Stopping Epidemics before They Start

In late March, thanks to a random safety check by Kraft Foods, and calls to the Food and Drug Administration from two ill people, health officials learned of salmonella-contaminated pistachios, and were able to alert the public. No one died from the tainted nuts, but that isn’t always the case. The salmonella-contaminated peanuts detected in September 2008 have caused at least nine deaths, and in general, 5,000 people die every year in the US as a result of food-borne illnesses. But today, GE Healthcare, a leading maker of health information technologies, announced an innovative partnership with the Centers for Disease Control and Johns Hopkins University to develop a rapid-response public health alert system to stop influenza and other public health threats, before they spread.

Currently, public health agencies (the CDC, the Food and Drug Administration, and/or local health authorities) generally learn about disease outbreaks only if a patient goes to the doctor and if that doctor requests a stool sample and sends it for testing to lab that is a member of PulseNet, a national network of public health labs run by the CDC and local health agencies. But not every patient goes to the doctor. And, according to Dr. Charles Safran, an associate professor at Harvard Medical School and chief of informatics at Beth Israel Hospital in Boston, "just 5-10 percent of the time do doctors actually order a test to determine the cause of an illness."

As Safran described the problem to me, he didn't blame primary care physicians, who are pressured by insurance companies to spend no more than 7 minutes with each patient. Given that time constraint, doctors are, understandably, more concerned with treating the patient than with collecting a data point that might be significant in the larger public health context. Of course, the more unusual the patient case, the more likely a doctor is to run tests and call local health authorities; but simple diarrhea and stomach pains isn’t going to prompt an alert.

Hence the need for a system like the one GE Healthcare and its partners are demo’ing today in Chicago at the Healthcare Information and Management Systems Society's annual HIMMS Conference. (As an aside, my colleague Damian Joseph will be attending the conference, so we can look forward to hearing about more cool technologies announced there.) Back to the matter at hand, the GE pilot system aims to seamlessly link the electronic medical records (EMRs) many doctors already use with the broader public health system.

So for instance, when a doctor sees a patient with diarrhea and a fever, he or she would record the symptoms in the patient’s EMR, and then upload the anonymous data point – a female patient, aged 65, in zip code 02138, showing a fever and gastrointestinal illness – to an online repository of public health information. As other patients visit other doctors in the area complaining of similar problems, that information is also input and uploaded to the database, allowing public health officials to see aggregate patterns and identify disease clusters much earlier.

That kind of early detection helps doctors treat patients better and helps prevent further spread. For instance, the system could prompt physicians to ask the patient if he handled food as part of his job, or if she took care of children or the elderly, the two populations who are most vulnerable to disease.

Such a system also offers two related advantages over the status quo: First, it gives public health agencies who have been broadcasting health alerts via the media, email, or Web sites a way to deliver more targeted warnings. Clinicians in zip codes where an outbreak has been detected could be told to look out for certain symptoms.

Second, it creates an easier two-way channel. No need to call or fax a form to the local public health agency, a requirement that is such an obstacle for many overworked doctors that they never report cases in the first place. GE Healthcare and its partners hope to make the reporting so easy that doctors can do it with a click.

The system announced today is a demonstration project using GE Healthcare’s Centricity system, a leading EMR program already used by 30,000 doctors. But the point is to show that the information a primary care clinician types into any flavor of EMR can be linked to a larger public health network in a way that, ultimately, would make all of us safer.

President Obama’s recent stimulus package includes $20 billion for investment in health IT. Some of that money will go to increasing the adoption of electronic medical records and to building so-called health information exchanges, which allow patient information to flow more easily between, say, the primary care doctor, the surgeon, and the radiologist. Dr. Safran can’t be alone in hoping that some of that health IT stimulus money is used to develop this public health alert system. Food-borne illnesses alone amount to $6 million in healthcare expenses annually. If we want to cut health care costs, this is the kind of system that can help public health agencies quickly identify and contain disease outbreaks.

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