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The explicit relationship between the clinical environment and public health dates from the 1878 Act of Congress, which authorized the U.S. Public Health Service to collect morbidity reports for quarantinable diseases. In the 1970s, hospital infection surveillance programs began to employ computer databases; in the 1980s, state health departments developed computer-based systems to monitor communicable diseases. Subsequent developments of databases and techniques such as data mining improved detection and facilitated alerts; compliance with reporting accelerated once direct connections were instituted between clinical laboratories and public health agencies. Personal health testing systems (HTS) also evolved, with the use of multiple tests in what became known as multiphasic screening. By 1965, Kaiser Permanente was using automated multiphasic health testing (AMHT) systems in two clinics in Northern California to provide systemized personal health checkups, including features described later as clinical decision support. By the early 1970s, AMHT systems had spread into many health care facilities, for a range of uses that included pre-admission screening of hospital patients and online records of outpatient encounters, both nationally and internationally. In the 1980s funding and reimbursement issues led to the termination of most AMHT programs; at Kaiser Permanente, AMHT was integrated into its larger systems. Since 2001, the CDC has funded the development of real time surveillance systems that take daily Health Level 7 feeds directly from clinical information systems as part of syndromic surveillance, a criterion in CDC’s meaningful use program. |
