Evaluation of Public Health Alert Messages Targeted for Clinicians During the Influenza A H1N1 Outbreak, Spring 2009: Implications for Alerting in EHRs

During outbreaks, federal, state, and local public health agencies send alerts to clinicians to increase awareness and improve testing and treatment decision-making to meet public health goals. EHRs allow for the delivery of public health alerts to clinicians at the point-of-care, and enterprise systems enable delivery of recommendations synthesized by clinical experts. Investigators from the University of Utah, CDC, Johns Hopkins, and GE Healthcare defined an alert information framework and demonstrated actionable alerts in an EHR at the 2009 HIMSS Interoperability Showcase. The alerts represented one level of public health authority (federal) and one scenario. Future implementations require a) an understanding of business processes and stakeholder needs, b) as assessment of the generalizability of the alert information framework developed, and c) an assessment of concordance between alert messages delivered by varying public health agencies and within the healthcare enterprise. During the 2009 novel Influenza A H1N1 outbreak, we performed these assessments as the outbreak unfolded. Between April 27 and May 6 (as of this submission), we compared communications from CDC, the Utah Department of Health, and the Salt Lake Valley Health Department targeted for Utah clinicians, with messages delivered within the Intermountain Healthcare and University Healthcare intranets. We mapped alert content to the previously-developed alert information framework, and identified problems with the framework. For example, the testing recommendations were not “static” (as previously specified), and the information had increasing levels of specificity closer to the point of care. In the context of limited medications and supplies, enterprise-specific testing and treatment guidelines was considered ‘sensitive' but important to share with enterprise clinicians. We found redundant alert authoring and opportunities for structured information and RSS feeds. Findings will inform the design of efficient systems for communicating between public health and clinicians and delivering actionable alerts.