Without the power of EHRs, the discovery of great levels of lead in the water supply of Flint, Mich.—and subsequent proof that its kids were collecting high levels of lead in their blood—is a tragic story that might not even be known to this day
Acting on a hunch, a pediatrician at Hurley Medical Center decided and ordered an analysis of blood test records that made a comparison of blood lead levels in small kids before and after the city changed its water supply from Lake Huron to the Flint River in a cost-saving step.
The outcomes, calculated from hundreds of particular records that were recognized and then geographically mapped, took merely 2 weeks. The stark evidence demonstrated a doubling, and in few places a tripling, of lead levels in one- and two-year-olds—ages in which the neurotoxin can cause important developmental damage. Those outcomes led to a shutdown of the Flint water supply and redeveloped the lake water source.
“We daily check blood lead levels, and there is no protective level of lead exposure,” claims Mona Hanna-Attisha, M.D., the pediatrician who acted on the hunch that bared the findings. “But particularly underserved minority communities have a pre-existing disparity in relations to lead exposure.” The Medicaid-mandated checks created the information, and their presence in an EHR from Epic that went into operation in the year 2011 made the pinpoint analysis possible.
The story is far from over. The next issue is to isolate and tag the records of 9,000 to 10,000 kids under the age of 6, whose brains are still progressing, and manage to track them long term to try to reduce the ill impacts that are likely to appear.
That is where the limits of the present healthcare IT infrastructure will be felt, claims Michael Roebuck, M.D., Hurley’s chief medical information officer. “This is a good case instance of the present capabilities and the future deficiencies of medical records.”
Everyone knew there was something in the water from the beginning. Days after the change, complaints about the odor, color, and increases in skin rashes all erupted. “But we were reassuring our families, because we were being reassured by government, that the water was secure,” claims Hanna-Attisha.
Then a research crew from Virginia Tech took measurements at several sites along the river and discovered high levels of lead. Hanna-Attisha took the report as a template for mapping records of blood levels geo coded to evaluate where they were greatest, as well as the highest before-and-after increases. “Where the water [lead] levels were the greatest was the exact similar place as (where) the blood levels were the greatest.”
Overall, the percentage of kids with elevated blood lead levels--described as 5 micrograms per deciliter or greater--went from 2.4% in the year 2013 to 4.9% in the year 2015. The water source was changed in the year of April 2014. In 1 ward, the percentage spiked from 4.8% to nearly 16%. The Virginia Tech outcomes recorded the greatest water lead levels in that similar ward—30% of the tested samples exceeded 15 parts per billion, which is the threshold for action by the Environmental Protection Agency.
This was the 1st increase in water lead levels in various years, claims Hanna-Attisha. “We set ourselves back decades in terms of where our blood lead levels are.”
The conclusions were even more important when contrasted with a trend of steadily reducing lead exposure in Flint and around the state. This was the 1st increase in various years, claims Hanna-Attisha. “We set ourselves back decades in terms of where our blood lead levels are.”
Unlike the proof of dirty water, lead exposure has no instant signs or symptoms. Merely by doing population-level investigation, “which is robust in systems such as Epic,” did the trends show up, she asserts. “If we had still been on paper, we possibly would still be poring through records.”
The power of the contemporary EHR is its capability to “grab information from various databases and combine information in a way that lets you do population-level analysis,” claims Roebuck. “As an instance, it is 1 thing to get a lab system to spit out a bunch of lead levels--I think that’s pretty easy. It’s another thing to get a lab system to spit out lead levels and addresses and primary care doctor and contact number . . . that then you can utilize to do population-level analysis.”
“If you need to geo-map them, you require their addresses. If you need to contact them, you require their PCPs and contact numbers. And modern-day data analytics makes that very convenient,” he adds.
The clear profit of population health analysis goes further. The rapid work staved off other threats that would have sustained, like public health advisories to boil water following episodes of large amounts of bacteria discovered in periodic samplings. For lead, it was the worst thing they could do.
“Even today, there are persons who consider, and rightly so, that boiling the water is the safest thing,” claims Hanna-Attisha. But boiling evaporates water while leaving behind all the lead. “That lead is going to focus in whatever you are boiling.” There were 3 boil advisories merely in the time before the lead was found.
However the lead discoveries kept things from getting worse, destruction is already done. Exposure reduces IQ and causes attention deficit, hyperactivity, impulse and conduct disorders. Nutrition options can reduce the effects, and services like universal preschool and mental health approach can counter few of the known affects on cognition and behavior, claims Hanna-Attisha. “We are definitely looking at a twenty-year lifespan tracking these kids.”
For Roebuck, “that is been the issue. The health IT infrastructure nationally is not in a spot still that tagging these children for the duration of their lifetime is convenient.”
Regionally, it may be doable in conjunction with the regional health data exchange, he claims. “As long as they stay in the city of Flint, we can handle the majority of that tagging; but as soon as few kid graduates high school and goes to college, or as soon as certain family member gets a latest job in a different state and the kid leaves the state, maintaining that information connection with that individual at that time is not something that is easily done.”
The tracking of developmental milestones and lead-linked health results will be the simple part, at least under the aegis of Hurley Medical Center and its EHR system. 1 necessary set of data will come from issue lists, those computerized details needed by the HITECH Act’s Meaningful Use program. The EHR also will have medical history and a diagnosis that may involve the cognitive and attitude changes most concerning to healthcare contributors, states Roebuck. “It is quite simple to get those out of the record.”
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