May 25, 2002 – Some implications of computerization in medical record keeping and of diagnostic testing of newborns were addressed at a recent forum for health-care professionals on St. Thomas.
The day of lectures, presentations and information sharing was sponsored by the Health Department's Maternal Child Health and Children with Special Health Care Needs divisions in conjunction with the V.I. Alliance for Primary Care.
Dr. Cristobal Cintron-Vargas, an epidemiologist in Puerto Rico, said improved tracking of data via computer can allow health-care providers to spot trends in infant mortality and the incidence of disease. In Puerto Rico, he said, such tracking led medical researchers to identify a rise in cadiovascular disease in infants. "Cardiovascular disease is a big problem in Puerto Rico," he said.
Previously, due to overly broad categorizing of infant deaths, Cintron-Vargas said, the disease was "hiding" within the category of "low birth weight."
He stressed the need for electronic record-keeping from birth as a means to determine patterns in infant mortality and illness. The Virgin Islands is moving toward such a computerized data system, health-care officials indicated.
Turning from birth to death statistics, Cintron-Vargas gave an example of how one small change in the entry of data can yield dramatic results. He said the recent addition of a check box on Puerto Rico's standard death certificate enabled health-care professionals to recognize a problem that had previously escaped notice. The check box is to indicate in the case of women who died whether they had been pregnant within their last year of life.
The data thus collected showed the medical community a higher correlation between pregnancy and deaths than previously had been assumed. Prior to the change in the death certificate, Cintron-Vargas said, Puerto Rico had recorded fewer than 10 pregnancy-related deaths per year. Since the change in the form, doctors are seeing an average of 31 such deaths each year, he said.
Hearing tests and genetic/metabolic screening of newborns was the focus of a presentation by C. Patricia Penn, who showed slides detailing the work done by the V.I. Alliance for Primary Care in these areas.
Thanks to a recent grant from the Maternal Child Health Bureau, Penn said, infants in the territory are routinely examined under the Integrated Newborn Screening Program to identify "in-born errors of metabolism that cause mental retardation and other significant medical complications if not diagnosed and treated early."
Infants also are screened for sickle-cell disease, sickle-cell trait and other significant hemoglobin abnormalities. Penn said sickle-cell disease and trait are prevalent in the population of the Virgin Islands. Routine testing had identified nearly 200 infants with sickle-cell disease and nearly 1,500 with sickle-cell trait by the end of the last fiscal year, she said.
Three deaths were directly attributable to the disease in children under 5 years of age on St. Thomas, she said. She did not have data for the other islands.
Families of newborns diagnosed with sickle-cell disease or trait receive ongoing counseling and education, care coordination, evaluation and case management by a pediatric blood specialist, including a penicillin regimen to reduce the incidence of bacterial infections, Penn said.
In an open discussion following the presentations, health-care providers raised questions about patient confidentiality with the growing use of electronic databases. Some expressed concern about the legality of having patient information readily accessible in an electronic medium.
James M. Barclay, an attorney specializing in health care, said the key is to restrict access within the medical-care operation that is responsible for keeping patient records. He stressed the need to ensure that only authorized personnel have access to patient information and also that such information not be given out to persons outside of the agency without authorization.
The public forum was held on May 16 at Palms Court Harborview Hotel. The V.I. Alliance for Primary Care has sponsored such forums annually since the group was established in 1992.

Publisher's note : Like the St. Croix Source now? Find out how you can love us twice as much — and show your support for the islands' free and independent news voice … click here.