This internal project, led by Frans de Wet, is a priority for Uber Operations. We understand the importance of this project, specifically the benefits it will provide to our public and private healthcare clients.  We look forward to updating the health technology community as we finalize our implementation. Be sure to return in a few days!

More information on Direct:

1. Main web site

2. Project Wiki

3. Project Blog

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

Today we announce the first cooperative agreement awards authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act.  It marks a major milestone in our journey towards nationwide adoption and meaningful use of health information technology (health IT).   One set of awards provides $386 million to 40 States and qualified State-Designated Entities to rapidly build capacity for exchanging health information across the health care system both within and between states through the State Health Information Exchange Cooperative Agreement Program. The other awards provide $375 million to create 32 Regional Extension Centers (RECs) that will support the efforts of health professionals, starting with priority primary care providers, to become meaningful users of electronic health records (EHRs). Additional awards will be made in both programs over the coming weeks. Together, these programs will help modernize the use of health information, improving the quality and efficiency of care for all Americans.
As part of the State Health Information Exchange Cooperative Agreement Program, states will play a leadership role in achieving HIE to meet health reform goals. The funds awarded will be used to establish and implement plans for statewide HIE by creating the appropriate governance, policies, and technical services required to support HIE. Developing this state-level capability will help us break down the   current barriers to HIE and help providers to qualify for Medicare and Medicaid incentives under the HITECH Act. The awards will also strongly encourage states to consider participating in the Nationwide Health Information Network as an approach to HIE.  This would create a pathway toward seamless, nationwide health information exchange.
While the State HIE awards will strengthen capacity for health information exchange, the Health Information Technology Extension Program awards will establish RECs to deliver direct outreach, education, and technical assistance services to health care providers in their regions. Each REC will focus most intensively on the physicians, physician assistants, and nurse practitioners who work as part of individual and small group primary care practices, as well as those who dedicate themselves to providing health care to the underserved. Primary care providers in small practices provide the great majority of such services in the U.S. but have limited resources to implement, meaningfully use, and maintain EHR systems. On-site technical assistance for these priority primary care providers will be a key service offered by the RECs.   RECs will assist providers who have not adopted EHRs, as well as those who have but need help progressing to meaningful use.  Regional extension centers will also help providers keep health information private and secure.
The Health Information Technology Extension Program and the State Health Information Exchange Cooperative Agreement Program are critical components to the end of a nation-wide interoperable, private and secure electronic health information system.  I look forward to working in collaboration with each state and REC as they establish their programs, begin work within their communities, and promote the transformation of our health care system. I applaud each awarded entity for its dedication to the mission of improving the quality of health care and for the leadership and guidance it will provide.
Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.

For more information and to receive regular updates from the Office of the National Coordinator for Health Information Technology, please subscribe to our Health IT News list.

Posted by Dana Blankenhorn @ 7:41 am

Health reform, at its heart, is an effort to transform market incentives.

In the current system, there is no reason to limit costs. The doctor who diagnoses an illness directs treatment. The more treatment, the more money is made by the hospital and its supply chain.

Payment is similarly disconnected from service. Insurers have tried, for years, to fight these cost rises on behalf of their customers, and failed.

Open source starts by connecting data. As Matt Mattox of Axial observed last week (talking with Jason Hibbets of Red Hat), it drives systems toward an open architecture.

The current Administration’s support for open source and open architectures is aimed at breaking apart data silos, collecting the data that can in turn drive change.

The fear of the Administration’s opponents is that government will control the data. But another important aspect of open source health care is that it can give patients access to their own data.

That’s the aim of Indivo, a new open source project from, among others the Harvard Medical School, the same people who are driving the Administration’s health reform proposals.

As Fred Trotter explains, it’s a Personal Health Record (PHR) platform engine. It’s both a way to make a PHR, and link PHRs together. It’s a way to break the silos being created in that market, much as the NHIN “Health Internet” is designed to break silos in the larger Electronic Health Record (EHR) market.

