Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland.
West J Emerg Med. 2022 Feb 14;23(2):115-123. doi: 10.5811/westjem.2021.9.52741.
Electronic influenza surveillance systems aid in health surveillance and clinical decision-making within the emergency department (ED). While major advances have been made in integrating clinical decision-making tools within the electronic health record (EHR), tools for sharing surveillance data are often piecemeal, with the need for data downloads and manual uploads to shared servers, delaying time from data acquisition to end-user. Real-time surveillance can help both clinicians and public health professionals recognize circulating influenza earlier in the season and provide ongoing situational awareness.
We created a prototype, cloud-based, real-time reporting system in two large, academically affiliated EDs that streamed continuous data on a web-based dashboard within hours of specimen collection during the influenza season. Data included influenza test results (positive or negative) coupled with test date, test instrument geolocation, and basic patient demographics. The system provided immediate reporting to frontline clinicians and to local, state, and federal health department partners.
We describe the process, infrastructure requirements, and challenges of developing and implementing the prototype system. Key process-related requirements for system development included merging data from the molecular test (GeneXpert) with the hospitals' EHRs, securing data, authorizing/authenticating users, and providing permissions for data access refining visualizations for end-users.
In this case study, we effectively integrated multiple data systems at four distinct hospital EDs, relaying data in near real time to hospital-based staff and local and national public health entities, to provide laboratory-confirmed influenza test results during the 2014-2015 influenza season. Future innovations need to focus on integrating the dashboard within the EHR and clinical decision tools.
电子流感监测系统有助于在急诊部（ED）进行健康监测和临床决策。虽然在电子病历（EHR）中整合临床决策工具已经取得了重大进展，但用于共享监测数据的工具通常是零散的，需要下载数据并手动上传到共享服务器，从而延迟了从数据采集到最终用户的时间。实时监测可以帮助临床医生和公共卫生专业人员更早地识别流感的传播，并提供持续的态势感知。
我们在两个大型学术附属的急诊部创建了一个原型、基于云的实时报告系统，该系统在流感季节内，在样本采集后的数小时内，通过基于网络的仪表板流式传输连续数据。数据包括流感检测结果（阳性或阴性），以及检测日期、检测仪器地理位置和基本患者人口统计学信息。该系统立即向一线临床医生以及当地、州和联邦卫生部门合作伙伴报告。
我们描述了开发和实施原型系统的过程、基础设施要求和挑战。系统开发的关键流程相关要求包括合并来自分子检测（GeneXpert）和医院 EHR 的数据，确保数据安全，授权/认证用户，并为数据访问提供权限，为最终用户优化可视化效果。
在本案例研究中，我们有效地整合了四个不同医院急诊部的多个数据系统，在 2014-2015 流感季节期间，将数据实时传送到医院工作人员和当地及国家公共卫生实体，提供实验室确认的流感检测结果。未来的创新需要专注于将仪表板整合到 EHR 和临床决策工具中。
