For infectious diseases with person-to-person spread, such as influenza, the individual’s likelihood of infection and the performance of rapid tests designed to detect them depends on the local incidence of disease.³ A clinician’s understanding of local disease incidence and unusual cases is dependent on observed trends or recent clinical experiences.⁴ Thus the timely dissemination of information about the incidence of circulating seasonal viruses to clinicians has the potential to improve their “situational awareness” about ongoing outbreaks. Improved awareness may then improve diagnostic precision and ultimately patient management.

Physicians practicing in the emergency departments of academic medical centers often have access to viral diagnostic testing as well as formal and informal communication about current outbreaks. In contrast, clinicians in other settings may have limited access to such information. Thus, they are an ideal target for interventions designed to improve the communication between public health and the front line.

Very little research has been done to address the feasibility and utility of providing surveillance data to clinicians and even less has been done to evaluate the effect this information may have on clinical practice and over all public health. The effectiveness of existing and emerging mechanisms for providing surveillance information to clinicians depends on the availability, specificity and timeliness of the data being used as well as the method of dissemination. Which data types (e.g., ILI vs. lab-confirmed cases of influenza) and which information dissemination mechanisms will be most useful to clinicians are understudied questions.

Historically, the information sources available to clinicians have included 1) news media, 2) listservs from the state and local health department, 3) websites such as the Centers for Disease Control and Prevention and the State health department and 4) informal communications amongst colleagues. In Utah, we have been able to take advantage of a unique resource - Intermountain Healthcare – where an exceptional degree of ongoing viral testing has provided the opportunity to add information about the activity level of several common viral pathogens to the armamentarium of information sources.

In November 2004, we convened 3 focus group meetings, with a total of 14 physicians in urgent care or general practice, to assess interest in population data about viral pathogens and discuss the design of the system for distributing reports. All of the participants desired access to information about circulating viral pathogens. The majority of participants were not aware of other resources for this type of information. Desired frequency of updates was variable, ranging from quarterly when activity was low to weekly and possibly more frequently during times of peak or unusual activity (e.g. winter). All agreed the information would be helpful but the reasons varied and included validating viral diagnoses and treatment decisions; report sharing leading to increased parent/patient satisfaction with their diagnosis; broader impact on ordering diagnostic testing (e.g., chest x-rays, labs); initiating preventive treatments (e.g., vaccination, antiviral prophylaxis or treatment) on at-risk patients; and antibiotic or steroid prescribing. Time series graphs were the preferred format for providing a quick overview, but most felt that a brief textual summary describing the “big picture” could be helpful. Ease of access was emphasized and the preferred method of communication was electronic format combining an ‘active notification’ including a brief textual summary message with a link to a ‘passive display.’

Viral testing results are stored in the laboratory information system (LIS) with a set of standardized test codes and result codes developed by central laboratory personnel. A load script, run each night between the hours of 10pm and 6am populates general laboratory tables in the enterprise data warehouse (EDW) Oracle 9i® database with data from the LIS. This means that the laboratory testing results are available with a 24-hour lag time. A materialized view, containing the specific microbiology results of interest, is used to improve the efficiency of reporting tools running against this data and to remove duplicate test results, quality assurance testing and results entered on test patients.

In this paper, we present a descriptive analysis and formative evaluation of the system. The ongoing use of the web site and the positive feedback from recipients of the emailed graphs demonstrate the feasibility and value of implementing an automated reporting system. As part of a newly funded study, this system is now being transitioned into a program to support timely exchange of information between clinicians and public health personnel. The pathogen-specific reports depicted here are complementary to other sources of data for public health surveillance. Germ Watch has the potential to fill a gap between reportable disease surveillance and syndromic disease surveillance.

The generation of meaningful population data about respiratory pathogens depends on having an adequate volume of patients from whom diagnostic samples are obtained. The practice of obtaining nasopharyngeal aspirates from acutely symptomatic children has been widely adopted in Utah, because of its perceived benefits for clinical decision-making. The Germ Watch system has successfully capitalized on this experience. It has aimed to enhance timely awareness of dissemination of infection at the population level, with a focus on respiratory viral pathogens and pertussis.