We should already have enough data to drive reform. We know what works. Wellness services work. Doing what is cost-effective first works. Every other industrial nation has used these tools to transform incentives and provide ample care at a fraction of the cost Americans pay.

But by making political arguments against science, those who benefit from current business models have succeeded, for now, in preventing reform.

So thousands of people will die needlessly this month, and next month, and the next, because they did not get needed care. And half those with diabetes will be reluctant to get treatment, for fear of losing their jobs and thus access to care.

My point is that these arguments may hold against the rivulets of data we now have available. By automating care under open source standards we can unleash a Google-sized torrent onto the research community, proving the case once and for all. By providing data to patients, we also empower them to demand change, and to seek services before they’re sick.

That’s why open source is health reform. Unlock a high enough flood of data and mere arguments will be blown away. Show people their own data, explain what it means, and people will demand the services needed in order to live and not just get well.

Source: http://healthcare.zdnet.com/?p=3273&alertspromo=&tag=nl.rSINGLE

By Mary Mosquera
Friday, January 22, 2010

The Health & Human Services Department has updated the government’s Connect software to incorporate the ability to query for a patient and to assure the identity of sender and recipient in the exchange of health data.

Connect is the federally developed software that lets agencies and healthcare organizations share health data by using the protocols, agreements and core services that comprise the nationwide health information network (NHIN).

HHS continues to improve or add more functionality to the Connect gateway software on a quarterly basis to be a model for health information exchange, according to Les Westberg, Connect’s technical lead in the Federal Health Architecture (FHA) program and an executive with Agilex.

Authentication requirements “should be in line with some of the tightest security that’s possible right now,” he said, during an online conference Jan. 19 about the latest version of Connect software. 

Authentication works hand-in-hand with the data use and reciprocal agreement (DURSA), which is a legal agreement signed by the organizations to assure a certain level of authentication, he said. The organizations communicate that authentication information with use of Security Assertion Mark-up Language (SAML), a standard for exchanging authentication and authorization data.

NHIN authentication services will include digital certificates to document a user’s identity has been verified, lists of those whose certification has been revoked and the ability to ask if an organization’s NHIN certification is still valid, Westberg said.

Another significant upgrade is the technical ability for Connect to be able to query if a patient is known to an exchange user. Some demographic data can accompany the query. That replaced a general notification that the system was looking for the subject, he said.

Connect also introduced a set of responses when a patient is discovered. The gateway can pass through the results of the discovery to the adapter, the interface between the healthcare organization and Connect; check the demographics first against a master patient index before passing through the information; or return the result and make a record of it

The FHA team revises Connect based on technical recommendations from the NHIN Specifications Factory, which is made up of representatives of the Office of the Nationa Coordinator for Health IT (ONC) and other public and private sectors involved in health information exchange. The NHIN requirements align with the latest Health IT Standards Panel and health information exchange standards, Westberg said.

Source: http://www.govhealthit.com/newsitem.aspx?nid=73030

By DAVID C. KIBBE and BRIAN KLEPPER

There is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.

Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a "network of networks" that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.

Suppose a RHIO is in your area. Your health data from hospitals, outpatient clinics, and other settings associated with Health System A, are collected and combined with health data stored in similar settings in Health System B. Possibly Health Systems C, D, and E have also collaborated with A and B in this RHIO. Most RHIOs have cost or will cost many millions of dollars to build and operate. They were greatly encouraged by the Office of the National Coordinator under the Bush Administration, and have received additional support and funding under the ARRA/HITECH provisions that establish Health Information Exchanges (HIEs). They generally create large database management systems housed in large data centers. They typically run on proprietary software, creating closed networks that may or may not permit access onto and off the Internet.

As an individual, you probably don’t have direct access to the RHIO data; only doctors and nurses are authorized to access your information. In most RHIOs, if you request access to your health information you must make the request the same way you would to your physician’s medical practice, and often you will receive the results on paper. Transfer of these medical records to another institution or to a new provider outside the RHIO is not possible in most cases, although some RHIOs and HIEs now permit patient accounts and viewing of selected data.

