Information Technology and the H1N1 Virus

At BIDMC, our Infection Control staff have sent out daily updates about the H1N1 Virus, our process changes to protect patients/staff, and our planning for future activities if the infection escalates.

There are many things that IT can do to support the hospital and the country during this outbreak. Here are five projects we've implemented.

1. Support CDC's Biosense

Every day, BIDMC electronically sends 4000 data elements to the Centers for Disease Control using the HITSP Biosurveillance standards. Patients are not identified - no names, MRN’s or addresses are sent. Birthdays are month and year only. Here are the data elements we send:

Inpatients
ADT information – a message that there was an admission, discharge or transfer with date and time
Diagnosis
Procedures
Pharmacy orders
Daily census

Emergency Department Visits
Visit information
Acuity
Diagnosis
Procedures
Pharmacy orders
Patient instructions

Outpatient Visits
Visit information
Diagnosis

All patients
Microbiology orders and results (including viral studies)
Radiology orders and results

The CDC uses this to track outbreaks and prioritize resource allocation.

2. Build an intranet site to educate faculty and staff

We've supported our Infection Control staff with template-based content management tools and launched "H1N1 Central". In this single intranet site we link together our institutional polices, CDC reports, local news, and best practices.

Also, all our login screens display the message

"H1N1 Influenza Employee Screen:
In order to prevent spread of infection to patients and staff,
the following guideline should be followed by all staff:
If you have two or more of the following:
- fever over 100 in past 7 days
- flu symptoms (chills, cough, sore throat, stuffy nose, body aches, headache)
in past 7 days
- contact within 6 ft of someone who has a flu-like illness
Please put on a mask if you are in the hospital, contact your manager/supervisor
immediately to arrange coverage for your absence and to advise regarding
need for swab testing. Contact your PCP if appropriate, and recover at home."


3. Employees have been told to stay home if they have flu symptoms. In the case of H1N1 or any infectious outbreak, it's important to support remote access to applications, data, and communications. BIDMC applications are all web-based and accessible anywhere in the world. All our files are web accessible as well as mountable via VPN. We have an SSLVPN from Juniper Networks available at https://secure.bidmc.harvard.edu. We have a web-based large file transfer systems available at https://transfer.bidmc.harvard.edu. We are testing the ability to route incoming phone calls to cell phones and home numbers. The combination of all these features makes working from home simple and seamless.

4. Provider Order Entry order sets for isolation of infected patients

We're enhancing our internally developed provider order entry system with order sets specific to H1N1 so that clinicians can easily order standardized protocols for H1N1 isolation and treatment.

5. Public Health data reporting

We've built an automated interface to the Boston Public Health Commission.

Every day we send the following data to them from the Emergency Department

Daily volume
Chief complaint
ICD9 codes
Date of service
Zip
Age
Gender
Race

The Public Health folks create control charts and identify unexpected variations in symptoms and diagnoses.

We also participate in the Aegis project, a regional real time mapping of symptoms from 20 hospitals. Aegis includes alerting and cluster detection tools for use by public health officials.

The Aegis team at Children's hospital has also created Healthmap which parses news stories and displays outbreak information.

We remain nimble and will support our local, regional and national stakeholders as needed during this outbreak.