The pediatrician who brought the water crisis in Flint, Michigan, to public attention used a Wisconsin tool to do so: Epic Systems’ electronic medical records.
Dr. Mona Hanna-Attisha, of Hurley Medical Center in Flint, analyzed confidential data from blood tests on children stored in software designed by Verona-based Epic Systems Corp.
She and her colleagues discovered that the percentage of Flint children with unsafe levels of lead in their blood doubled — and nearly tripled in the inner city — after the city, under state management, switched its water supply in April 2014.
“If we did not have Epic, if we did not have (electronic medical records), if we were still on paper, it would have taken forever to get these results,” Hanna-Attisha said.
Hanna-Attisha shared her findings at a press conference in September, eventually prompting Michigan officials to distribute bottled water and water filters, and return Flint to its previous water supply.
She is part of a state-appointed committee responding to the problem. Congress is considering federal aid to replace and fix lead-contaminated pipes in the majority black, post-industrial city of 100,000.
Hurley Medical Center has used Epic records since 2010. Epic, with 9,400 employees, has nearly 400 customers that store medical data for more than half of Americans.
In an effort to save money, Flint started getting its water from the Flint River in April 2014 instead of using Lake Huron water from Detroit.
The river water is more corrosive to lead pipes, and residents started complaining about the water’s smell and brown color. A new pipeline from Flint to Lake Huron is expected to be ready this year.
In September 2015, Virginia Tech researchers reported elevated lead levels in Flint’s drinking water. That prompted Hanna-Attisha to look at levels in young children, who are especially susceptible to the harmful effects of lead, including decreased intelligence and inability to pay attention.
“It’s a well known neurotoxin,” she said. “If there’s any possibility it’s in kids, it’s a disaster.”
Using Epic records, she compared blood test results for the 736 Flint children under 5 whose tests were processed at Hurley from January to September 2013 with results from 737 children for the same period in 2015. Hurley handles about two-thirds of the tests in Genesee County, which includes Flint.
The percentage of those with elevated blood lead levels — 5 micrograms per deciliter or higher — increased from 2.4 percent in 2013 to 4.9 percent in 2015.
In parts of the city with the highest lead levels in drinking water, the percentage of children with unsafe blood levels rose from 4 percent to 10.6 percent.
“It directly correlated with the water lead levels,” Hanna-Attisha said.
Among more than 2,000 children outside of the city, whose homes weren’t directly affected by the drinking water switch, the percentage with high blood lead levels went from 0.7 percent to 1.2 percent, a change that wasn’t statistically significant.
The researchers used home addresses from the Epic records and geographic information system software to study the geographic variation.
Hurley is now putting a lead alert in all of the Flint children’s medical records so doctors can counsel families and watch for symptoms, which typically take a few years to develop.
“It will help us track these patients in the future to see how they are doing,” Hanna-Attisha said.
Dr. Sean McCormick, who works in clinical informatics at Epic, said the Flint researchers used standard Epic software and didn’t require special assistance.
“It’s a good example of how (Epic records) can be applied to a specific problem,” he said.
Another example is MetroHealth System, in Cleveland, which said Epic records helped it better manage patients with diabetes, averting 17 amputations and 2,200 hospitalizations over three years.
Dean Clinic has used Epic records to enroll more people in tobacco cessation programs, and Madison hospitals have used the records to boost colon cancer screening, McCormick said.
Epic’s Cosmos Research Network — a group of about a dozen health care organizations around the country, including Johns Hopkins Medicine and Duke University Health System — plans to share Epic record data to improve asthma care.