By contrast, the Health Internet is a more current model, centered on the patient/consumer. As the name implies, the Health Internet leverages the Web’s physical network and its open protocols and standards for health data exchange controlled by patients (and/or patient agents, like doctors, through authorized web services). The idea is to develop mechanisms that allow health information to pass easily across institutional and business boundaries, to anywhere it’s needed. The Health Internet builds on the same Internet infrastructure and conventions that under-gird the transactions of major industry sectors like banking, e-commerce, retail sales, home mortgage business, and media and entertainment. Because this infrastructure is largely already in place, although little-used by health care entities now, the Health Internet could grow and scale rapidly at very little cost.

You can already see how the Health Internet is developing. You go to a CVS MinuteClinic, or to a handful of doctors, hospitals, labs, or pharmacies that offer you a personal health record account that lets you transfer your data in machine-readable format at will. You also create a Google Health account (or Microsoft HealthVault, Keas, or any number of personal health record platform websites) which allows you to upload your machine-readable, structured health data to them.

Next, you give your Google Health account permission to transfer your summary health data: to a doctor in anticipation of a visit; to a family member who is helping look after you; to a service that offers decision-support based on your information to help you solve some of your health/wellness problems; or to a service that will organize your health data into folders categorized by date, or provider, or episode of illness. The important thing here is that you, the individual, are deciding when, why, and where your health information is going.

The Health Internet example we’ve described above is performing the foundational transactions required of a national health information exchange network, and is doing so today. There are many examples, and they are growing organically, without government support, without new and complex standards, and at very low cost.

Even so, the Health Internet’s growth is constrained mainly by the limited data available to patients and consumers from their doctors and hospitals, who continue to resist the idea that individuals ought to control their own data. They are also inhibited by patients’ reluctance to challenge their doctors and hospitals on this point.

These and other barriers also make the Health Internet an imperfect solution to the goals of secure and efficient interoperable health data transfer. For example, current coding and classification systems remain a complex stumbling block to any model of health data exchange. Various coding systems are in use. Some are proprietary and require pay-for-use, and others need to be extended and gain industry consensus to be truly useful.

But it is no coincidence that the British government is investigating using both Google Health and Microsoft HealthVault for personal health data exchange, moving away from its own National Health Service program, after the latter spent billions on a national information network that doesn’t appear to work. The NHIN "network of networks" model in this country is beginning to flounder, too, and may never achieve its future potential as a national system. The reasons are partly political, economic, and technological. An NHIN system’s triple burdens – smoothing over competitive markets, enormous cost, and proprietary complexity – created so that large systems like the VA and the DOD, Kaiser and Geisinger, can exchange data without having to reach the Internet, will likely sink this ship even before the British program runs aground.

The Health Internet, on the other hand, has the obvious advantage of not "re-inventing the wheel."  As former Intel CEO Craig Barrett famously said, "We already have a network for health data, it’s called the Internet."  Proponents of the Health Internet argue that, while health data and privacy and security are very important, the data themselves are inherently no different from financial data or the kinds of personal information routinely — and very securely — transported over the Internet using fair market encryption and other security technologies to protect it from intrusion, capture, or breach.  So why go backwards to create the equivalent of Prodigy or AOL in every state?  It could take forever.

We want to give credit to David Blumenthal, the Obama health team members and the folks at HHS who are taking a hard look at how best to create a secure and efficient method for health data transfer in this country.

David C. Kibbe MD MBA and Brian Klepper PhD write together on health care market dynamics, technology, policy and innovation.

November 16, 2009 in Brian Klepper, David Kibbe, HITECH, NHIN, RHIOs, Web/Tech | Permalink

Series of task orders planned for late 2009

• By Alice Lipowicz
• Nov 06, 2009

The Health and Human Services Department is planning to award a series of competitive contracts by the end of this year to bring the Nationwide Health Information Network (NHIN) to full production.

NHIN is HHS’ pilot project for demonstrating the secure exchange of patient health data on a network. It is currently being used in a limited fashion by several federal and state agencies, as well as health care providers.

