According to Amy Zimmerman, chief of health information technology for the Rhode Island Department of Health, 100 percent of the state’s retail pharmacies can receive e-prescriptions and 80 percent of those pharmacies can have their dispensed prescription data aggregated at Surescripts and then used by the state to monitor H1N1. Zimmerman said the state has been promoting e-prescribing since 2003 in collaboration with the Rhode Island Quality Institute, a nonprofit organization. “When Surescripts first came into being and wanted to pilot the e-prescribing network, it chose Rhode Island and partnered with the Quality Institute to do that,” she said.
Surescripts uses the pharmacies’ data to report how much Tamiflu and other anti-virals are being dispensed to patients and categorizes the information by ZIP code and age group. The reports are sent to the state every two weeks and the data excludes personal information, Zimmerman said.
According to the state’s statement, the information allows health officials to:
1. Use the data as a valuable proxy for detecting a potential outbreak of swine flu, including its location and affected age group.
2. Offer a more far-reaching and granular view of potential flu activity when compared to the state's Sentinel system — 25 physician practices around the state that report flu outbreaks to the Rhode Island Department of Health.
3. Help detect discrepancies between disease outbreaks reported by the Sentinel system and outbreaks identified based on flu prescriptions.
“The data is very valuable for being able to monitor trends over time to be able to see if there is an increase in the dispensing of the anti-viral medications, and we can map that against our other surveillance indicators of actual disease,” Zimmerman said.
The other surveillance indicators include a syndromic surveillance system — the reporting of emergency room visits for influenza-like illness — and 25 physician sites across the state that also report influenza-like illness data.
“You would expect to see the increase in the dispensing of anti-viral medication when you start to see peaks in influenza-like illness,” Zimmerman said. “So it allows us to monitor the trends; it allows us to identify if there’s potentially over prescribing.”
She said observing e-prescription trends allows state health officials to monitor and ensure that anti-virals are being appropriately dispensed. “For instance, Tamiflu is appropriate to be dispensed for H1N1, but seasonal flu seems to be resistant to that — so if there’s a lot of seasonal flu and not a lot of H1N1, you would not expect to see a lot of Tamiflu being dispensed,” Zimmerman said.
She added that the information aids health officials in determining if additional education is needed to ensure that anti-viral medication is being prescribed appropriately. If the reports say that a lot of anti-viral medication is being dispensed, but there’s not information indicating an outbreak in the area, officials can educate doctors in the area about the findings.
“As the director of health has said, it’s a different tool, it’s another measure that has become very handy in putting the big picture together,” Zimmerman said.
[Photo courtesy of James Gathany/Centers for Disease Control and Prevention.]
