More than 214 people have been diagnosed with aspergillus meningitis after having received an injection of the drug Methylprednisolone. Tests showed the drug was contaminated with a fungus. As of this writing, there have been 15 deaths in 15 states. The current CDC numbers are here.
Meanwhile, and perhaps previously unrelated, there's been another contamination event going on related to healthcare information technology. In the media, and specifically an article in The New York Times and an opinion piece in The Wall Street Journal, the topic of healthcare delivery in general, and the value of a policy that provides funding for healthcare IT has heated up with the political season.
Two thoughtful and accomplished professors, Ross Koppel and Stephen Soumerai, wrote the opinion piece. In it, they stated that the benefits of healthcare information technology are wildly overblown and represent a fanciful initiative that should be shut down.
A number of knowledgeable healthcare IT experts have identified a series of flaws in their reasoning. They include the failure to consider the time frame of expected benefits relative to the tests the authors were applying.
Physicians Peter Basch and Michael Zaroukian wrote a comprehensive 6-part blog that challenges the position of Koppel and Soumerai. The blog’s overview is here, with links to each installment.
In essence, these experts were asserting that the professors were contaminating the public discourse, framing a debate of the facts where no debate truly exists. So let's look into this meningitis outbreak and its healthcare IT implications.
The scientific promise of medicine is that we can identify, predict and mitigate disease, either with the impact of primary prevention, limiting the condition from happening in first place, or to cure or mitigate the impact of disease. The intent, of course, is to maintain as much function as possible, prolong healthy life, and reduce or avoid pain in the process.
Applying that to the drug contamination issue, the challenge was to identify the aspergillus meningitis, identify the cause—the contaminated Methylprednisolone—and eliminate subsequent cases by removing the medication from the drug supply. The process included identifying those patients who had already received the drug, but had not yet expressed signs of the disease, for prophylactic treatment where appropriate.
This raises many IT questions I would like you to consider. Do providers who have implemented an electronic health record (EHR) to meet MU Stage One criteria have a better chance to support handling the identification and management of this outbreak? Did those providers using EHRs have a higher rate of identifying patients with the contaminated drug-induced meningitis than providers who did not have electronic health records meeting Stage One criteria?
Did providers with EHRs whose patients received the drug receive quicker notification and follow up for assessment? And, being more forward-looking, should we use cases like this outbreak to inform the use cases that will be specified as test cases in MU Stages Two and Three?
The data underlying the answers to these questions should be collected very soon by state health departments, the CDC, and other agencies involved in the investigations currently underway. This could be done by simply documenting where EHRs were being used, and the data they contained relative to the investigation.
What would that look like? For each patient, was their care managed using an EHR? Was that record certified for Stage One, and had the provider using that system attested to MU or was it in the process of doing so?
Further, what elements of the case report for each patient were electronically available on the systems? For example, was CPOE used to order the medication for the injection, perhaps as part of an order set? Was cerebrospinal fluid drawn on the patient to establish the diagnosis, and was that result electronically captured and integrated with the patient's record? How about the culture results for those tests? Were the procedure codes, CPT, J Codes, etc., captured in the practice management portion of the EHR to reliably identify patients at risk?
Then we come to the analysis. Was there a material difference between using EHRs versus other methods in the time to diagnosis and treat these patients? And finally, were the mortality rates different between those patients whose care was managed using an EHR and those who were not?
How we manage and treat this instance of drug contamination and its impact can shed light on how we deal with the arguably contaminated claim that electronic health records are immaterial to improving health and reducing the cost of care delivery. The data to have an informed policy going into the election are directly in front of us. We have only to collect it, record it, and interpret it wisely.
You know my position; what do you think?
Joseph I. Bormel, MD, MPH
CMO and Vice President
QuadraMed Corporation