The outbreak of swine flu that has dominated public health concerns for the past several weeks could be a blessing for the Obama administration's health information technology plans.
As Obama administration officials look to thwart a swine flu pandemic, the influx of political and public attention coming to disease tracking could help energize the administration's health information technology priorities, several experts say.
The Bush administration responded to anthrax attacks and Severe Acute Respiratory Syndrome (SARS) outbreaks in 2001 and 2002 with a rush of funding for public health disease-tracking, detection and surveillance IT systems. Public health agencies also got money for communications and logistics systems. But once the immediate threats passed, development slowed.
Now, with swine flu making headlines worldwide and the White House seeking $1.5 billion in supplemental funds to fight it, some health policy experts are recommending fusing public health IT goals with the broader electronic health record agenda.
The Obama administration already is making available $17 billion in economic stimulus law funding for doctors and hospitals to convert to electronic records. There also is $2 billion to set up a national health IT information exchange system.
“Public health has to be on the table,” said Dr. John Loonsk, a former senior health policy official at the Health and Human Services Department. “We cannot have a [private-sector] health IT infrastructure and a separate public health IT infrastructure.”
“Thought is being given to the use of electronic health records for biosurveillance,” said Dr. Harry Greenspun, chief medical officer at Perot Systems’ health care unit. “The challenge is to get more electronic information into the systems to get them more active.”
Linking public health with EHRs offers advantages. Electronic records allow for speedier, more comprehensive analysis and information sharing. Analysis could start, for example, with a patient sick with swine flu and, by quickly combing through emergency room records and clinical care records from the same geographic area, determine if there is a cluster of infections.
The goal is to “synthesize the data in a meaningful, actionable way,” Greenspun said.
One idea being talked about is requiring that providers transmit electronic patient data to public health departments and agencies to make them eligible to receive the $17 billion in economic stimulus law incentives for EHRs. Under the law, the physicians and hospitals who can demonstrate meaningful use of EHRs will receive extra payments.
“The health IT stimulus package was a great first step,” said Amy Ising, chairwoman of a public health committee for the Healthcare Information and Management Systems Society. “I don’t want public health to get lost in that mix.” She suggests that public health reporting should be a key component for meaningful use under the stimulus law.
Integrating electronic clinical records and public health will be a challenge. Health IT promoters already face concerns about privacy, security and costs that have resulted in low adoption rates of electronic record-keeping by providers. Public health data, while made anonymous for reporting purposes, must be available in full to investigators and clinicians.
Perhaps most important, the current heightened political attention on public health might not endure. The tremendous interest in improving public health reporting systems that the anthrax attacks and SARS outbreak inspired faded over time. “This field has gone up and down,” Greenspun said.
Some of the $1.5 billion in supplemental funds requested by the president for swine flu April 28 will pay for disease tracking, surveillance and monitoring. But it might be too early to designate the best use of those funds until having a better handle on the patterns of infection, Greenspun said.
“We need to know where and how it is spreading,” Greenspun said. “If it turns out to have a regional pattern, the funding may need to be focused regionally.”
Federal, state and local agencies use several disease and symptom detection, tracking and surveillance systems. Each has its own datasets from which it draws information and assesses patterns.
For example, the National Electronic Disease Surveillance System (NEDSS) collects data from state and local public health agencies and labs on reportable diseases. The Centers for Disease Control and Prevention’s BioSense is a disease surveillance network that looks for clusters of unusual symptoms. The Public Health Information Network (PHIN) is intended for outbreak information sharing and situational awareness.
The systems are effective, but there are gaps. Currently, 16 states are using the NEDSS software to feed their data directly into the system, said Dr. Robert Wah, chief medical officer at Computer Sciences Corp., which developed the NEDSS software. Most other states have built or are in the process of building NEDSS-compatible systems.
“This is a robust system,” Wah said, “and there is flexibility.” He noted that several days ago, officials in Texas created a new NEDSS reporting format for swine flu that is now being made available to other states.
But some observers say they believe the existing network is inadequate. “The federal systems we are familiar with are not global. There are lapses and gaps in coverage,” said James Wilson, chief scientist at VeraTect, a Kirkland, Wash., solutions provider that has created an around-the-clock early detection system for global diseases. The company is making the system available to public health agencies.
Most state public health departments feed data into the federal networks. But some systems are more active in collecting and transmitting data than others. A decade ago, disease information was collected disease by disease. NEDSS and other federal efforts worked to set up integrated reporting, but many experts say they believe there needs to be more integration.
“We need integration of functionality at the highest levels,” Wah said.
State and local organizations handle a significant portion of public health monitoring and tracking, with federal authorities providing coordination and aggregating data.
State authorities would like their disease-tracking systems to operate better, more automatically and more comprehensively, said David Jackson, product manager at the Utah Department of Health. In January, Utah initiated a new open-source system, called CSI Trisano, with the Collaborative Software Initiative.
For example, Jackson said, states would use tools that automatically notify local health departments and public officials of new cases by phone and e-mail. Calendar programs would be useful to help public authorities track dates of exposure, infection, contagion and treatment. Ideally, states would like reporting portals on the Web so that trusted physicians can enter information directly into the system.
After the 2001 terrorist attacks, federal funding allowed Utah and other states to strengthen their infrastructure and implement some practices to improve disease detection and management, Jackson said. “There is a lot of work that can still be done.”
Loonsk, who held senior positions at the Office of the National Coordinator for Health IT and CDC before joining CGI Federal as vice president for health care strategy in April, agrees that the nation’s disease-tracking systems are a work in progress.
Although one of the initial goals of systems such as PHIN, BioSense and NEDSS included detection of new disease outbreaks, other federal systems have been more useful in managing, tracking and monitoring outbreaks after the initial identification of a disease, he said. The greatest improvement to the disease-tracking systems would come if public health were integrated with EHRs, Loonsk and others believe.
“I think electronic health records are critical in getting good data from clinical care to public health,” Loonsk said. “It is a meaningful use.”