CDC adopts new, near real-time flu tracking system

Computerworld - Dr. Chris Crow, a family physician in Plano, Texas, said that in 10 years of practicing medicine, he has never seen flu spread like it has in the past six weeks. Crow said he has been treating at least three new flu patients a day during that time.

"It has been absolutely incredible watching this," said Crow, who runs Village Health Partners, a practice with 10 physicians. "When we had the initial H1N1 scare back in the spring, the county and state health departments were absolutely overwhelmed with the volume of calls and tests being reported to them."

At that time, county and state officials were so overwhelmed that they told doctors to stop sending in test results because they couldn't handle the volume, Crow said. But that changed this week when the U.S. Centers for Disease Control and Prevention (CDC) launched an effort to better and more easily track the H1N1, or swine flu, virus and other seasonal influenza activity throughout the United States.

The CDC said it is now tracking data on 14 million patients from physician practices and hospitals that is stored on a relational database hosted by GE Healthcare, General Electric Co.'s health care division. The data is submitted daily from physicians' offices and hospitals that use GE's electronic medical record (EMR) system. The data is then uploaded to a database used by GE Healthcare's Medical Quality Improvement Consortium (MQIC), a group of EMR users who have agreed to pool their data. Once it is in the MQIC database, which was designed according to HIPAA-compliance parameters of patient anonymity and best practices, it can be queried.

The CDC can perform queries to look for flu-like symptoms being reported by physicians and then disseminate the data to health care providers and local government officials throughout the country, who can alert businesses and others about flu outbreak hot spots.

The CDC also hopes its analysis of the data will help it better understand the characteristics of H1N1 outbreaks and determine who is most at risk for developing complications from the virus.

Prior to implementing the new system, the CDC relied heavily on tracking insurance claims data, which could take days, if not weeks, to make its way to the agency's medical staff for analysis.

"You not only want to get the data from here to there, but then you also have to say, 'I need to normalize that data,'" said Dr. Mark Dente, chief medical informatics officer for GE Healthcare IT. "For example, one doctor says hypertension, another says HTN and someone else says high blood pressure, but it all means the same thing when you enter a query against the data."

According to the CDC officials, the organization selected GE Healthcare's system for the project because of the database's built-in reporting capabilities.

Crow's practice has used GE's Centricity electronic medical record system for six years, so when the CDC program was launched, he was allowed access to the query engine that accessed data in the national GE database.

Like Crow, all participating physicians automatically contribute data they collect from patients to the MQIC database through normal use of the Centricity EMR system. The data aggregated by MQIC has no personally identifying information, so patient privacy is not at risk.

Crow said he has been using MQIC aggregated data to give physicians in his practice feedback based on evidence-based guidelines and benchmarks provided by the National Committee of Quality Assurances -- a standardization organization for clinical care for disease management.

Now that the CDC also has access to the MQIC database, Crow said, it will be able to track prescriptions, vaccination rates and clinical symptoms such as fever, nausea and chills, as well as variables such as procedures performed, pregnancy and patient age, within 24 hours of the data being compiled from thousands of participating doctors' offices across the country.

"This is monumental, because they're taking my and other doctors' data every day and looking for clues for new flu cases, such as fever ... diagnosing codes and testing results," Crow said. "This is going to allow the CDC to have the daily update for what's going on for 14 million patients."

Once the CDC can spot regional upticks in flu cases, it will be able to send notifications to physicians and businesses signed up for CDC flu alerts, and they can then take precautions against spreading the illness, Dente said.

"In terms of physicians, at the very beginning this allows you to suspect the flu before you otherwise might," said Crow. "From a patient standpoint, it alerts them to come in sooner. Getting in sooner can help the symptoms as well as the duration of the illness by using antivirals that are out there today."