H1N1 biosurveillance – Practice Fusion implements reports for vaccination candidates

H1N1 flu is a high-profile public health concern in the U.S. this year, as it has been around the world. The World Health Organization has declared it to be a pandemic, and in the United States, the CDC has marshaled significant resources to respond to this public health crisis.

One of the main responses to this pandemic has been the development of widespread vaccination. Unlike other vaccines, the CDC is making the H1N1 vaccine available to private and public health care providers free of cost (for the vaccine supply itself). The CDC has developed criteria for who should be the first to get the vaccine – and the recommendations are significantly different than for annual, seasonal flu. Whereas seasonal flu vaccination is focused on seniors, adults with chronic conditions, and children, the H1N1 recommendations are targeted to a different population: (1) pregnant women, (2) all infants and children <=24 years of age, (3) healthcare workers, (4) adults taking care of infants less than 6months of age, and (5) adults ages 25-64 with chronic medical conditions (like diabetes, renal failure, COPD, cancer, etc.). Of note, seniors>=65 year of age are not in the first tier of susceptibility for H1N1 (unlike seasonal flu). If there is enough supply left after vaccination of the first-tier population, then all adults 25-64 (regardless of chronic condition) would be the next tier, and seniors >65 would be the third tier.

Through local intermediary organizations, private practicing physicians across the country received questionnaires in the last 1-2 weeks asking for patient counts in the 5 above-described categories, in order to know how much vaccine to ship to each doctor’s office. Estimating such tallies can be a challenge for physician practices, particularly if they do not have electronic tools like Electronic Health Records (EHRs).

Considerable hope has been placed on EHRs to help in biosurveillance around H1N1. Most EHRs, where they exist (and only 13% of practices have implemented even a rudimentary system), are locally-hosted with data sets limited to just their own practices, and are challenged to come up with ad-hoc reports such as these. By significant contrast, Practice Fusion is a hosted, web-based EHR that spans a great many practices, many of them small-group and solo.

Responding to both user requests and public health imperative, Practice Fusion created a new report for identifying patients who are candidates for H1N1 vaccination, using the CDC criteria described above. Approximately 300,000 patients are identified as belonging to these categories, system-wide. This is a number not to be sneezed at! Perhaps, apart from Kaiser or the Veterans Administration system, this represents one of the broadest and most-rapidly deployed reports seen in the biosurveillance efforts to date.

Practice Fusion is making this new report available to all its EHR users, so that each practice can run its internal report to both count the candidates (in order to obtain adequate quantities of vaccines from the CDC), and identify the specific patients to contact for vaccination once the supplies arrive. And, consistent with the Practice Fusion business policy, this report is included in the web-based application free of charge to physician practices.

Such an ability again underscores the intrinsic superiority of a web-based application over local, client/server EHR installations – the ability to render an important public-health report quickly to all users everywhere, without need for any “product upgrades,” is only possible with a web-based system. We are proud of our contributions, and hope that utilizing our services in this way will help the country face the H1N1 epidemic with the powerful tools and technologies that we are developing.


Robert Rowley, MD – Chief Medical Officer, Practice Fusion, Inc.