HHS’ Office of the National Coordinator for Health Information Technology announced on Nov. 5 that was seeking to award a sole-source bridge contract now to prepare for the upcoming series of competitive contracts for the NHIN.

Under the bridge contract, the goal is to continue ongoing work on “developing a strategy, program governance, technical requirements, program artifacts, and facilitation processes” to move the NHIN to production readiness and production status, the notice states.

HHS intends to bridge the gap between an existing contract vehicle and an upcoming full and open competition in late 2009, the announcement said.

“This competitive contract process in late 2009 will result in the selection of a set of task order contractors which will provide the range of skills, knowledge, and experience to advance the work toward a full production NHIN,” HHS said.

HHS has been developing NHIN since 2004 to facilitate health information exchange, which is considered an important component in achieving the full benefits of electronic health records, including possibly improved quality, better public health and reduced costs. As currently designed, NHIN would function as a network of networks linking a number of regional health information exchanges.

Congress and the Obama administration provided $20 billion for promotion of electronic health records in the economic stimulus law. About $2 billion will go for health exchanges. HHS faces problems in identifying the best technical standards for secure, interoperable exchanges.

HHS said its role is to create an infrastructure for national exchange of health data, which is the NHIN. Expertise is needed for “programmatic, management, architecture and infrastructure” activities, the notice states.

The bridge contractor will help HHS develop a strategy and governance structure for the NHIN, outline steps needed to move the NHIN to production status; guide stakeholder and workgroup activities; and lead a communications campaign for the NHIN which includes a Web site.

Although HHS intends to negotiate with a sole-source provider for the bridge contract, interested parties may state their concerns and offer their capabilities in written submissions by Nov. 20.

By David Talbot

By one estimate, only 17 percent of U.S. doctors use electronic records. But the federal government has ambitious plans to create a network in which patient information is shared electronically among medical institutions. As National Coördinator for Health Information Technology, David Blumenthal is writing the rules under which the federal government will spend more than $21 billion in stimulus funds to get the job done (see "Prescription: Networking"). Blumenthal, previously a practicing physician at Massachusetts General Hospital in Boston, spoke with David Talbot, Technology Review‘s chief correspondent.

TR: How long will it take to create a national health-information network?

David Blumenthal: The president has said that everyone will have an electronic health record by 2014. That is the goal we are working toward right now. We are trying to make the network available as fast as we can.

TR: Can health IT reduce the skyrocketing U.S. health-care costs?

DB: The Congressional Budget Office projected dollar savings from the [stimulus] legislation at about $12 billion over 10 years. I expect that the actual savings will far exceed that amount.

TR: How do we get around the potential problems with electronic systems–such as overwhelming physicians with data or actually causing medical errors?

DB: Electronic health records and other forms of health IT can certainly be improved, and there are examples of bad implementation and other problems. I still think that on the whole, across the country we’d be better off with universal availability of electronic health records. We’d have fewer errors, fewer missed diagnoses, less duplication of tests, and fewer adverse drug events.

TR: If health-IT systems reduce such errors and lead to fewer needless procedures, why haven’t the insurance companies stampeded to get them installed?

DB: The insurance companies have been able to pass along the costs of waste in our health-care system to their clients.

TR: You are setting the definitions of "meaningful use"–the criteria hospitals and physicians must meet to collect their cash incentives for installing IT. What will be in these definitions?

DB: I can’t speak to the specific criteria at this point. We are in the middle of writing the regulations, and the initial release is anticipated in December.

TR: You’re giving out $564 million for states to form health-information exchanges among medical providers. Why don’t even the most electronically progressive hospitals–including your own Mass General–already share their data?

DB: There has never been a business case for health-information exchange. As a matter of fact, there has been a negative case: if you give away your information, you may lose it. You may lose the patient.

TR: You mean lose him or her to a competing hospital.

DB: That’s right.

TR: The Institute of Medicine has said that between 44,000 and 98,000 Americans die every year from medical errors of various kinds, and that IT can help. Are patients dying because of a lack of information exchange?

