outbreak is that this virus is more fit and transmissible and hence there has been much more transmission."

'Situational awareness'

If appropriate, travel history could lead doctors to gather more information, conduct further tests, and quickly order protective measures for patients' families, co-workers or other daily contacts, and health care personnel.

Also, travel history in electronic health records can be integrated with computerised decision-making to suggest specific diagnoses in recent travellers, the researchers said.

Their article appears in the Annals of Internal Medicine.

"We have the infrastructure to do this easily with the electronic medical record; we just need to implement it in a way to make it useful to the care teams," said Perl, who studies outbreaks and pandemics.

"Once the infrastructure is built, we'll also need to communicate what is called 'situational awareness' to ensure that providers know what geographic areas have infections so that they can act accordingly," she added.

Potential stress on infrastructure

The emergence of new infectious respiratory diseases in recent decades, including Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), highlight the need for health care providers to know patients' travel history.

"MERS and SARS were associated with very specific travel. MERS was associated with travel to the Arabian Peninsula, and SARS was associated with travel primarily to Hong Kong, Singapore and Beijing," Perl said.

"Currently Covid is similar in that there are geographic clusters, but those lines may be blurring as the outbreak expands," she said.

"The challenges and potential stress on the public health infrastructure, including the hospitals which are part of this, will be notable in that we could see large numbers of patients," Perl said. "Our role will not only be to care for these patients but to communicate to them the strategies that they can use to protect themselves."

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