September 17th, 2009
(Boston) – Using technology originally developed for mass disasters, Boston disease trackers are embarking on a novel experiment – one of the first in the country – aimed at eventually creating a citywide registry of everyone who has had a flu vaccination.
The resulting vaccination map would allow swift intervention in neighborhoods left vulnerable to the fast-moving respiratory illness.
The trial starts this afternoon, when several hundred people are expected to queue up for immunizations at the headquarters of the Boston Public Health Commission. Each of them will get a bracelet printed with a unique identifier code. Information about the vaccine’s recipients, and the shot, will be entered into handheld devices similar to those used by delivery truck drivers.
Infectious disease specialists in Boston and elsewhere predicted that the registry approach could prove even more useful if something more sinister strikes: a bioterrorism attack or the long-feared arrival of a global flu epidemic. In such crises, the registry could be used to track who received a special vaccine or antidote to a deadly germ.
“Anything you can do to better pinpoint who’s vaccinated and who’s not, that’s absolutely vital,” said Michael Osterholm, director of the Center for Infectious Disease Research & Policy at the University of Minnesota. “I wish more cities were doing this kind of thing.”
Boston is believed to be the first city to embrace this particular approach to tracking vaccinations against the seasonal flu, estimated to kill 36,000 people each year in the United States, principally the elderly.
But when Boston bought the monitoring system from a Milwaukee company in 2006, emergency authorities had a far different use in mind: tracking people injured in big fires, plane crashes, or other disasters.
“When there’s a large catastrophic event, people end up in a variety of healthcare facilities,” said Dr. Anita Barry, Boston’s director of communicable disease control. “Of course, their family members and loved ones are trying to find out where they are and how they’re doing.”
To see how well the system would work, emergency crews tested it at the Boston Marathon and the Fourth of July extravaganza on the Esplanade. The trial proved successful.
“If we can make it work in the Boston Marathon medical tent, then you have to think about making it so that it can work in other environments as well – whether it’s a community clinic or a doctor’s office or a flu shot clinic,” said Rich Serino, chief of Boston Emergency Medical Services. Thus, the idea to use the registry as a flu vaccine tracker was born.
Every autumn in medical offices across the country, flu vaccine floods in. The perishable medical product must be delivered to millions in a matter of months.
Keeping track of that cache of vaccine – and which patients are getting it – is a daunting proposition.
In some medical offices, the information is entered into electronic medical records. At Boston’s health department, nurses fill out paper forms.
But there’s never been any way to systematically monitor whether, for example, Dorchester has lower vaccination rates than the North End.
“When you’re working in one clinic, you don’t have a good sense of that,” said Dr. Alfred DeMaria, top disease doctor at the Massachusetts Department of Public Health. “But if you’re tracking multiple clinics in real time, you can see where the uptake is better and where it’s less, and then focus on outreach.”
Today’s experiment, which does not require any additional direct spending, is a first step toward that.
When people arrive for their shots, they will get an ID bracelet with a barcode. Next, basic information – name, age, gender, address – will be entered into the patient tracking database. There will be electronic records, too, of who gave the vaccine and whether it was injected into the right arm or the left, and time-stamped for that day.
The resulting trove of data could be used to figure out why some patients had to wait longer than others to be vaccinated. “When all is said and done,” said Jun Davantes, director of product management at EMSystems, the company that makes the technology, “Boston will be able to identify where there are certain bottlenecks in the process and hopefully improve it the next time around.”
Ultimately, city health authorities said, they envision creating a network across the city that would allow public and private providers of flu shots to add data to a registry.
But acknowledging patients’ privacy concerns, officials promised that if a citywide system were implemented, only a limited amount of information would be gathered – all sitting behind an encrypted firewall.
“I have had people say, ‘Oh, that’s so big brother,’ ” said Laura Williams, EMS deputy chief of staff. “But in truth, the unique identifier is unique to the incident. It’s not like you will go to the hospital, and they’ll say, ‘You’re the one who got the flu vaccine at 10 o’clock yesterday at the Boston Public Health Commission.’ ”