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Leveraging HIT for Public Health Surveillance

Leveraging HIT for Public Health Surveillance. Presented by: Edward Barthell, MD, MS HIT Summit October 22, 2004. Infinity Healthcare – Emergency physician staffing American College of Emergency Physicians Frontlines of Medicine workgroup

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Leveraging HIT for Public Health Surveillance

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  1. Leveraging HIT for Public Health Surveillance Presented by: Edward Barthell, MD, MS HIT Summit October 22, 2004

  2. Infinity Healthcare – Emergency physician staffing American College of Emergency Physicians Frontlines of Medicine workgroup EMSystem - ASP for diversion, mass casualty mgt, ED data collection and communication National Institute of Medical Informatics Wisconsin Health Info Exchange Edward Barthell, MD, MS © Edward N. Barthell, MD, MS

  3. Agenda: Establishing a vision Sharing data Syndromic surveillance Lessons Future plans © Edward N. Barthell, MD, MS

  4. A public-private partnership dedicated to driving improvement in the quality, safety, and cost-effectiveness of health care through information technology

  5. eHI Vision :An interconnected, electronic health information infrastructure that benefits all stakeholders in the health care system …

  6. eHI Vision • Computerized patient records in every clinician’s office. • Interoperable health care systems with secure connectivity across providers, patients, payers, public health and others.

  7. eHI Vision • Clinicians armed with the information they need to make the best clinical decisions at the right time. • Consumers, patients and caregivers armed with the information they need to manage and address their own health care needs.

  8. EM Physicians and Computers • ACEP Informatics Section • Annual ACEP Informatics Meeting

  9. © Edward Barthell, MD, MS

  10. Emergency Department of the Future ACEP Scientific Assembly New Orleans September 1996 © Edward N. Barthell, MD, MS

  11. EDOF Project • Provide a strategic vision & enthusiasm among emergency physicians & the medical industry. • Present a show case for medical products & computerized technologies. • Provide optimism about the future of medicine. • A place for education & learning. © Edward N. Barthell, MD, MS

  12. DEEDS Authorized reuse of DEEDS based ED data can potentially help…. © Edward N. Barthell, MD, MS

  13. Surveillance and Preparedness © Edward Barthell, MD, MS

  14. Rand Science and Technology Institute – Infrastructure for successful preparedness must address: • Objectives • Capabilities • Stakeholders • Data Needs © Edward Barhtell, MD, MS

  15. History - Barriers • Inadequate systems for sharing information between clinical providers • Inadequate sharing of information between clinical providers and other stakeholders © Edward N. Barthell, MD, MS

  16. Emergency Medicine Normal operational mode = survival as priority © Edward Barthell, MD, MS

  17. © Edward Barthell, MD, MS

  18. New motivation…. © Edward Barthell, MD, MS

  19. Public Health Goal Indianapolis Network for Patient Care (INPC): Link clinical activities and public health activities to improve the population’s health J. Marc Overhage, MD, PhD 2003

  20. Frontlines of Medicine • Develop a standardized approach for submission of emergency encounter data to regional centers to allow for rapid deployment of widespread syndromic surveillance © Edward N. Barthell, MD, MS

  21. Frontlines Recommendations • Focus on real time data collection and analysis • Best initial mechanism is systematic passive collection as a by-product of routine care of individual patients

  22. Methods • Published initial paper with proposed approach and standards • Identified experts / stakeholders • Invited feedback, established partners • Consensus conference April 2002 © Edward N. Barthell, MD, MS

  23. Annals of Emergency Medicine, April 2002 © Edward N. Barthell, MD, MS

  24. Methods • Delphi survey process via email • Initial validation of results • Triage surveillance report data elements • Chief complaint values • Publish resulting recommendations • Encourage pilot testing, evaluation • Encourage widespread deployment © Edward N. Barthell, MD, MS

  25. Frontlines Recommendations • Flexibility is needed • Focus on standardizing the message, not standardizing the data capture mechanism © Edward Barthell, MD, MS

  26. Annals of Emergency Medicine, September 2004 © Edward N. Barthell, MD, MS

  27. Real time data capture ED system triage export Free standing system Web based triage tool ADT Export Tool Internet – SSL - XML NLP Module Web based triage server Web Service Frontlines Architecture Frontlines Primary Database Frontlines Secondary Database NEDSS Integrated Repository Reporting Tools NEDSS Tools Provider reports Public Health reports © Edward N. Barthell, MD, MS

