Will health information technology tackle epidemics?
IT vendors and the Centers for Disease Control and Prevention are working on it.
At the Healthcare Information and Management Systems Society convention in Chicago, six health IT companies, working in collaboration with the CDC, demonstrated the potential for having public-health communications capabilities incorporated into their systems and into the proposed national health information network.
GE Healthcare, one of the demonstrators, featured a pilot program to determine the efficacy of triggering two-way communication between an office-based physician and public health authorities during the physicians routine use of an electronic health-record system. Other vendors demonstrating technology addressing different public-health communication scenarios were EHR vendors Allscripts-Misys Healthcare Solutions, Greenway Medical Technologies, NextGen Healthcare, and computer services consultants and systems developers Science Applications International Corp., and IBM Corp.
Under the GE pilot demonstration, a public health alert system would be either manually triggered or automatically accessed during the early part of a physicians encounter with a patient. The system would use vital signs as well as the chief complaint and other items on the problem list as potential triggers of a system response even before a diagnosis is made, according to Charles Safran, a physician who is chief of the Division of Clinical Informatics at 585-bed Beth Israel Deaconess Medical Center, Boston, who has been working on the project for about a year.
Ideally, a query to the public-health alert system and a response would be routed automatically by programming in the EHR, but a less-sophisticated possibility is that the physician would manually send out an e-request, said Safran, a past president of the American Medical Informatics Association.
In an interview, Safran talked his way through a hypothetical clinical encounter to demonstrate how the system might work.
So, Im in my office in Kansas City, Safran said. The public health department there has activated the system for the Kansas City metro area. A public health official who has an indexed case in their region goes into the knowledge repository and says, I have a case in this specific geographical area, and if there are any reported cases, report them to me.
Meanwhile, back in his office with his EHR, Safran said, I have a patient that has diarrhea, a fever, and (I) record that. Either the physician presses a button and queries for public health alerts, or this could be automatic at a section of the charting. A request goes off and a limited amount of de-identified data goes out about a woman with abdominal pain, fever and diarrhea. The knowledge repository says, Yeah, weve had some bad pistachios reported in this area, including two cases in the next county. The information comes back to my record. First of all, the message comes back and asks whether the patient is a food handler or is taking care of small children. If the answer is yes, some information pops out relevant to that person.
That might include reminders about handwashing or a recommendation that the food handler or child caregiver take a few days off.
As the physician continues, Safran said, The alert embeds in an order set to the physician which says, We think its a good idea to order a stool culture. Do you agree? Click here. And then there is a reminder that gets tucked away, when the stool culture gets back that sends the results anonymously to the public health official who sent the alert.
These e-conversations would be between the physician and the local or regional public health officials, Safran said. The control of care is local. The reporting mechanisms for national roll-up are already in place.
Currently, one problem with public health reporting is underreporting, Safran said. We know that only about 5% to 10% of the time physicians get the right test to confirm the diagnosis.
Physicians, Safran said, either dont think to report a public health problem, or are too busy and even if we get the test, we dont report it.
There are about 75 million cases of food-borne illnesses a year, Safran said. They carry about a $6 billion price tag through treatment costs or loss of work. Its a pretty significant problem thats getting worse through global agriculture and the centralization of our food supply. It happens daily."
Not all of the efforts in the CDC initiative are pilots, said Charles Magruder, a physician board-certified in public health working as a program manager of the health information exchange program at the CDC under its director of the National Center for Public Health Informatics. The CDC is funding the $38 million effort to establish improved, computerized links between providers in the trenches and local, state and federal public health agencies.
The New York initiative that were working on, were providing funding to them on a contractual basis to demonstrate how public health can interact with the medical community through health information exchanges, Magruder said. Its a superb plan. Those RHIOs (regional health information organizations) are at this junction interacting with EHR vendors. New York City has been doing research in decision support where they have examples of real-world public health information, and they have assessed how they have used it in their medical practices.
In Indianapolishome of the Regenstrief Institute, which also participated in the HIMSS demonstrationthe Docs 4 Docs clinical-messaging program run by the Indiana Health Information Exchange disseminates information to the medical community from the HIE and from public health, Magruder said. They have their own EMR system that works for their emergency medical community.
Also during the HIMSS convention, federal officials announced the release of open-source software to be used as a common interface with federal healthcare organizations and the proposed NHIN. The American Health Information Community developed a set of use cases aimed at creating a minimum public health communications capability for biosurveillance.
Leveraging those use cases, Magruder said, By August of this year, we hope to have established NHIN gateways at all of the state health departments and send it to the CDC.
Participants are to meet May 7 in New York to discuss standards and formats, Magruder said.
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