Use of An Electronic Health Record System to Guide 2009 Pandemic Influenza A (H1N1) Response in the Indian Health Service

Background: The Indian Health Service (IHS), which provides care to 1.4 million American Indians and Alaska Natives, uses an electronic health record system, called the Resource and Patient Management System (RPMS), at the majority of its health care facilities. In response to the pandemic H1N1 (2009) influenza outbreak, IHS developed a new, near-real time, Influenza Awareness System (IAS) using RPMS data.

Objectives:

1. Provide timely monitoring of influenza-like illness (ILI) trends
2. Detect and respond to outbreaks and local hot spots
3. Guide resource allocation, including employee vaccine distribution
4. Monitor 2009 H1N1 and seasonal flu vaccine coverage and safety

Methods: Participation in the IAS was voluntary. Data from IHS sites around the country were exported daily to a centralized database. We defined a list of ICD-9 codes for ILI, and also collected temperature measurements and codes for 2009 H1N1 and seasonal influenza vaccine. Weekly summary reports on ILI activity and 2009 H1N1 and seasonal influenza vaccine coverage were provided at the national, regional, and facility level.

Results: Over 60% of IHS-funded facilities participated in the IAS. The proportion of all medical visits that were ILI-related revealed significant regional variation. As initial supplies of H1N1 vaccine became available, data on ILI activity were used to guide H1N1 vaccine allocations for IHS healthcare personnel. Data on H1N1 doses administered were used to monitor vaccine distribution to tribal communities. As of December 7th, 106,782 doses of vaccine had been administered to patients. Data on H1N1 and seasonal influenza vaccine coverage in the different priority groups are forthcoming. 

Conclusions: For the first time IHS was able to use national-level, real time surveillance data to respond to an outbreak.  IAS data allowed IHS to make data-driven decisions for resource allocation, assisted the agency in responding to concerns around vaccine distribution, and informed vaccination strategies at the local level.