USA Today reports this morning that the federal government has only received 38 million of the targeted 200 million doses of the H1N1 (swine flu) vaccine for 2009. This lackluster progress means that vaccinating against the virus for a majority of the U.S. population – including the most susceptible: young children and the elderly – is not going to happen this year.
Like with anything in life, when there is a shortfall, the current inventory needs to be prioritized. The tough question is who prioritizes and how long does it take them to get patients informed of the physician’s recommendation to get vaccinated?
The CDC has a set of basic and emergency guidelines on how to handle H1N1 virus infection. I liked it so much, I downloaded one of their web widgets (see below) to help raise awareness on how to guard against acquiring the virus – my good deed of the day.
According to their guidelines if you have a headache, sore throat, and/or runny or stuffy nose … you may have the swine flu and should probably seek treatment and perhaps get vaccinated. I see where this is going: everyone is going to want to get vaccinated.
How, then, do we prioritize those valuable 200 million doses of H1N1 vaccine?
There are a couple of options: First, as patients present in a care setting, screen them and make a recommendation. This is effective but clearly impractical, as it requires all patients be seen.
Second, State and Federal public health agencies run their algorithms against reported problem lists and physician diagnoses to determine which groups may be infected and require vaccination. This is also effective but requires a lot of timely data and connectivity, which often doesn’t exist given the archaic technology still in place. How will we ever detect and control outbreaks, especially in highly dense populations like New York City, if the surveillance is on that type of time delay?
Health information exchanges (HIEs) focus the limited resources of public health agencies to deal with situations like the H1N1 outbreak, primarily by getting them out of the connectivity business so they can focus on their real priority: improving public health. Ensuring that only a handful of connected data feeds need to be managed, HIE networks provide public health agencies with de-identified data in near real-time. Current supply-and-demand theory suggests that less time spent by public health agencies on connectivity and problem detection equates to more time spent on prevention, such as detailed data mining of de-identified, longitudinal health records to help prioritize vaccination recipients. Prevention is complex – because it requires that providers reach high-risk patients like those with diabetes, heart disease, and chronic lung disease to schedule them to come in for a vaccination – yet it is very important.
Many have attacked the value of HIEs (generally critique is focused on the financial sustainability models for the organizations that operate them). For those not yet convinced of their value, look no further than the current state – the 2009 shortage of H1N1 flu vaccinations – and its potential impact on the healthcare spend over the next six months.