DB: Patients are suffering because necessary information is not available at the point of care. With robust health-­information exchange, there can be improved quality of care and improved care coördination. Today, the average 65-year-old with five chronic conditions has 14 doctors and is on multiple medications.

TR: Do any technological barriers, such as conflicting standards, stand in the way of these hospital exchanges? Would we need to give everyone a national health-care ID to properly merge or reconcile their records?

DB: No. I think we have almost all the standards we need, but we have to get people to use them. And we can do this without a single health-care ID.

TR: Why not a single health-care ID? Wouldn’t that make things simpler?

DB: We have a big job ahead of us to achieve widespread adoption and meaningful use of electronic records. We can get to where we want to go without a single health-care ID.

TR: Was the changeover to electronic records difficult for you personally?

DB: At some time over the last 10 years, I was basically required to use electronic records. I learned it gradually over time. As I got more capable, I became increasingly convinced of its value in clinical care. It was making me a better physician.

TR: How, for example?

DB: A couple of years ago, I saw a patient with a urinary-tract infection. I entered the order for Bactrim [a sulfa drug] on my computerized physician-order-entry system–and a warning came up saying this patient is allergic to sulfa. I am sure in the paper record there was a record of that, but it’s often easy to overlook things in a voluminous paper record. That kind of gain, repeated hundreds of thousands of times across the country, can result in real improvements in care.

Copyright Technology Review 2009.

Tue Oct 27, 2009 9:02am EDT

New Mexico Health Information Collaborative (NMHIC) Appointed as State's
Official Health Information Exchange (HIE)
MedPlus(R) Provides Technology Solution to Enable Meaningful Data Sharing for
Improved Health Outcomes

ALBUQUERQUE, N.M., Oct. 27 /PRNewswire-FirstCall/ -- Maggie Gunter, PhD,
president of the New Mexico Health Information Collaborative (NMHIC),
announced today that the organization has been appointed as the state's
official health information exchange (HIE) by New Mexico Governor Bill
Richardson.

NMHIC will create the health information exchange infrastructure to connect
New Mexico's health care providers through a contract with its technology
partner, MedPlus, the healthcare information technology subsidiary of Quest
Diagnostics Incorporated (NYSE: DGX). MedPlus will connect New Mexico's health
care providers to a centralized network containing critical electronic patient
information, using its Centergy(TM) suite of integrated technology solutions. 

State-wide HIEs are critical for building a Nationwide Health Information
Network (NHIN). To ensure this continuity of care, NMHIC will enable health
care information to be linked electronically across organizations, both
regionally and nationally, and to move clinical information among disparate
health care information systems, including physician offices. MedPlus has
connected some of the nation's largest HIEs, including one third of the
original NHIN demonstration projects, one of which is NMHIC.

"New Mexico is a leader in the use of health information technology, and HIE
is key to our success," said Governor Bill Richardson. "The New Mexico Health
Information Collaborative has already built a solid foundation during the last
several years, thus making it an ideal choice to help move us closer to the
goal of quality health care for all at affordable prices."

 NMHIC partner health care providers will have access to a centralized network
of important information such as lab results, patient record summaries,
radiology images, discharge summaries, medication history and claims data.
Several leading New Mexico health care providers are already participating in
NMHIC, including: Presbyterian Healthcare Services, TriCore Reference
Laboratory, Holy Cross Hospital and Albuquerque Ambulance.

"It is an honor that NMHIC has been selected to serve as the state's HIE and
to help drive critical data exchange," said Maggie Gunter, PhD, president of
NMHIC. "Our goal is to enable New Mexico health care organizations to deliver
more efficient and timely patient care by providing streamlined access to
vital information related to different aspects of the care process.  MedPlus
has been instrumental in facilitating the seamless flow of data through all
points and has provided a comprehensive Web-based portal that is the core of
the HIE." 

