Can EHRs Track Pandemic Influenza in Hawaii?
KNHL News in Hawaii is doing a special on pandemic influenza in Hawaii. The introductory video can be found here. The first part aired last night. Vaccine: Part I What is a Pandemic?. Part II and III will air next Wednesday, April 22 and the following Wednesday, April 29. The KHNL site states “With this particular virus there is no immunity. The body, the immune cells have not seen these things before,” said Dr. Vivek Nerurkar, the interim Chair of the Tropical Medicine and Infectious Diseases Department at the University of Hawaii’s John A. Burns School of Medicine.
Dr. Sarah Park, Chief, Disease Outbreak Control Division said “There are so many unknowns in a pandemic.” According to Health Director Chiyome Fukino, a Pandemic “is a worldwide event.” She brings considerable focus to the topic by further stating “people really need to be thinking about being self sustaining.”
The Department of Health (DOH) wants the public’s opinion. You can reach them at their website or by email at pandemicfluinfo@doh.hawaii.gov. There are several resources there including an extensive Hawaii Public Health Pandemic Flu Plan as well as a condensed Hawaii Public Health Pandemic Flu Executive Summary. This ties into the guidelines posted at the federal pandemic flu website, www.pandemicflu.gov. Dr. Park goes on to talk about just in time (Piggly Wiggly finally gets the credit it is due) supply management. This model of supply chain management has made FEDEX, UPS and Wal-Mart the Goliaths of efficiency. They are also the bane of survival. Entire textbooks have been written on this; it ties into Deming and most recently Six Sigma.
“Due to Hawaii’s unique geographic location in the Central Pacific Ocean, we realize how important it is to establish some type of monitoring as well as a detection system,” said Health Director Chiyome Fukino, M.D. It does make you think, doesn’t it? We often think that a food shortage or supply interruption would be a worst-case scenario. Actually, having the supplies 5 miles away and not being able to travel to them would be the worst case.
In an electronic environment, it is also a best case. Since individual clinics, doctor’s offices and hospitals can gather information independently, they can also report it independently. A sort of electronic isolation would occur since travel would be limited. This is the perfect environment for reporting of electronic health information. Healthcare information technology can be brought to bear on the problem as a robust tool. Using vitals signs, numbers of patient visits, types of visits, chief complaint, etc., an alert system and information gathering repository could be created using deidentified patient health information (PHI). This same alert system could be extended or broadcast to the Centers for Medicare & Medicaid Services (CMS) on a national level. Vaccination rates and availability could be assessed much more rapidly with a good data infrastructure. The local initiative of HB1782 is the beginning a statewide clinical data repository and health information exchange. See my previous post, for more on health information exchange.
The Clinical Care Classification (CCC) System “is a standardized, coded nursing terminology that identifies the discrete elements of nursing practice. CCC provides a unique framework and coding structure for capturing the essence of patient care in all health care settings.” These types of algorithms and disease classifications are invaluable in setting up a structure to detect disease outbreaks such as the flu. There will be too much piecemeal or anecdotal information available and not enough specific information such as symptoms, vital signs, diseases (ICD9), orders (CPT codes) and outcomes. . For more information, see these terminology tables for Components, Diagnoses, Interventions, Actions, and Outcomes.
Dr. Sarah Park, also stated “We won’t have things being repaired in a timely basis. And it’s not just electricity. For us in public health, we worry about clean water. I’m sure everyone remembers the sewage spill. Can you imagine if we didn’t have enough people to take deal with any sewage issues? If we didn’t have people to ensure the potable water system?” She goes on to talk about various stages of medical screening and alerts from the airlines. I discuss an alert system more below.
The military services have large numbers of ancillary staff such as Independent Duty Hospital Corpsmen and Preventive Medicine Technicians, specialists in potable water and sanitation, but they will also undoubtedly be busy.
A few years ago, Dr. George Underwood, Medical Informatics, Clinical Informatics Section, Information Management Division,Tripler Army Medical Center did a presentation at a Armed Forces Epidemiological Board (AFEB) meeting entitled Pandemic Influenza Tracking in the DoD Community on Oahu. (PowerPoint). (PowerPoint)
Automated disease tracking is bleeding edge healthcare information technology. Anyone have a few million laying around?
About 4 years ago I was called by to do a programming project at Tripler. It was for a new computer system called AHLTA. I translated the Clinical Practice Guidelines from paper to electronic forms. The form layout templates are called Alternate Input Method (AIM) forms. These forms allow standardized data entry for easy coding and reporting. Just what the Doctor ordered. The AHLTA system replaced CHCS II, that replaced CHCS I (I feel old now), the system I learned on in 1996. It is now used by over 5000 providers at more than 100 locations worldwide. While definitely not user-friendly it is reporting friendly. This is the task that will plague (sorry) us for years to come. Getting the data in without turning MDs into clerk-typists, while providing readily available quality care, while following clinical practices, while making the computer platform user friendly, while reporting to CMS and all the while smiling you talk to the patient. Lots to do, don’t you think? I consider us to be in the fortunate position of getting it done.
