CDC Goes for theBy Doug Bartholomew | Posted 2006-03-06 Print
The federal agency says its real-time data gathering can ward off a potential flu pandemic. Not every health-care provider is convinced.Big Picture on Contagion">
But a hospital's medical staff might not know they have a serious problem on their hands when patients start coming in with symptoms, Groves says, while CDC scientists and analysts will be able to see a major flu outbreak as it develops over a broader geographic area. Having this bigger picture will help public agencies—not just medical but police, emergency and National Guard units, if needed—to marshal a better-organized response.
Another issue that CDC must deal with to obtain wider acceptance of BioSense is turf poaching. Although participation on the part of hospitals is voluntary, many physicians and health officials see the CDC's impending spread of BioSense as a sign of the federal government encroaching on what has traditionally been the domain of local health-care providers and organizations.
They say it's their responsibility—not the CDC's—to respond to and manage a local or regional flu outbreak. "The local health departments and hospitals are responsible for dealing with a pandemic," Dr. Fernyak says. "I think the CDC is not taking into consideration the local situation. CDC is not going to be responding to a pandemic on the ground. The local hospitals and physicians are."
Another challenge for the agency is convincing hospitals to allow the federal government to, in effect, listen in on their daily treatment of patients on a real-time basis. The privacy and security of the patient information that hospitals are being asked to surrender is one reason many are reluctant to sign up. The Health Insurance Portability and Accountability Act (HIPAA) restricts their use of patient data and stipulates the need for medical organizations to rigorously safeguard patient information.
HIPAA, though, makes an exception in this case, since the law allows hospitals to share information with public-health agencies such as the CDC, which guarantees that no data is used that would enable identification of individual patients.
Even so, physicians are decidedly chary about surrendering patient medical information to Uncle Sam's databases.
"The CDC has not told us how they plan to deal with the issues of confidentiality and privacy of this information," Dr. Fernyak says. "We have a lot of concerns about the handling of that data and how it will be used by the CDC."
Surprisingly, until the first of the year, the CDC had been receiving regular patient information once a day only from naval and Army hospitals, VA hospitals and a major medical laboratory. This data is still coming in, but the CDC expects this year to gradually wean itself from depending only on this dated information as a larger number of hospitals' patient medical information comes onstream via BioSense.
The agency has also been depending for early detection on a variety of largely ad hoc sources of patient and medical information. For instance, CDC analysts monitor mortality rates in various cities. If a spike in mortality rates occurs in a particular city, agency staff investigate further, checking for other indications such as a corresponding jump in outpatient visits or an increase in reports of viruses.
But gathering this data was slow and labor intensive. "Before now, there never was an attempt to aggregate this much data in near-real time to see what is happening in a hospital or in a city," the CDC's Rhodes explains.
The medical information transmitted daily from government hospitals, for instance, was extremely limited in scope, excluding all civilian medical centers. It was also stale in medical terms—three days old on average. That latency makes the information nearly useless for anyone trying to detect and stem an outbreak of an infectious disease—a situation that experts say can change dramatically each day, if not hourly.
That's why the CDC feels there's no time to waste.
Humans have been stricken with avian influenza in China, Turkey and Nigeria, with more than 90 fatalities since 2003. Most recently, on Feb. 10, Indonesian officials reported that a
23-year-old woman from West Java province died of bird flu.
Experts, including Dr. Fernyak, are concerned that sooner or later, the virus could mutate and spread widely and
rapidly among humans, causing a pandemic. "It could happen in four months or 10 years," she says. "Statistically it's going to happen sometime; we just don't know when."
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