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Analytics & Research

athenaResearch Weekly Flu Report: Providers Prescribing Antivirals at Higher Rate


Iyue Sung, Director of athenaResearchEarlier this week, we reported on the current rates of influenza-like illness (ILI), based on data from roughly one million patient visits on the athenahealth network. That report showed a steep increase in ILI rates for the week ending Saturday, December 13 (see previous post). It’s not certain that this season will be as severe as that of 2012-2013 (data for pediatrics suggests that is a real possibility); however, providers are testing for flu more consistently than previous years, and prescribing antivirals more often.

Our data shows that the number of flu tests ordered, per patient visit in which ILI is diagnosed, has risen each of the past two years (Figure 1, graph A). This season, providers are ordering flu tests at a rate of 0.53 tests per visit with an ILI diagnosis, compared to 0.37 for last season and 0.34 for 2012-2013. (Note: There can be multiple tests per patient visit, e.g. Type A and B.)

Providers are also more likely to prescribe antivirals for ILI this flu season, compared to the past two seasons (Figure 1, graph B). This is likely a result of the increased number of tests, as well as the CDC issued advisory recommending the prescription of antivirals this season to reduce flu symptoms.

This combination of an increase in flu tests and an increase in prescriptions for antivirals suggests that health care providers have become more proactive about treating the flu. One reason could be a fundamental change in providers’ approach to flu, after the severe season of 2012-2013. An alternative explanation is that providers are aware of, and are responding to, one of this season’s flu strains (H3N2), the same strain that was predominant two seasons ago.



Given the increase in both ILI rates and flu treatment activity, we would not be surprised if this season has yet to peak. With next week’s flu update, we’ll provide state level maps, which we hope will be helpful as people embark on Christmas travel.

As always, your comments and suggestions are welcome and may be directed to athenaresearch@athenahealth.com, or to @IyueSung or @JoshGray_HIT on Twitter.

athenaResearch analyst Stewart Richardson generated the analysis for this report.


Analytics & Research

athenaResearch Weekly Flu Report: Pediatric Rates Surpass Last Season’s High


Iyue Sung, Director of athenaResearchOver the past two weeks, the athenaResearch team noted an uptick in national influenza-like illness (ILI) rates within the athenahealth cloud-based network. However, for the week ending this past Saturday, December 13, the increase in flu diagnosis has accelerated further. Based on our data from roughly one million patient visits to more than 20,000 primary care providers and 2,500 pediatricians, ILI rates are currently tracking at levels similar to 2012-2013, which was a particularly severe flu season. More alarming is a steep increase in pediatric rates, as shown in Figure 1.



These levels are driven by surges in the South and Midwest (shown in Figure 2), where pediatric flu rates have already surpassed last year’s peak levels and show no signs of abating. Although rates in the Northeast and the West are relatively modest, they are also higher than this time last year. Taken together, there appears to be a consistent pattern, across regions and age groups, of ILI rates moving towards a severe 2014-2015 flu season. The CDC warned of such potential on December 4, with one contributing factor being the mutation of this season’s predominant flu strain (H3N2). The trends for all four regions are illustrated below.



In an effort to improve our flu reporting capabilities and usefulness, we are making the data values underlying these graphs available to the public, and we invite you to review them. Throughout the season, we’ll continue to experiment and brainstorm on other flu data views that would provide new insight. As always, your comments and suggestions are welcome and may be directed to athenaresearch@athenahealth.com, or to @IyueSung or @JoshGray_HIT on Twitter.

athenaResearch analyst Stewart Richardson generated the analysis for this report.


Analytics & Research

athenaResearch Weekly Flu Report: Rates Continuing to Climb


Iyue Sung, Director of athenaResearchInfluenza-like illness (ILI) rates continue to climb, according to the most recent patient visit data from the athenahealth cloud-based network, containing more than 55 million patient records. This finding is consistent with the latest reports from our friends at Healthmap and the Centers for Disease Control and Prevention (CDC). In a related note, the CDC also issued a health advisory last week that one strain of the flu virus (H3N2) has mutated, which decreases the effectiveness of the flu vaccine.

Figure 1 shows a few interesting patterns. On a national level, ILI rates have been climbing for several weeks. But for the week ending this past Saturday, December 6, we’re seeing a slight bend, or a slower climb; similar patterns appear in the South and the Midwest.


Among the pediatric population (ages birth-18), national rates have also been climbing for several weeks, with a slight dip in the South (Figure 2). However, in the Midwest, rates for this season appear to have reached levels similar to last year’s peak.



