EHRs and the surveillance of acute respiratory infections in primary care settings after Hurricane Sandy

Background: Increased respiratory infections were a potential concern in New York City after Hurricane Sandy. EHRs may be able to supplement existing disease reporting to provide meaningful emergency information. Objectives: Explore the usefulness of an ad hoc distributed query system for monitoring primary care patients during emergencies using bronchitis and pneumonia as a case study. Methods: Data were collected via queries sent to a network of 617 primary care practices in New York City, with 455 returning complete data sets. Data were collected by patient age, patient zip, and pneumonia or bronchitis assessed in the EHR with ICD-9 codes, using two-week time periods from October to December, 2011 and 2012. Overall patient visits and disease rates from before and after Hurricane Sandy were compared. Results: An average of 118,000 patient visits occurred during each two week period. The average number of patients per practice decreased in the two weeks following Sandy compared to the two weeks prior to the event; however, in subsequent time periods patient counts returned to pre-Sandy levels. Between October and December 2012, bronchitis rates averaged 0.79% among adults from affected areas; 0.46% among adults from unaffected areas; 0.60% among elderly from affected areas; and 0.52% among elderly in unaffected areas. Similar average rates were observed during the corresponding time period in 2011. Rates rose in the 4 to 6 weeks following the hurricane relative to the 2 weeks prior to the hurricane among all groups. Discussion/Conclusion: This EHR system returns data on primary care patients in as little as 24 hours; additionally, patient volume captured by the system returned to normal within two weeks of the hurricane. This suggests this system could help monitor outpatient care utilization and respiratory illness in future emergencies, offering valuable information to primary care providers, policymakers, and other responders.