Info highway pavers are eyeing TB programs

Immigrant data need to be on-line, DQ says

Someday soon, every TB control program in the United States, from the biggest urban program to the smallest one-stethoscope clinic, may be sending and receiving data on-line.

If that happens, most of the thanks probably should go to the Centers for Disease Control and Prevention’s Department of Quarantine (DQ) and to the Public Health Practice Program Office, which developed the concept. Experts at DQ are burning the midnight oil as they try to inject some oomph into TB controllers’ traditionally snail-paced modes of communication.

Ideally, DQ would like to pave a smooth, two-lane electronic highway on which information would flow quickly and accurately, starting at DQ headquarters and running through state health departments down to local jurisdictions and then all the way back up again.

It’s a vision TB controllers of every stripe should welcome, says Frank Seawright, chief of data man agement at DQ. For one reason, state programs badly need a more accurate way to tell how many immigrants and refugees the programs spend their time and dollars screening for TB. As it stands, few states know what their true burden of immigrants looks like, and that makes it tough to base funding requests on true needs.

Data on immigrants start falling through the cracks at the very start of the process, says Seawright. That’s when the Immigration and Naturalization Service (INS) sometimes fails to intercept immigrants or simply doesn’t pass on TB notifications to one of the nation’s eight quarantine stations.

"We know this happens," says Seawright, "because we’ll have the TB rates for country X; but the percentages on the data we get back from one part of the country won’t match at all to what we get from another place."

After stumbles at the front end, "Q stations" send whatever data they receive to state programs, except in some situations where they send it directly to a big city, such as Los Angeles, Chicago, or Seattle. Then, the city is supposed to touch base with the state; sometimes that happens, and sometimes not.

Slowly the data sift down, usually by snail mail, to smaller programs that are supposed to report their findings. They do — sometimes.

In the case of refugees, there are additional problems. Since all refugees must pass through one of the quarantine stations, information is usually accurate at the start. But data on refugees go to two places: the state program and the state refugee processing office. The refugee office is supposed to report to the state, but "there’s lots of confusion on this point," says Seawright.

Besides giving states a better handle on what’s happening within their own borders, seamless electronic linkage could provide a good gauge on how well panel physicians overseas are performing their jobs. In other words, it’ll be easier to see whether a chest X-ray marked "suspicious" by a panel physician in, say, the Philippines looks suspicious to physicians here as well.

A direct link with processing centers

Seawright hopes eventually to link up electronically with panel physicians at the big processing centers in countries that supply the United States with most of its immigrants. That would make DQ less dependent upon the INS for data, and it would close up that gap in the line.

To begin with, DQ officials have inaugurated a pilot program in which data from the eight quarantine stations are sent electronically to selected state health departments. For now, how the states get the information to the local jurisdiction may vary, from phone calls to faxes to snail mail. Seawright wants that to change. "One thing we’re trying to do here is to force this issue a little bit," he says. "We want local programs to realize this is coming, and they need to gear up for it."

It’s a matter of attitude more than money, he adds. "These things aren’t that expensive, for heaven’s sake! On the back page of this morning’s New York Times, I saw a computer priced at $400 if you sign up for CompuServe for a year."

The trouble is, lots of small programs still regard the Internet with suspicion; while big-city mayors may view it as a luxury their health departments don’t deserve.

As it stands, many states already have joined the future. New York state has "a Cadillac program," with electronic capabilities throughout all jurisdictions; so do Georgia and a handful of other states as well.