CDC calls public health IT a 'pony express' system

Computerworld - The nation's public health IT infrastructure is so antiquated that in March, the Centers for Disease Control and Prevention likened it to a "pony express" system that relies on paper-based reports and telephone calls in a world driven by the speed of e-mail and the Internet.

Despite years of warning about the possibility of bioterrorism attacks, when the first one occurred on Oct. 4, only half of the country's 59 state and territorial health departments and 6,000 state and local health departments and boards had full-time Internet connectivity, according to a report (download .pdf) on the public health infrastructure by the Atlanta-based CDC. Another 20% lacked e-mail, according to the agency.

Dr. Paul Weisner, director of the Board of Health in DeKalb County, Ga., which includes Atlanta, views a robust IT infrastructure as critical to managing a bioterrorist attack. "Early detection and response is critical, and it all hinges on communications and information technology," he said.

The CDC tapped DeKalb County for a pilot project to enhance the capabilities of the nationwide Health Alert Network, a secure system intended to eventually connect all public health departments with the CDC. But Weisner said his agency lacks the kind of basic technology provided by Atlanta-based United Parcel Service Inc. to help its customers track packages. "We need to get into the modern age of communications," he said. "UPS lets you track a package in real time, but I can't track my emergency room patients in real time. Instead, I have an icon on my desk here that only gives me an update every 24 hours."

Dr. Rex Archer, director of the Kansas City, Mo., health department, said real-time information is needed to track not only emergency room visits, but also other indicators that could signal the spread of a natural or deliberate outbreak of disease. He wants systems to track indicators such as high levels of absenteeism and pharmacy visits and then rapidly collate it. The public health system also needs to be able to correlate information from examinations of "a hundred patients" exhibiting the same symptoms so that it can respond to the kind of crisis the nation faces today, he said.

But, Archer added, the public health infrastructure is "woefully inadequate"' to handle a major crisis, due to inadequate funding, which has restricted the deployment of systems that public health professionals need.

For example, the CDC has started to deploy a secure information system called the Epidemic Information Exchange (EPI-X), which uses digital certificates to ensure the privacy of data. But deployment of the full-scale EPI-X system has been restricted to the state level, leaving Archer with a read-only terminal. Archer said he needs the full-scale capability of EPI-X today.