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Eight years ago, the HITECH Act launched an ambitious effort to modernize the U.S. health IT infrastructure. But the culture surrounding access to and sharing of information still needs to change to promote the seamless and secure flow of electronic information.

The US health care system is in the midst of an enormous change in the way health care providers and hospitals document, monitor, and share information about health and care delivery. Part of this transition involves a wholesale, but currently uneven, shift from paper-based records to electronic health record (EHR) systems. We used the most recent longitudinal survey of US hospitals to track how they are adopting and using EHR systems. Only 44 percent of hospitals report having and using what we define as at least a basic EHR system. And although 42.2 percent meet all of the federal stage 1 \"meaningful-use\" criteria, only 5.1 percent could meet the broader set of stage 2 criteria. Large urban hospitals continue to outpace rural and nonteaching hospitals in adopting EHR systems. The increase in adoption overall suggests that the positive and negative financial incentives currently in place across the US health care system are working as intended. However, achieving a nationwide health information technology infrastructure may require efforts targeted at smaller and rural hospitals. [PUBLICATION ABSTRACT]

The ability to detect disease outbreaks early is important in order to minimize morbidity and mortality through timely implementation of disease prevention and control measures. Many national, state, and local health departments are launching disease surveillance systems with daily analyses of hospital emergency department visits, ambulance dispatch calls, or pharmacy sales for which population-at-risk information is unavailable or irrelevant. We propose a prospective space-time permutation scan statistic for the early detection of disease outbreaks that uses only case numbers, with no need for population-at-risk data. It makes minimal assumptions about the time, geographical location, or size of the outbreak, and it adjusts for natural purely spatial and purely temporal variation. The new method was evaluated using daily analyses of hospital emergency department visits in New York City. Four of the five strongest signals were likely local precursors to citywide outbreaks due to rotavirus, norovirus, and influenza. The number of false signals was at most modest. If such results hold up over longer study times and in other locations, the space-time permutation scan statistic will be an important tool for local and national health departments that are setting up early disease detection surveillance systems.

The importance of understanding age when estimating the impact of influenza on hospitalizations and deaths has been well described, yet existing surveillance systems have not made adequate use of age-specific data. Monitoring influenza-related morbidity using electronic health data may provide timely and detailed insight into the age-specific course, impact and epidemiology of seasonal drift and reassortment epidemic viruses. The purpose of this study was to evaluate the use of emergency department (ED) chief complaint data for measuring influenza-attributable morbidity by age and by predominant circulating virus. We analyzed electronically reported ED fever and respiratory chief complaint and viral surveillance data in New York City (NYC) during the 2001-2002 through 2005-2006 influenza seasons, and inferred dominant circulating viruses from national surveillance reports. We estimated influenza-attributable impact as observed visits in excess of a model-predicted baseline during influenza periods, and epidemic timing by threshold and cross correlation. We found excess fever and respiratory ED visits occurred predominantly among school-aged children (8.5 excess ED visits per 1,000 children aged 5-17 y) with little or no impact on adults during the early-2002 B/Victoria-lineage epidemic; increased fever and respiratory ED visits among children younger than 5 y during respiratory syncytial virus-predominant periods preceding epidemic influenza; and excess ED visits across all ages during the 2003-2004 (9.2 excess visits per 1,000 population) and 2004-2005 (5.2 excess visits per 1,000 population) A/H3N2 Fujian-lineage epidemics, with the relative impact shifted within and between seasons from younger to older ages. During each influenza epidemic period in the study, ED visits were increased among school-aged children, and each epidemic peaked among school-aged children before other impacted age groups. Influenza-related morbidity in NYC was highly age- and strain-specific. The impact of reemerging B/Victoria-lineage influenza was focused primarily on school-aged children born since the virus was last widespread in the US, while epidemic A/Fujian-lineage influenza affected all age groups, consistent with a novel antigenic variant. The correspondence between predominant circulating viruses and excess ED visits, hospitalizations, and deaths shows that excess fever and respiratory ED visits provide a reliable surrogate measure of incident influenza-attributable morbidity. The highly age-specific impact of influenza by subtype and strain suggests that greater age detail be incorporated into ongoing surveillance. Influenza morbidity surveillance using electronic data currently available in many jurisdictions can provide timely and representative information about the age-specific epidemiology of circulating influenza viruses.

