EpidemicsReal-time disease monitoring can help improve diagnoses

Discovering epidemics or knowing when one is brewing is particularly difficult at the local level as doctors lack a broader perspective of what is occurring. It is often only when a hospital or a waiting room has become inundated with a certain disease that local doctors are aware that something is amiss.

To help provide local doctors with better information that could help stem the spread of infectious diseases, public health officials are pushing for the creation of a real-time national disease monitoring system.

Currently, hundreds of hospitals, clinics, and health departments across the United States automatically report certain symptoms and diagnoses to the government. With this information federal health officials are able to track the spread of diseases, outbreaks, and even a biological attack, but until a major outbreak occurs, local doctors are not privy to this data.

Dr. Alfred DeMaria of the Massachusetts Department of Public Health said it is quite difficult for doctors to learn of what their neighboring colleagues are diagnosing as they have to call the health department to ask if anyone has heard of a specific case of a disease as they attempt to diagnose a patient’s symptoms.

Providing doctors with a fast, real time analysis of disease, “would be very helpful,” said DeMaria. “The key is to make the system entirely automated and real-time.”

To that end, federal health authorities are working to create a Web tool that would allow doctors to search for local disease monitoring information. In addition, the tool would also send automatic alerts about disease outbreaks to the electronic health records of patients with similar symptoms.

In a recent Harvard University study, Drs. Andrew Fine and Kenneth Mandl analyzed thousands of patient records to verify if real-time tracking of diseases held quantifiable benefits.

After studying incidents of strep throat, the Harvard researchers determined that of the 82,000 patient visits they examined, knowing what levels of strep throat were circulating around them would result in more accurate diagnoses, minimize the number of unnecessary tests, and reduce the amount of wasted antibiotics.

Strep throat is commonly misdiagnosed in adults as it is most prevalent among young children and doctors can administer a rapid test that sometimes misses the bug. The researchers found that if doctors know how much strep throat is circulating, they can more closely examine a patient’s symptoms and order a test before prescribing antibiotics.

Mandl and Fine determined that of the roughly 10.5 million annual patient visits for suspected strep throat, disease monitoring could prevent 166,000 patients from receiving unnecessary antibiotics. On the other hand, if monitoring indicates that there is a large strep throat outbreak, patients who normally would not get tested would receive a test, resulting in the positive diagnoses of 62,000 cases a year that would otherwise gone undetected.