Electronic tracking helps N.J. hospitals keep ahead of curve on flu
January 16, 2013By Andrew Kitchenman, of NJ Spotlight
When Anne Dikon saw a flu case in early December, she knew it was time to tell the staff at her hospital, Robert Wood Johnson University Hospital Hamilton, to get ready for a potentially early flu season.
As the hospital's infection prevention director, Dikon credits the hospital's quick response to the outbreak to MedMined, an electronic surveillance program that the hospital uses to combat the spread of all infections, including the flu.
While this year's influenza season in New Jersey has been earlier and more severe than in recent memory, some state healthcare providers had a head start in preparing for an increase in cases, thanks in part to the data mining made possible through the program. Both hospital and insurance officials are describing the program as an example of how information technology can be used to improve healthcare.
MedMined produces frequent and detailed data reports that allow hospitals to pinpoint potential sources of infections within a hospital quickly, as well as tracking whatever new infections a hospital's patients are experiencing.
After the first six cases at RWJ Hamilton occurred by Dec. 10, the program produced a chart showing hospital staff members that a stark increase was occurring.
"It was very nice to prove what I had said," said Dikon, who is also a registered nurse. "We started to see our community pattern [of flu cases], which was a change."
Dikon said she was already wary of a potentially difficult flu season after a mild season last year, when the first case didn't arrive until February and no one was admitted to the hospital for the flu.
As soon as RWJ Hamilton staff entered information about new flu patients, MedMined was turning this data into reports for Dikon. Since the first cases arrived in early December, the pace has increased rapidly, possibly fueled by large gatherings during the holidays, Dikon said. MedMined has been helpful in keeping RWJ Hamilton ahead of the curve, she said, with staff members being provided with early and frequent warnings to get vaccinated for the flu and to be aware of flu symptoms.
Through January 15, RWJ Hamilton has had 166 patients testing positive for the most common type of the flu, compared with 13 last year and 73 in the winter of 2010-2011. In addition, there have been roughly 20 admissions, Dikon said.
Prior to the introduction of MedMined at the hospital in 2005, Dikon relied on reports from the hospital's laboratory staff to determine when new infections occurred. While she still uses these reports, the MedMined data is frequently faster, more detailed and presented in a format that is particularly helpful for informing other hospital staff members with details about the virus and how they should respond to it.
"It would show up even if it was just one" case, Dikon said.
Now Dikon is aware first thing in the morning about each new case that arrives overnight. In addition to tracking patients whose lab tests turn up positive for infections, MedMined also tracks when patients show flu-like symptoms or when doctors prescribe the antiviral drug Tamiflu, catching additional cases that were not tested.
Under the old system, "by the time you figured out what's going on, you could have other things happening," because of the time consumed studying reports, she said.
Information is shared with emergency department staff and the environmental services staff that cleans the building and is included in the hospital's inhouse daily newsletter. It's also used in communicating with local and county health department officials, as well as state officials.
Dikon also has been scheduling visits with community groups, emphasizing the importance of flu shots and good hygiene.
"It's a more proactive way of looking at things, instead of reactive," Dikon said of the hospital's responses based on the surveillance reports.
Like other hospitals in the state, RWJ Hamilton has set up respiratory hygiene stations near its entrance, stocking them with masks, hand sanitizer and pamphlets on the flu.
In addition, it is urging potential visitors who aren't feeling well to avoid coming to the hospital to reduce the chance of spreading infection. The hospital also has used signs prepared by the U.S. Centers for Disease Control that urge family members who aren't feeling well to call relatives who are patients rather than visiting the hospital. It also has been considering whether to restrict the ages of visitors.
MedMined is produced by California-based CareFusion and used by 34 New Jersey hospitals, including 22 that use the program through Horizon Blue Cross Blue Shield's Infection Prevention Partnership.
Horizon was touting this program long before this flu season. Through 2011, the insurance company estimated that 14,000 infections had been prevented, avoiding $51 million in healthcare costs, due to the use of MedMined. This has been accomplished by using MedMined to head off the spread of hospital-acquired infections by pinpointing where cases first occur. The hospital also can use MedMined to prevent flu patients from infecting other patients.
Jim Albano, Horizon's vice president of network management, said RWJ Hamilton has been aggressive in fighting hospital-acquired infections. He oversees Horizon's infection-prevention program.
"A flu outbreak of this magnitude places great demands on hospitals to both treat patients and to limit the spread of the flu infection," Albano said in a statement. "RWJ has the tools in place to protect its entire patient population from the flu and other infections."
CareFusion consultant Rachel Long, who works with hospitals on MedMined, said 30 percent to 40 percent of hospitals nationally are now using some form of data surveillance.
The graphs that MedMined produces help infection-prevention officials "tell the story" of which infections are affecting a hospital. The program was designed to find the floors or units in a hospital where infections originated, including other types of infection, such as fungal meningitis.
"It helps to tell a nice story very quickly because we're not managing the data, we're automating the data for you," said Long.
MedMined "is doing exactly what surveillance is intended for, which is the clinician helping to educate the people at risk," Long said. "I'm a huge believer in electronic surveillance -- it does help save lives."
Long, who is based in North Carolina, noted that the flu first appeared in the southern United States this year and has already peaked in that region, while it has just started to reach California. She said it's possible that New Jersey is peaking this week and that the number of cases may start to decline next week.
"In the next few weeks it ought to really drop," she said.
Dikon agreed, expressing hope that the early start to the flu season means that it will reach its apex earlier than the normal February peak.
"In the next couple of weeks, we'll see if we're on the upswing or the downswing" of this year's flu season, she said.
NJ Spotlight, an independent online news service on issues critical to New Jersey, makes its in-depth reporting available to NewsWorks.