The attack rate increased sharply with age, and seven patients died. In late August 1999, a specialist in infectious diseases contacted the New York City Department of Health about two patients with encephalitis at a hospital in northern Queens. A preliminary epidemiologic investigation at the nearby hospitals identified six additional cases of encephalitis. These eight cases occurred among previously healthy persons 58 to 87 years of age 1 who presented with a febrile illness followed by changes in mental status. All but one had severe muscle weakness. Four had flaccid paralysis requiring ventilatory support, and three were thought to have atypical Guillain–Barré syndrome. 2 , 3 Hematologic and biochemical tests of patients' cerebrospinal fluid . . .

Background We performed a longitudinal study of viral etiology in samples collected in New York City during May 2009 to May 2010 from outpatients with fever or respiratory disease symptoms in the context of a pilot respiratory virus surveillance system. Methods Samples were assessed for the presence of 13 viruses, including influenza A virus, by MassTag PCR. Results At least one virus was detected in 52% of 940 samples analyzed, with 3% showing co-infections. The most frequently detected agents were rhinoviruses and influenza A, all representing the 2009 pandemic H1N1 strain. The incidence of influenza H1N1-positive samples was highest in late spring 2009, followed by a decline in summer and early fall, when rhinovirus infections became predominant before H1N1 reemerged in winter. Our study also identified a focal outbreak of enterovirus 68 in the early fall of 2009. Conclusion MassTag multiplex PCR affords opportunities to track the epidemiology of infectious diseases and may guide clinicians and public health practitioners in influenza-like illness and outbreak management. Nonetheless, a substantial proportion of influenza-like illness remains unexplained underscoring the need for additional platforms.

Despite a history of public health progress and the most expensive health care system in the world, the United States failed in its initial response to COVID-19. Much of this failure resulted from a presidential administration that sidelined, undermined, and maligned public health. But the roots of failure are deeper. Recovering from the pandemic and building health and public health back better will require recognizing the roots of failure and working persistently to achieve the progress that the country needs- especially among the most underserved communities. This must begin with recognizing the shortcomings in the US health system response to the pandemic, but the multiple overlapping failures laid bare by this crisis demonstrate the need for a systemic, multifaceted, sustained approach to reform that goes beyond pandemic preparedness.Over the past 40 years, the United States has gone from having a life expectancy near the average for upperincome countries and average per capita health care costs to being a negative outlier (Figures A and B [available as a supplement to the online version of this article at http://www.ajph. org]). This does not have to be. The current moment affords us the opportunity to examine and address the fundamental structural defects that underly these failures. We can improve both healthy life expectancy and the efficiency of our health system if we (1) strengthen our public health systems, (2) reorient health care delivery to reward providers for preventing illness and managing the overall health of populations efficiently (a reversal of current incentives), and (3) empower individuals to make healthier decisions by addressing the preventable root causes of poor health.

Patient-centered care is considered one pillar of a high-performing, high-quality health care system. It is a key component of many efforts to transform care and achieve better population health. Expansion of health information technology and consumer e-health tools-electronic tools and services such as secure e-mail messaging between patients and providers, or mobile health apps-have created new opportunities for individuals to participate actively in monitoring and directing their health and health care. The Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services leads the strategy to increase electronic access to health information, support the development of tools that enable people to take action with that information, and shift attitudes related to the traditional roles of patients and providers. In this article we review recent evidence in support of consumer e-health and present the federal strategy to promote advances in consumer e-health to increase patient engagement, improve individual health, and achieve broader health care system improvements. [PUBLICATION ABSTRACT]

Electronic health information exchange addresses a critical need in the US health care system to have information follow patients to support patient care. Today little information is shared electronically, leaving doctors without the information they need to provide the best care. With payment reforms providing a strong business driver, the demand for health information exchange is poised to grow. The Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, has led the process of establishing the essential building blocks that will support health information exchange. Over the coming year, this office will develop additional policies and standards that will make information exchange easier and cheaper and facilitate its use on a broader scale. Adapted from the source document.

This mathematical modeling study examines the potential for contract tracing to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the context of reduced physical distancing under different assumptions for case detection, tracing, and quarantine efficacy.