CDC expands flu-tracking efforts

The H1N1 swine flu virus has created an urgent need for public health authorities to track where and how quickly the illness is spreading.

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A murky crystal ball?

With the pandemic H1N1 flu spreading rapidly this year, officials at the Centers for Disease Control and Prevention have been aggressively expanding their information technology toolkit to provide better, faster and more in-depth data on the virus, also known as swine flu.

The virus has created an urgent need for public health authorities to track where and how quickly the illness is spreading. The Centers for Disease Control and Prevention, along with some state agencies and private entities, have responded to the challenge with new IT initiatives.

On Sept. 1, CDC began securely exchanging public health data daily via the Nationwide Health Information Network. The pilot project is gathering flu symptom data from health care providers in Indiana, New York and Washington state.

The flu data exchange is a new use for the NHIN, itself a pilot project of the Health and Human Services Department’s Office of the National Coordinator for Health IT.

“We are supporting the use of the NHIN for biosurveillance,” said Dr. Charles Magruder, senior adviser for health information exchange activities at CDC’s for Public Health Informatics and leader of the agency’s NHIN pilot project. “It has the potential to be a broad and robust system.”

The NHIN eventually will be used for national health data exchange, but is currently a platform for several demonstration projects, including one involving the Social Security Administration and MedVirginia, a regional network of health care providers, to exchange patient medical information for determining disability benefits eligibility. It will soon be accepting data from the Veterans Affairs and Defense departments.

CDC worked with Harris and Cisco Systems to demonstrate that it could upload flu symptom data from three state health departments in a timely fashion. Researchers then aggregate and analyze the information looking for trends and make the results available to state public health officials.

The data includes clinical information on patients’ symptoms, lab results, geographic information, age and gender, Magruder said. The data has been stripped of all personally identifiable information and is put into a format that both NHIN and the CDC can work with.

One of the key advantages to using NHIN is timeliness, Magruder said. Since Sept. 1, CDC has received new H1N1 data daily.

“We are showing how the biosurveillance use case can be demonstrated in a standards-based and interoperable system,” he said. “One of the motivators for the project is to show that existing standards can facilitate the sharing of data. The NHIN is a key component of developing those capabilities.”

“I am very impressed with what the NHIN has to offer in terms of enhancing our capabilities to collect and move this type of data,” he added.

The three states’ health departments are linked to CDC through the Connect gateway software developed by HHS. The agency’s partners in the project include the New York eHealth Collaborative, Indiana’s Regenstrief Institute and Science Applications International Corp. under a contract with Washington state, Magruder said.

Once the program has been fully evaluated, CDC might expand it to include other states and diseases, he added.
CDC also partnered with the International Society for Disease Surveillance and the Public Health Informatics Institute to create a new tracking system, called Distribute, that aggregates nationwide data from state and local health departments on emergency room patients with flu symptoms.

Distribute provides the CDC with further detail on geographic and age-specific trends, officials said. For example, in the Washington, D.C., area, Distribute reports that between Sept. 13 and Oct. 11, the number of emergency room visits related to flu symptoms more than doubled -- from 2.3 percent to 4.7 percent.

Other initiatives

CDC is also working with two other initiatives that began monitoring H1N1 flu activity this year: Cerner’s Flu Pandemic Initiative and the GeoSentinel global flu and disease tracking system established at the University of Alabama at Birmingham.

The initiatives complement existing CDC surveillance systems, including BioSense, the National Electronic Disease Surveillance System and the Influenza-Like Illness Surveillance Network.

CDC worked with health IT vendor Cerner to set up a national electronic swine flu tracking system. It takes advantage of Cerner’s network of lab, doctor and hospital clients, which spans as much as 30 percent of the country’s health care system. HHS Secretary Kathleen Sebelius called Cerner’s flu network a whole new model for disease monitoring when she spoke in Kansas City, Mo., Oct. 14 at a conference sponsored by Cerner.

The system, which began operating several weeks ago, is receiving data from about 1,000 hospitals, doctors and labs, said Kelli Christman, a Cerner spokeswoman.

The company set up the system voluntarily and sends results to CDC on a daily basis. The goal is to provide CDC and other clients with real-time information on hot spots of flu activity to help with preparedness efforts.

“We are providing a free service to enhance situational awareness,” Christman said. The system can be expanded to cover additional diseases or health events, such as negative reactions to vaccines, and the data can be customized to reflect activity in a specific region, she added.

The GeoSentinel network takes a global approach by connecting 48 clinics on several continents to track emerging diseases, including H1N1 flu, which first appeared in Mexico and spread worldwide within six weeks.

Unlike traditional flu surveillance systems, GeoSentinel tracks where patients got sick, not where they live.

"GeoSentinel is showing us travelers and mobile populations getting the flu," said Dr. David Freedman, co-director of GeoSentinel. "We are tracking which countries and places have intense enough transmission that they are then exporting flu and potentially seeding other countries.”

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