Tennessee Health Department workers visited multiple hospitals daily during the early weeks of a deadly fungal meningitis outbreak, picking up stacks of printed patient records to be entered into databases by hand.
But it was taking too long as the number of patients rapidly grew. So for the first time during an ongoing public health emergency, agency leaders decided they needed the hospitals to allow them to access the records from their computers.
Emails obtained by The Associated Press under the state's public records law indicated that less than three weeks after the Health Department alerted the public to the meningitis outbreak, most of the hospitals involved had created an electronic tunnel that allowed the state to quickly monitor treatments and patient conditions without physically visiting each facility.
"Once we were deep into the outbreak, that was a lifesaver in terms of dealing with the complexity of the information that we were trying to handle," state epidemiologist Dr. Tim Jones said.
"Because this was so urgent and because there was so much communication going back and forth, there was no way that we could send staff out every day to all these hospitals, going back and forth with piles of records."
The outbreak of fungal meningitis and other infections has been linked to epidural steroid injections created by a Massachusetts pharmacy and has killed 45 people and sickened nearly 700 across the country.
In Tennessee, where the very first cases emerged in late September, 147 people have gotten sick and 14 have died. The Health Department was following those cases as well as collecting detailed information on approximately 1,000 people all over the state considered at risk because they received injections from the recalled lots.
Tennessee hospitals are required to report patient information on certain kinds of diseases and infections to the Health Department, and a doctor at Vanderbilt University Medical Center was in immediate contact with the agency after discovering a rare fungal meningitis infection had killed a patient who had recently undergone a steroid injection.
Although hospitals collect much data electronically and share it that way internally, they don't normally allowmedical professionals outside the institution to tap into their data system. Federal law requires them to protect a patient's privacy.
Now, Health Department officials are considering pushing legislation that would allow it to make arrangements with hospitals to more quickly share patient records electronically in public health emergencies.
Arranging secure electronic access to the data stored at hospitals across the state took several days in early October, and each hospital had different health care information systems and policies, Jones said.
Vanderbilt took slightly longer than other hospitals to give state investigators access to its patient data, according to the emails obtained by AP.
Jones wrote to Vanderbilt on Oct. 12, saying not having remote electronic access was "becoming a substantial hindrance to our investigation."
By Oct. 18, the state had electronic access to records from St. Thomas Hospital, Baptist Hospital, Cumberland Medical Center, Cookeville Regional Medical Center and all HCA hospitals. Vanderbilt joined the next day.
Vanderbilt had been complying with the state's requests for data within hours of receiving them before ultimately giving investigators access to its computer system, said Titus Daniels, director for Vanderbilt's medical information services.
"The challenge here is the balance between privacy and access," Daniels said.
Jones said there could be some benefit to creating state code or policies that would set out guidelines for how the state could access information clinics in such emergencies. The access was limited to only those patients who were involved in the outbreak, Jones said.
"One of the issues that we grapple with, if we have electronic access to an institution's medical records, we just need to be able to reassure everyone and have policies in place that we are only accessing the records that we have a legal right to," Jones said.
Dr. Daniel Pollock, surveillance branch chief in the federal Centers for Disease Control and Prevention's division of health care quality promotion, said this is an area of health care that is rapidly developing with technological changes. That makes it important to have agreements with hospitals regarding patient data ahead of such outbreaks.
Pollock said the CDC gets patient data on health care-related infections from thousands of hospitals, clinics and medical facilities who voluntarily submit it electronically.
The way Tennessee's health investigators worked with local hospitals is a good demonstration of how electronic access is critical when outbreaks emerge, he said.
"At the state level, there are opportunities to establish policies and practices that would enable remote access to electronic health record systems, and I expect we will be seeing a lot of activity on the state level on that front," he said.