2014.ISDS.Abstracts.Final.pdf


ISDS Annual Conference Proceedings 2014. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2014 Conference Abstracts

Utility and Acceptability of Influenza Surveillance 
amongst Emergency Providers
Andrea F. Dugas*1, Howard Burkom2, Anna L. DuVal1, Richard Rothman1 and a National 
Emergency Department Influenza Consortium1

1Johns Hopkins University, Baltimore, MD, USA; 2Johns Hopkins Applied Physics Lab, Baltimore, MD, USA

Objective
To evaluate the utility and acceptability of a real-time cloud based 

influenza surveillance tool amongst emergency department (ED) 
providers.

Introduction
Each year, influenza affects approximately 5-20% of the United 

States population causing over 200,000 hospitalizations and 3,000 – 
49,000 deaths 1-3. As a key point of entry to the health care system, 
EDs are responsible for the initial management and treatment of 
a substantial proportion of these influenza patients, thus directly 
impacting overall public health. As the front line of influenza 
diagnosis and treatment, ED providers may benefit from real-time 
easily shared influenza surveillance information.

Methods
We created a real-time laboratory-based influenza surveillance 

system at two US academic emergency medicine departments. From 
November 2013 – April 2014 we systematically tested patients with 
acute respiratory illness at these two EDs using Cepheid Xpert Flu, 
a rapid highly sensitive PCR-based assay that provides significant 
improvement over traditional rapid antigen tests 4. Test results were 
instantaneously uploaded to a cloud-based data aggregation system 
available to ED providers via a web-based interface. Providers also 
received bimonthly email updates summating year to date results. ED 
providers were surveyed prior to the start, and after the conclusion of 
the influenza season, to assess providers views regarding acceptability 
and utility of the internet and email-based surveillance provided 
throughout the influenza season.

Results
Influenza surveillance at the 2 sites identified 82 subjects with 

confirmed influenza among 1032 enrolled patients. Of 198 providers 
contacted, 151 (76%) responded to the pre-survey; and 86 (57%) 
of those completed the post-survey. Of the included participants, 
42% were female, 11% were midlevel providers, 48% were resident 
physicians, and 40% were attending physicians. On the pre-survey, 
the majority of providers indicated that they sporadically obtain 
influenza surveillance actively (62%) and passively (48%), and that 
additional information on influenza prevalence would be useful 
(75%). On the post survey, most providers reported that they did not 
go to the provided surveillance website (54%), but the surveillance 
emails impacted their general awareness of influenza (72%), clinical 
diagnosis of influenza (24%), decision-making to test for influenza 
(31%), and decision-making to treat influenza (24%). Overall, the 
additional surveillance data impacted the providers’ influenza testing 
(66%) and treatment (51%) practices.

Conclusions
The majority of ED providers found surveillance data useful and 

indicated the additional information impacted their clinical practice. 
Providers are more receptive to obtaining surveillance information via 
passive means such as emails than via active means such as visiting a 

website. Accurate and timely surveillance information, distributed in 
a provider-oriented format, can impact ED provider management of 
patients with suspected influenza.

Keywords
Influenza; Surveillance system; Clinical decision support

Acknowledgments

This work was supported by the Cooperative Agreement IDSEP130014-
01-00 from The Assistant Secretary for Preparedness and Response. Its 
contents are solely the responsibility of the authors and do not necessarily 
represent the official views of The Assistant Secretary for Preparedness 
and Response (within the U.S. Department of Health and Human 
Services).

References

1. Centers for Disease Control and Prevention. Seasonal Influenza. 2011; 
http://www.cdc.gov/flu/about/qa/disease.htm. Accessed Feb 8, 2011, 
2011.

2. Thompson WW, Shay DK, Weintraub E, et al. Mortality associated
with influenza and respiratory syncytial virus in the United States. 
JAMA. 2003;289(2):179-186.

3. Thompson WWS, D.K., Weintraub E, Brammer L, Bridges CB, Cox
NJ, Fukuda K. Influenza-associated hospitalizations in the United 
States. JAMA. 2004;292(11):1333-1340.

4. DiMaio MA, Sahoo MK, Waggoner J, Pinsky BA. Comparison of
Xpert Flu rapid nucleic acid testing with rapid antigen testing for the 
diagnosis of influenza A and B. J Virol Methods. 2012;186(1-2):137-
140.

*Andrea F. Dugas
E-mail: adugas1@jhmi.edu    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 7(1):e71, 2015