The MedPlus Centergy integrated solution features a combination of a Clinical
Portal, robust Data Exchange Services and a modular ambulatory EMR, Care360
EHR. The Clinical Portal aggregates patient-specific data from various
clinical systems and, in compliance with HIPAA, presents information in a
single Web-based view at multiple inpatient and remote points of care. The
Data Exchange Services form the foundation for the collection, integration,
aggregation and distribution of clinical data, while preserving it behind the
sponsoring organization's firewall. This real-time data is available to
physicians and provides them with the information needed to make more informed
decisions, ensuring high quality care for their patients.   

"HIEs are an important component of driving better outcomes for patients and
more efficient health care," said Richard Mahoney, president of MedPlus and
vice president of Healthcare Information Solutions at Quest Diagnostics.
"Organizations such as NMHIC are the foundation of building a better health
care system and we are honored to be playing such an important role in helping
them to achieve their goals."

About The New Mexico Health Information Collaborative

The New Mexico Health Information Collaborative (NMHIC) is the name of New
Mexico's rapidly growing health information exchange (HIE) network, as well as
the community collaborative that has supported its development with time and
funding. The collaborative includes important New Mexico stakeholders
representing the largest health care providers, payers, employers, state
agencies and consumers. NMHIC was created in 2004, and continues to be fully
staffed and operated by the Lovelace Clinic Foundation. LCF is a non-profit
applied health research organization founded in 1990.

About MedPlus

MedPlus, based in Cincinnati, Ohio, is the healthcare information technology
subsidiary of Quest Diagnostics Incorporated. MedPlus is a leading developer
and integrator of clinical connectivity and health care information exchange
solutions designed to foster better patient care and improve business
performance for health care institutions, physicians and patients. The
company's Centergy(TM) and ChartMaxx® solutions efficiently and securely
collect, store, manage and integrate clinical information within an
organization, enterprise, practice or community. Centergy enables clinicians
to access patient data in a centralized view aggregated from multiple care
sites. ChartMaxx, the company's award-winning DMI and electronic patient
record system, has been implemented in more than 100 hospitals and integrated
health care delivery networks and has more than 300,000 users. For more
information, visit www.MedPlus.com.

About Quest Diagnostics

Quest Diagnostics is the world's leading provider of diagnostic testing,
information and services that patients and doctors need to make better health
care decisions. The company offers the broadest access to diagnostic testing
services through its network of laboratories and patient service centers, and
provides interpretive consultation through its extensive medical and
scientific staff. Quest Diagnostics is a pioneer in developing innovative
diagnostic tests and advanced health care information technology solutions
that help improve patient care. Additional company information is available at
www.QuestDiagnostics.com.

    Contacts:
    Dave Perry (NMHIC Media): 505-938-9910
    Barb Short (Quest Diagnostics Media): 973-520-2800
    Kathleen Valentine (Quest Diagnostics Investors): 973-520-2900

SOURCE  Quest Diagnostics Incorporated

Dave Perry (NMHIC Media): +1-505-938-9910, Barb Short (Quest Diagnostics
Media): +1-973-520-2800, Kathleen Valentine (Quest Diagnostics Investors):
+1-973-520-2900

New initiatives track and share information on the pandemic flu

• By Alice Lipowicz
• Oct 21, 2009

Also in this report

With the pandemic H1N1 flu spreading rapidly this year, officials at the Centers for Disease Control and Prevention have been aggressively expanding their information technology toolkit to provide better, faster and more in-depth data on the virus, also known as swine flu.

The virus has created an urgent need for public health authorities to track where and how quickly the illness is spreading. The Centers for Disease Control and Prevention, along with some state agencies and private entities, have responded to the challenge with new IT initiatives.

On Sept. 1, CDC began securely exchanging public health data daily via the Nationwide Health Information Network. The pilot project is gathering flu symptom data from health care providers in Indiana, New York and Washington state.

The flu data exchange is a new use for the NHIN, itself a pilot project of the Health and Human Services Department’s Office of the National Coordinator for Health IT.

