December 19, 2006Computerized monitoring of healthcare data is crucial in preparing for an influenza pandemic, but the tools are not in place yet, according to medical experts.
On Monday, the White House released a status report on implementation of the nation's strategy for a pandemic. The action plan, issued six months ago, directs federal agencies to complete goals for preventing, monitoring and responding to a global flu outbreak.
Ninety-two percent of all actions due within six months have been completed, according to the update, but doctors said biosurveillance work is still under way.
For starters, healthcare providers and public health authorities need to adhere to a common set of surveillance standards. This fall, a Health and Human Services Department-funded panel made headway by developing standards for the secure collection of biosurveillance data.
"We did harmonize all the various disparate data systems that exist in the country," said John Halamka, chairman of the health information technology standards panel that delivered the specifications to the HHS secretary. The panel is helping to shape the national health information network by addressing issues of privacy and security.
Halamka, also the chief information officer at Beth Israel Deaconess Medical Center in Boston, said several hospital systems across the country, including his, share patient data -- stripped of personal identifiers -- with the Centers for Disease Control and Prevention. The information contains only age, gender and chief complaint of the patient.
In addition, Beth Israel Deaconess participates in a city-wide, real-time system that monitors spikes in illnesses across all Boston emergency rooms.
But Halamka acknowledged that not every hospital is live with biosurveillance capability. "Boston happens to be a pretty wired place. ... It's going to take a couple years for vendors to bake that into their software," he said.
Other medical providers are less optimistic that pandemic biosurveillance will ever blanket the country, let alone the world.
Unless health information is portable, cheap, easy and safe to move, surveillance is nearly impossible, said David Kibbe, former director of and now senior adviser to the health IT center at the American Academy of Family Physicians.
The center has "not spent any sort of directed time thinking about how these standards and these collaborations with the government, health plans, would directly relate to pandemic or biosurveillance activities," he said.
The inactivity is partly due to a lack of urgency. "We haven't had a pandemic yet," Kibbe said. "It seems like a second-order or third-level problem from where I sit."
The other hindrance is money. "The basic problem is that there is almost no business case for interoperability in healthcare -- and certainly no business case for biosurveillance," he said. "It's not the technology; it's the political, business part of this that makes biosurveillance so difficult to achieve."
December 19, 2006