Vaccine tracking bracelets in Boston

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One of the first in the country! Coming soon to your city.

Boston launches flu shot tracking
City to pinpoint areas of low rates of vaccination
By Stephen Smith, Globe Staff | November 21, 2008

Using technology originally developed for mass disasters, Boston disease
trackers are embarking on a novel experiment - one of the first in the
country - aimed at eventually creating a citywide registry of everyone who has
had a flu vaccination.

The resulting vaccination map would allow swift intervention in
neighborhoods left vulnerable to the fast-moving respiratory illness.

The trial starts this afternoon, when several hundred people are expected
to queue up for immunizations at the headquarters of the Boston Public
Health Commission. Each of them will get a bracelet printed with a unique
identifier code. Information about the vaccine's recipients, and the shot, will
be entered into handheld devices similar to those used by delivery truck
drivers.

Infectious disease specialists in Boston and elsewhere predicted that the
registry approach could prove even more useful if something more sinister
strikes: a bioterrorism attack or the long-feared arrival of a global flu
epidemic. In such crises, the registry could be used to track who received a
special vaccine or antidote to a deadly germ.

"Anything you can do to better pinpoint who's vaccinated and who's not,
that's absolutely vital," said Michael Osterholm, director of the Center for
Infectious Disease Research & Policy at the University of Minnesota. "I
wish more cities were doing this kind of thing."

Boston is believed to be the first city to embrace this particular
approach to tracking vaccinations against the seasonal flu, estimated to kill
36,000 people each year in the United States, principally the elderly.
But when Boston bought the monitoring system from a Milwaukee company in
2006, emergency authorities had a far different use in mind: tracking people
injured in big fires, plane crashes, or other disasters.

"When there's a large catastrophic event, people end up in a variety of
healthcare facilities," said Dr. Anita Barry, Boston's director of
communicable disease control. "Of course, their family members and loved ones are
trying to find out where they are and how they're doing."

To see how well the system would work, emergency crews tested it at the
Boston Marathon and the Fourth of July extravaganza on the Esplanade. The
trial proved successful.

"If we can make it work in the Boston Marathon medical tent, then you have
to think about making it so that it can work in other environments as well
- whether it's a community clinic or a doctor's office or a flu shot
clinic," said Rich Serino, chief of Boston Emergency Medical Services. Thus, the
idea to use the registry as a flu vaccine tracker was born.

Every autumn in medical offices across the country, flu vaccine floods in.
The perishable medical product must be delivered to millions in a matter
of months.

Keeping track of that cache of vaccine - and which patients are getting it
- is a daunting proposition.
In some medical offices, the information is entered into electronic
medical records. At Boston's health department, nurses fill out paper forms.

But there's never been any way to systematically monitor whether, for
example, Dorchester has lower vaccination rates than the North End.

"When you're working in one clinic, you don't have a good sense of that,"
said Dr. Alfred DeMaria, top disease doctor at the Massachusetts Department
of Public Health. "But if you're tracking multiple clinics in real time,
you can see where the uptake is better and where it's less, and then focus
on outreach."
Today's experiment, which does not require any additional direct spending,
is a first step toward that.

When people arrive for their shots, they will get an ID bracelet with a
barcode. Next, basic information - name, age, gender, address - will be
entered into the patient tracking database. There will be electronic records,
too, of who gave the vaccine and whether it was injected into the right arm
or the left, and time-stamped for that day.

The resulting trove of data could be used to figure out why some patients
had to wait longer than others to be vaccinated. "When all is said and
done," said Jun Davantes, director of product management at EMSystems, the
company that makes the technology, "Boston will be able to identify where there
are certain bottlenecks in the process and hopefully improve it the next
time around."

Ultimately, city health authorities said, they envision creating a network
across the city that would allow public and private providers of flu shots
to add data to a registry.

But acknowledging patients' privacy concerns, officials promised that if a
citywide system were implemented, only a limited amount of information
would be gathered - all sitting behind an encrypted firewall.

"I have had people say, 'Oh, that's so big brother,' " said Laura
Williams, EMS deputy chief of staff. "But in truth, the unique identifier is unique
to the incident. It's not like you will go to the hospital, and they'll
say, 'You're the one who got the flu vaccine at 10 o'clock yesterday at the
Boston Public Health Commission.' "

Stephen Smith can be reached at _stsmith@globe.sts_
(mailto:stsmith@globe.com) .