The full content of Annals is available to subscribers

Subscribe/Learn More  >
Editorials |

Fortune Favors a Prepared Health Care System

Tara N. Palmore, MD; and David K. Henderson, MD
[+] Article, Author, and Disclosure Information

From National Institutes of Health, Bethesda, MD 20892.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2792.

Requests for Single Reprints: David K. Henderson, MD, National Institutes of Health Clinical Center Building 10, Room 6-1480, 10 Center Drive, Bethesda, MD 20892: e-mail, dkh@nih.gov.

Current Author Addresses: Drs. Palmore and Henderson: National Institutes of Health Clinical Center Building 10, Room 6-1480, 10 Center Drive, Bethesda, MD 20892.

Ann Intern Med. 2012;156(1_Part_1):54-55. doi:10.7326/0003-4819-156-1-201201030-00011
Text Size: A A A

The articles by Bush and Perez and by Elkin and colleagues in this issue concern the role of clinicians and biosurveillance systems in detecting bioterrorism and emerging infections. The editorialists note that Bush and Perez's account of the anthrax attacks reminds us that “fortune favors the prepared mind.” Elkin and colleagues' study reminds us that the challenges for the next decade include learning how to select optimal biosurveillance systems and translate the information from these tools into concrete actions that improve public health.

First Page Preview

View Large
First page PDF preview





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
The Knowledge Required for Value Based Healthcare
Posted on January 29, 2012
Peter L.Elkin, Physician Scientist, Steven H. Brown
Mount Sinai School of Medicine
Conflict of Interest: None Declared
We would like to thank Drs. Palmore and Henderson for their thoughtful editorial. (1) We agree that the prepared healthcare system includes the ability to quickly analyze clinical data and to respond rapidly to public health emergencies. (2) Advances in Health Informatics over the last 20 years have given us tools that, if applied, can help us prepare for and face future healthcare crisis (3) We believe that evaluations of Informatics interventions, like other clinical or public health interventions, should be a prerequisite to changing clinical or public health practice. We agree with Drs. Palmore and Henderson that additional evaluations are necessary and thank them for recognizing our contribution. Drs. Palmore and Henderson raise the important issue that Healthcare costs are on the rise and we need more affordable care. We could not agree more. Healthcare reform has put into place new payment strategies that realign incentives toward high quality care. These include Accountable Care Organizations where payers and healthcare providers share in the savings that stem from lower cost and higher quality care. Many strategies used to systematize clinical practice while improving the quality and safety of care require clinical data monitoring . As with biosurveillance, relevant clinical data is often in free text. The same technology that allows us to monitor our population for emerging infectious diseases and acts of bioterrorism can support fully automated electronic quality and safety monitoring (collectively referred to as the field of eQuality). (4-6) Health Informatics systems that can monitor clinical care are an integral and essential part of any plan to provide better healthcare value while improving healthcare quality and safety.(7) Standards organizations such as HL7 and IHTSDO have made foundational contributions by developing standards for health record structure and for meaningful representation and exchange of structured data. Health Informatics approaches that allow us to turn the free text health record content into codified knowledge are another important piece of the puzzle that can bring us closer to the goal of automated biosurveillance, quality and safety monitoring. Our study, has contributed to achieving this goal by demonstrating the effective use of EHR data for secondary purposes such as biosurveillance. Although cost issues need to be discussed and an optimal strategy devised, we should not delay in our efforts to deploy and test strategies that have the potential to bring us closer to these important national goals. We encourage others to extend our results toward building a safer and more effective systematized healthcare system for the United States of America. Peter L. Elkin, MD, MACP, FACMI Steven H. Brown, MD, MS, FACMI


1. Palmore TN, Henderson DK. Fortune favors a prepared health care system. Ann Intern Med. Jan 3;156(1 Pt 1):54-5.

2. Elkin PL, Froehling DA, Wahner-Roedler DL, Brown SH, Bailey KR. Comparison of natural language processing biosurveillance methods for identifying influenza from encounter notes. Ann Intern Med. Jan 3;156(1 Pt 1):11-8.

3. Elkin PL, Brown SH, Husser CS, Bauer BA, Wahner-Roedler D, Rosenbloom ST, et al. Evaluation of the content coverage of SNOMED CT: ability of SNOMED clinical terms to represent clinical problem lists. Mayo Clin Proc. 2006 Jun;81(6):741-8.

4. Brown SH, Elkin PL, Rosenbloom ST, Fielstein E, Speroff T. eQuality for all: Extending automated quality measurement of free text clinical narratives. AMIA Annu Symp Proc. 2008:71-5.

5. Brown SH, Speroff T, Fielstein EM, Bauer BA, Wahner-Roedler DL, Greevy R, et al. eQuality: electronic quality assessment from narrative clinical reports. Mayo Clin Proc. 2006 Nov;81(11):1472-81.

6. Murff HJ, FitzHenry F, Matheny ME, Gentry N, Kotter KL, Crimin K, et al. Automated identification of postoperative complications within an electronic medical record using natural language processing. JAMA. Aug 24;306(8):848-55.

7. Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med. 2003 Jun 19;348(25):2526-34.

Conflict of Interest:

None declared

Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.