Given the differences in rates between regions and age groups, it’s not clear whether this season will be mild, or we’ll see rates climb towards those experienced during the severe 2012-2013 season. As the height of flu season is fast approaching, we will, of course, continue to share our flu data throughout the holiday season. As always, your comments and suggestions are welcome and may be directed to athenaresearch@athenahealth.com, or to @IyueSung or @JoshGray_HIT on Twitter.

athenaResearch analyst Stewart Richardson generated the analysis for this report.


Analytics & Research

Flu Season Striking Early this Holiday Season


Iyue Sung, Director of athenaResearchAs many of us prepare to spend time with family and friends this week, you may want to think twice about sharing that slice of pumpkin pie with mom, or shaking hands with your brother-in-law — flu season has arrived.

Last week, we reported early signs of the flu season, based on patient visit data from the athenahealth cloud-based network. We track approximately one million visits per week to 20,000 primary care providers around the country who are on our EHR. Because athenahealth is a cloud based software and services provider, we are able to report on disease trends around the country with minimal delay. Our latest data (for the week ending Saturday, November 22nd) shows that influenza-like illness (ILI) rates are beginning to rise across the country (Figure 1).



Figure 2 shows that the increase is particularly high among children (birth-18). The percent of visits to pediatricians with a diagnosis of ILI increased from 2.8% to 3.5% last week alone. As a result, flu is more widespread among children this year than last and rapidly approaching rates seen in the difficult flu season of 2012-2013.



Among adults, flu is climbing most in the Midwest region, where we’re seeing a climb similar to that during the 2012-2013 season (Figure 3).



Continuing with data from the Midwest, pediatric rates of ILI run substantially higher than that of general population: 2.8% of pediatric visits in the week ended November 22 had a diagnosis of flu more than three times as high as the 0.8% rate seen with adults (Figure 4).



Pediatric ILI rates are trending highest in the South, where for the week ending November 22, rates reached 4.5%, up from 3.2% the previous week. Pediatric ILI visit rates peaked at 11.5% during the 2012-2013 flu season (Figure 5).



We wish you all safe travels this Thanksgiving week — but we also encourage everyone to keep in mind that influenza should not be taken lightly, particularly with the young and elderly. Please get vaccinated.

We will monitor our data and provide flu updates throughout the holidays. As always, your comments and suggestions are welcome and may be directed to athenaresearch@athenahealth.com, or to @IyueSung or @JoshGray_HIT on Twitter.

athenaResearch analyst Stewart Richardson generated the analysis for this report.


Analytics & Research

Have There Been Lower Vaccination Rates This Flu Season?


Iyue Sung, Director of Core AnalyticsNext week is Thanksgiving, meaning the official start of the holiday season — and the unofficial start of flu season. Reports of production delays for flu vaccines leads to this edition’s question: Have there been lower vaccination rates this year?

Fortunately, data from the athenahealth cloud-based network suggests that the production delays have had minimal impact. These estimates are based on approximately 43 million primary care visits nationally from 2012 and 2014, between the 30th and 46th weeks of the year (week 46 in 2014 ended November 16).

Figure 1 shows the percentage of patient visits that included a flu shot during the first 17 weeks of the flu season (roughly the end of July through November 15).


It appears that, for that period of time, vaccination rates are actually slightly higher this year compared to the last two seasons.

However, there are signs that influenza-like illness (ILI) rates are starting to climb, especially in the Midwest. Figure 2 suggests that the region might be headed towards either an early flu season, or flu levels that will fall between last year’s relatively mild outbreak and the severe levels of the 2012-2013 season.

Figure 3 shows that, on a national level, ILI rates are moving at a similar trajectory to last year’s trends.




Although Ebola has justifiably received tremendous disease surveillance attention this year, influenza has the highest associated mortality rate of any infectious disease, on the order of thousands of deaths each year. As the flu season unfolds, we will continue to monitor changes in ILI rates from physicians on our EHR, and report out on any noteworthy patterns.

Also, to support efforts to monitor and control this disease, we provide data (summarized to preserve anonymity) to researchers and public health departments interested in better understanding flu patterns. For example, healthmap.org uses athenaResearch data to anticipate trends in national ILI rates, and Columbus Public Health and the Cuyahoga Board of Health include our statistics in their weekly reports.

If you have a suggestion or comment regarding other ways we can put our data to good use in the service of public health, please reach out. And look for future flu trend reports right here.

athenaResearch analyst Stewart Richardson also contributed to this report.


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