“We are supporting the use of the NHIN for biosurveillance,” said Dr. Charles Magruder, senior adviser for health information exchange activities at CDC’s for Public Health Informatics and leader of the agency’s NHIN pilot project. “It has the potential to be a broad and robust system.”

The NHIN eventually will be used for national health data exchange, but is currently a platform for several demonstration projects, including one involving the Social Security Administration and MedVirginia, a regional network of health care providers, to exchange patient medical information for determining disability benefits eligibility. It will soon be accepting data from the Veterans Affairs and Defense departments.

CDC worked with Harris and Cisco Systems to demonstrate that it could upload flu symptom data from three state health departments in a timely fashion. Researchers then aggregate and analyze the information looking for trends and make the results available to state public health officials.

The data includes clinical information on patients’ symptoms, lab results, geographic information, age and gender, Magruder said. The data has been stripped of all personally identifiable information and is put into a format that both NHIN and the CDC can work with.

One of the key advantages to using NHIN is timeliness, Magruder said. Since Sept. 1, CDC has received new H1N1 data daily.

“We are showing how the biosurveillance use case can be demonstrated in a standards-based and interoperable system,” he said. “One of the motivators for the project is to show that existing standards can facilitate the sharing of data. The NHIN is a key component of developing those capabilities.”

“I am very impressed with what the NHIN has to offer in terms of enhancing our capabilities to collect and move this type of data,” he added.

The three states’ health departments are linked to CDC through the Connect gateway software developed by HHS. The agency’s partners in the project include the New York eHealth Collaborative, Indiana’s Regenstrief Institute and Science Applications International Corp. under a contract with Washington state, Magruder said.

Once the program has been fully evaluated, CDC might expand it to include other states and diseases, he added.
CDC also partnered with the International Society for Disease Surveillance and the Public Health Informatics Institute to create a new tracking system, called Distribute, that aggregates nationwide data from state and local health departments on emergency room patients with flu symptoms.

Distribute provides the CDC with further detail on geographic and age-specific trends, officials said. For example, in the Washington, D.C., area, Distribute reports that between Sept. 13 and Oct. 11, the number of emergency room visits related to flu symptoms more than doubled — from 2.3 percent to 4.7 percent.

Other initiatives

CDC is also working with two other initiatives that began monitoring H1N1 flu activity this year: Cerner’s Flu Pandemic Initiative and the GeoSentinel global flu and disease tracking system established at the University of Alabama at Birmingham.

The initiatives complement existing CDC surveillance systems, including BioSense, the National Electronic Disease Surveillance System and the Influenza-Like Illness Surveillance Network.

CDC worked with health IT vendor Cerner to set up a national electronic swine flu tracking system. It takes advantage of Cerner’s network of lab, doctor and hospital clients, which spans as much as 30 percent of the country’s health care system. HHS Secretary Kathleen Sebelius called Cerner’s flu network a whole new model for disease monitoring when she spoke in Kansas City, Mo., Oct. 14 at a conference sponsored by Cerner.

The system, which began operating several weeks ago, is receiving data from about 1,000 hospitals, doctors and labs, said Kelli Christman, a Cerner spokeswoman.

The company set up the system voluntarily and sends results to CDC on a daily basis. The goal is to provide CDC and other clients with real-time information on hot spots of flu activity to help with preparedness efforts.

“We are providing a free service to enhance situational awareness,” Christman said. The system can be expanded to cover additional diseases or health events, such as negative reactions to vaccines, and the data can be customized to reflect activity in a specific region, she added.

The GeoSentinel network takes a global approach by connecting 48 clinics on several continents to track emerging diseases, including H1N1 flu, which first appeared in Mexico and spread worldwide within six weeks.

Unlike traditional flu surveillance systems, GeoSentinel tracks where patients got sick, not where they live.

"GeoSentinel is showing us travelers and mobile populations getting the flu," said Dr. David Freedman, co-director of GeoSentinel. "We are tracking which countries and places have intense enough transmission that they are then exporting flu and potentially seeding other countries.”

About the Author

Alice Lipowicz is a staff writer for Federal Computer Week.