  28. Frontlines Recommendations Interlinked regional surveillance centers Nationwide surveillance Potential international applications Scalable…

  29. EMSystem • All area hospital emergency departments linked via internet • Hospital diversion information • Mass casualty management • Emergency visit registry to support public health © Edward N. Barthell, MD, MS

  30. I-1 Hospital Legacy Systems Hospital Legacy Systems Hospital Legacy Systems Security Server Application Servers Web Server Reporting Tools Regional DB Browser Browser Browser Browser Researcher, ACEP, Public Health Browsers Participating Hospitals Emerg Dept Server Local DB Internet Hot Back up Site Application Service Provider (ASP) Model Infinity / EMSystem Data Center © Edward N. Barthell, MD, MS

  31. © Edward N. Barthell, MD, MS

  32. © Edward N. Barthell, MD,MS

  33. Syndromic Surveillance:John Snow & the Broad Street Pump J. Marc Overhage, MD, PhD 2003

  34. Milwaukee cryptosporidiosis outbreak – a model • March - April 1993 • Largest waterborne U.S. outbreak • Contaminated reservoir • Parasitic intestinal infection • Over 400,000 people sick (52% attack rate) Diarrhea, 111 deaths © Edward N. Barthell, MD, FACEP

  35. Symptoms at home (by telephone questionnaire) 6 13.2 ER Syndrome (GI) data 7 2.6 Data source Time following peak water turbidity, days Signal-to-noise ratio Illness in nursing homes 8 65.6 School absenteeism 9 5.1 Clinical laboratory tests 15 1485.7 Milwaukee cryptosporidiosis outbreak Proctor, Epidem Infect, 1998 © Edward N. Barthell, MD, FACEP

  36. Current Surveillance Process Emergency Management Law Enforcement Public Health (CDC) Medical Responders Traditional Epidemiology Slow Investigating & Reporting Public Health Reporting Lab Results Positive Confirmed Diagnosis Data Sources Containing Indicators Emergency Depts Astute Private Practitioner © Edward N. Barthell, MD, FACEP

  37. Emergency Syndromic Surveillance Potential Capabilities • Ubiquitous in distribution • 24 x 7 x 365 • Real time: much faster detection than waiting for labs / cultures • Cost effective © Edward N. Barthell, MD, FACEP

  38. Capture Data © Edward N. Barthell, MD, FACEP

  39. Universal Triage Form © Edward N. Barthell, MD, FACEP

  40. Real time data capture ED system triage export Free standing system Web based triage tool ADT Export Tool Internet – SSL - XML NLP Module Web based triage server Web Service Frontlines Architecture Frontlines Primary Database Frontlines Secondary Database NEDSS Integrated Repository Reporting Tools NEDSS Tools Provider reports Public Health reports © Edward N. Barthell, MD, FACEP

  41. Conceptualization of Prevalence Reports - Dr. K Mandl Adjusted Fever Visits Adjusted Injury Visits Adjusted M.I. Visits 56 56 56 Adjusted Asthma Visits Adjusted Rash Visits Adjusted Bleeding Visits 56 56 56 Adjusted Siezure Visits Adjusted Psych Visits Adjusted Stroke Visits 56 56 56 © Edward N. Barthell, MD, FACEP

  42. Real time data capture ED system triage export Free standing system Web based triage tool ADT Export Tool Internet – SSL - XML NLP Module Web based triage server Web Service Frontlines Architecture Frontlines Primary Database Frontlines Secondary Database NEDSS Integrated Repository Reporting Tools NEDSS Tools Provider reports Public Health reports © Edward N. Barthell, MD, FACEP

  43. Oh my! © Edward N. Barthell, MD, FACEP

  44. Take action to improve the situation …. © Edward N. Barthell, MD, FACEP

  45. Evolving Model of Surveillance Simple Data Collection and Analysis A Tiered Interactive Communication System © Edward N. Barthell, MD, FACEP

  46. © Edward Barthell, MD, MS

  47. SARS – A Real World Example

  48. © Edward Barthell, MD, MS

  49. Surveillance – Volume Based using EMSystem Emergency Management Law Enforcement Public Health (CDC) Medical Responders Clinical Providers “Agile Forms” © Edward N. Barthell, MD, FACEP

  50. SARS Surveillance – EMSystem • Sun Mar 16th – Initial conference call • Mon Mar 17th – Agreement on data to be collected • Tues Mar 18th – Nurse mgr notification • Wed Mar 19th – Data collection begins © Edward N. Barthell, MD, FACEP

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