I was watching the movie I am Legend on HBO Sunday evening. I’m not sure if there is any correlation between HBO’s decision to broadcast of the film in May and the outbreak of the H1N1 Swine Flu. However, it did start me thinking about pandemics and what could be done to better contain these outbreaks before they turn all of Manhattan into nocturnal, cannibalistic zombies. The widespread outbreaks of H1N1 in Mexico and the US have made this subject top of mind for everyone from politicians to economists. Of course, pandemics are yet another area in which B2B interoperability and integration technologies could play a significant role.
The Center for Information Technology Leadership published a comprehensive report on how B2B interoperability in the US health care community could not only reduce costs but improve the quality of care. Much of the data cited in this post is sourced from the 2004 report entitled The Value of Healthcare Information Exchange and Interoperability. See my January post on how the Obama administration could save $75B annually from B2B interoperability in health care for more background information.
Tracking Pandemics at the State, Local and Federal Level
State laws require providers and laboratories to report cases of certain diseases to local and state public health departments. Nationally “notifiable” diseases are forwarded by the state agencies onto the Centers for Disease Control and Prevention (CDC). Connections between the states and the CDC are electronic and highly automated. However, the first mile between the providers and the local and state agencies is highly manual. Providers typically submit data via phone, fax, hard copy forms or very basic B2B communications methods such as a web portal. For larger provider groups operating in multiple regions, notifications to state health agencies become even more cumbersome. The 50 US states maintain more than 100 different systems to collect data each with its own communications mode.
The most closely monitored “notifiable” diseases are frequently under-reported in the US. Various studies conducted between 1970 and 1999 showed that only 79% of all STD, tuberculosis and AIDS cases were reported to public health agencies. Reporting rates for other diseases was much lower at 49%. There are several reasons for the reporting challenges. But certainly one of the key issues is the ease with which the information can be transmitted to health authorities. There is no question that the primitive communications methods used to collect provider data is a critical barrier to success. However, even more problematic is the dependency upon overworked and understaffed provider personnel to take the time to consistently file the reports.
Electronic Health Records – Public Health Benefits
A better methodology for reporting on “notifiable” diseases would be to eliminate the need for human initiation altogether. The process could be completely automated by connecting health care provider’s Health Information Systems and Practice Management Systems which contain the patient data to Public Health and Safety tracking systems. However, connecting the tens of thousands of medical practices to the hundreds of different public health systems could prove quite an ambitious integration project. A less complex and costly alternative would leverage the concept of Electronic Health Records (EHR). The EHR would significantly simplify tracking of public health epidemics without the need for bespoke integration between various state agencies and each different medical provider.
The EHR provides a comprehensive set of information about each patient including demographics, medications, immunizations, allergies, physician notes, laboratory data, radiology reports and past medical history. EHR information could be stored in a series of centralized repository deployed around the country. Each repository could contain the full medical records or just pointers to the locations of the records. Triggers could be set up to automatically identify trends in data sets that might not be otherwise noticed, helping to provide an early warning system for potential disease outbreaks. In the event of a pandemic or bioterrorist event, public health officials could easily access de-identified EHR data such as physician’s notes, patient demographics and medical history. Without the dependency upon manual data entry, the latency of information flow could be reduced and the quality of information collected could be improved. Administrative costs would be reduced considerably. Average cost to send a report manually is $14 as compared to only $0.03 electronically. CITL estimated that the use of electronic data flow from providers and laboratories to public health agencies would reduce administrative costs by $195M annually. CITL did not quantify the potential economic savings from early identification of pandemics and bioterrorist events, but there is no question that these could be in the billions of dollars.
B2B Interoperability and EHR
Of course, a key technology enabler for EHR is interoperability between the various health care providers and the corresponding state, local and federal agencies. Medical data is transmitted between providers, payers and public agencies using a variety of B2B standards including DICOM, HL7, NCPDP, and HIPAA-compliant EDI transactions. EHRs could aggregate the available data related to prescriptions, claims, lab reports and radiology images into an electronic record. Additional services could be layered onto the B2B integration framework such as data quality could be used to ensure the completeness of records and business activity monitoring to identify behavioral trends.
Another concept evangelized in the CITL report is the idea of a National Electronic Disease Surveillance System (NEDSS). The NEDSS would collect data from a number of relevant sources outside of the health care system which could be useful for monitoring Examples might include 911 call analysis; veterinary clinic activity; OTC pharmacy sales; school absenteeism; health web-site traffic and retail sales of facial tissue, Orange Juice. Such practices have been deployed by the US Department of Defense and the Utah Department of Health during the Salt Lake City Olympics in 2002. Such an effort would require integrating additional state and local agencies, educational institutions and retail chains electronically using B2B.
One Response to “B2B Integration could help improve tracking of Pandemics such as H1N1 Swine Flu”
The benefits of digital medical records are tremendous and I think electronic health records will lead to betterment and advancement of health care..