Experts: Pandemic flu threat requires e-medical records

Health authorities fighting a pandemic flu outbreak would benefit greatly from access to robust, real-time, electronic medical records, according to several health experts who testified at a congressional hearing this week.

Very few hospitals ? perhaps as few as 10 to 15 percent ? have computerized medical records systems that connect with public health departments, Dr. Tara O'Toole, chief executive of the Center for Biosecurity at the University of Pittsburgh Medical Center, told the House Committee on Homeland Security Feb. 8.

Many of the systems "are not as robust as one would wish, and very, very few of them have links to public health," O'Toole added.

Many hospital record systems track a single disease or are designed for a limited purpose, rather than being useful for multiple goals such as monitoring a flu epidemic, she said.

A more comprehensive solution "would be a true integrated electronic health network to take care of patients on a routine day, but would also give you real-time, situational statistics during an epidemic. [But] that is going to be a ways off," O'Toole said.

"There are very few emergency departments right now that are on paperless systems, probably less than 10 percent in the country right now. None of those systems, that I am aware of, are hooked up to the health department," Dr. David Seaberg, president of the Florida College of Emergency Physicians, said at the hearing.

Most emergency rooms still use paper and an ad-hoc approach to determine what incidents should be reported and to whom, O'Toole said.

"Since 9/11, in those entities that actually dealt with anthrax, that has gotten a little bit better, and there are more electronic exchanges of information," O'Toole said. "But then, most public health authorities have to go through and say, 'Am I going to investigate this or not?' Half of what got called in as emergencies did not warrant an investigation. It is a very laborious process right now."

In Maryland, hospital emergency rooms are creating a system with public health officials. "It is very basic, but it is an electronic system, so that in my office, I can see the volume of activity in the emergency rooms in my county," Frances Phillips, health officer in Anne Arundel County, Md., said at the hearing. For example, the system can indicate how many people need ventilators. But it cannot offer much information beyond that, she said.

Maryland may be ahead of other states in developing surveillance systems because of its experience with anthrax but it still needs work, Phillips said. Participating hospitals, physicians and public health use "telephone and fax and postcards. So that is what we are working with," Phillips said.

For many years, public health departments have had typical disease reporting systems. More recently, many major cities and some states have established so-called syndromic surveillance systems, in which data from hospital emergency rooms, drugstores, doctors' offices and other sources flows into a public health department on a daily or hourly basis. The information is then analyzed for spikes in fevers, severe coughs and other symptoms that could provide an early warning of an emerging disease or biological attack.

Large employers are starting to participate in the early warning surveillance systems, Ernest Blackwelder, senior vice president of the Business Executives for National Security, testified.

One of his group's initiatives is a workplace sentinel program sponsored with the New Jersey Public Health Department. They are designing a Web-based reporting system that will enable large employers to report spikes in absenteeism to state and local epidemiologists, Blackwelder said.