Data Collected By The Healthcare System

Similar to biosurveillance, the practice of medicine is information intensive. The healthcare system records many types of data for every patient encounter. Table 6.1 lists data that clinicians routinely record as part of the admission history and physical for each patient admitted to a hospital. They record similar data throughout an inpatient stay and for outpatient visits. If just these data were fully and immediately available to biosurveillance organizations for all patients seen by clinicians with possible infectious diseases, their ability to detect and characterize disease outbreaks would be enhanced considerably.

Access, however, is a significant barrier to the use of healthcare data in biosurveillance. Healthcare workers record many important data only on paper. The types of data that are most often "locked away'' on paper are the very data needed for early detection and rapid characterization of an outbreak—a patient's symptoms, travel history, immunization history, history of recent foods consumed, and contacts with sick individuals or animals. This problem is especially severe in outpatient offices, which have lower levels of automation than do hospitals. This barrier to access will gradually disappear because of a number of trends, including the falling cost of IT, consolidation of the healthcare system, and federal initiatives such as the National Health Information Infrastructure (NHII) (Yasnoff et al., 2001, 2004; Rippen and Yasnoff, 2004).

Even when the healthcare system records data electronically (as is typically the case for results of laboratory tests and radiology examinations), the data are encoded in nonstandard formats that represent a barrier to regional integration of data for biosurveillance. This problem will also gradually resolve as the healthcare system adopts standard methods for representing and storing data (discussed in detail in Chapter 32, "Information Technology Standards in Biosurveillance"), a process that has been ongoing for several decades and is gaining momentum under NHII.

1 This situation is changing as a result of increased awareness of the societal cost of hospital-acquired infections in terms of morbidity, mortality, and economic costs. Recent JCAHO rules now hold the CEO of a healthcare organization accountable for ensuring adequate funding of infection control.

2 Influential organizations include the Society for Healthcare Epidemiology of America (SHEA), Association for Professionals in Infection Control and Epidemiology (APIC), and the Hospital Infections Control Practices Advisory Committee (HICPAC) of the CDC.

TABLE 6.1 Diagnostic and Epidemiological Data Recorded in an Admission History and Physical Examination

Type of Data

Examples of Data Relevant to Clinical Diagnosis (Case Detection), Outbreak Detection, or Characterization

Demographics

Age, gender, home and work address

History of present illness

Symptoms (cough, fever, diarrhea) and their timing; significant negatives

Physical examination

Temperature, rashes, evidence of pneumonia

Laboratory results

Blood, stool, and sputum cultures; cerebrospinal fluid analyses; examinations of stool for ova and parasites

Radiology results

Chest radiographs

Travel and exposure histories

Travel to endemic area, drinking of unboiled water, animal bites

Vaccinations

Measles, hepatitis, influenza, yellow fever vaccinations

Personal/social history

Intravenous drug use, sexual practices, occupation, household members

Past medical history

Diabetes, HIV, transfusions

Allergies

Medications, insects

Current medications

Ciprofloxacin, Tamovir

Diagnostic impression

"pneumonia, rule out anthrax''

Data are checked if they could be used in a case-control study to elucidate outbreak characteristics such as source or to determine if a patient matches a case definition.

Data are checked if they could be used in a case-control study to elucidate outbreak characteristics such as source or to determine if a patient matches a case definition.

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