Making Biosense of DataBy Doug Bartholomew | Posted 2006-03-06 Email Print
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The federal agency says its real-time data gathering can ward off a potential flu pandemic. Not every health-care provider is convinced.
The agency has signed on the Constella Group, a health-care information-technology consultant, to try to bring
hospitals along. "We explain to them the benefits of having this data in a standardized form, and that they are consciously participating in a project that is in both their interest and for the public good," says Wayne Myers, director of Constella's Health Sciences division.
But that still might not be enough for the CDC to overcome hospital resistance. "There are significant practicality issues," says Dr. Susan Fernyak, director of the communicable disease control and prevention program at the San Francisco Department of Public Health. "It is no small thing for a hospital to take on another I.T. project these days."
For instance, simply to get a local hospital to kick the habit of faxing data to the city health department in favor of transmitting it electronically is a major challenge, Dr. Fernyak points out. "You'd think that would be a no-brainer, right?" she asks rhetorically. "But a lot of work has to go into it to make it happen. It takes software, hardware and personnel resources to make the transition."
To ease the information-technology burden on participating hospitals, the BioSense network cleverly depends only on medical data that has already being gathered routinely at most large hospitals. This includes information such as emergency-room admissions records, radiology test results, laboratory test findings and prescriptions.
To bypass the need for additional data entry, the CDC installs on each participating hospital's network custom software that the agency developed. This system, in effect, "listens" to the facility's network traffic, filtering out the non-flu-oriented diagnoses and test results and capturing relevant patient records, diagnoses and prescription information.
The software converts this information to the health-care industry's standard HL7 data messaging format, aggregating and transmitting it over the Web to the CDC using public key infrastructure (PKI) encryption.
The system collects and transmits the hospital data every 15 minutes to a central data repository at the CDC. The data to be captured and transmitted includes patient demographics, the chief medical complaint, onset of illness, diagnoses, medical procedures, laboratory results including microbiology information, radiology results and medications prescribed.
But in order for BioSense to capture data for transmission, a hospital must standardize patient and other medical information. Most hospitals use their own data codes.
This means that once a hospital agrees to participate, the CDC and its contractors must work to modify the hospital's data codes as well as map and bundle the data so it can be transmitted and received. "To standardize the data and do all the data validation steps is a huge technological challenge," Rhodes asserts.
CDC technicians first need to learn how a hospital identifies relevant medical conditions and then recode them according to the agency's standards for each symptom, malady or drug. This allows the CDC's software to listen to the hospital's network and identify relevant pieces of information about a patient who came in complaining of cough, fever and headache, as well as the patient's diagnosis and any prescribed medications.
Making this process a little easier is the fact that many large hospitals already use an "interface engine," essentially a hub, to route medical information around the organization's network. "We're using a similar tool that we call the BioSense integrator," Groves of SAIC explains. "It stuffs through the same data flows, filtering the information we want, changing its format, putting it in the right code and batching it every 15 minutes to the CDC."
The federal disease control agency, in effect, taps into the hospital's network, opportunistically taking the data it wants for analysis.
Few would argue with the CDC's ultimate goal: to permit a faster, better informed, more effective response that could save millions of lives. Yet the medical community questions whether the BioSense network is worth it.
"If there is a pandemic flu, we are not going to know about it from a system like this," Dr. Fernyak insists. "In the case of a pandemic flu, we're not going to need an electronic data system to tell us there's a new strain of flu out there."
Adds Dr. John Rosenberg, director of the Infectious Disease Laboratory at the State of California's Department of Health Services in Richmond, Calif., "I think it would be particularly useless for influenza, because for any influenza-like illness, there is no way to say someone has it for sure." Physicians may record six or seven different diagnoses for influenza-like symptoms, which usually include fever, nasal congestion, muscle and bone aches, and include chest X-ray results, he says.
Dr. Rosenberg says that if an epidemic broke out, "You'd know it before the data rolled in. When your emergency rooms fill up, you make a phone call; this is probably a better measure. We're not advocating or supporting the BioSense network, but if a health-care organization wants to participate in it, that's fine."
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