eHealth plans national health network to fight epidemics like SARS

A consortium of public health agencies, hospitals, health care plans and medical IT systems vendors is working to create an automated early warning system to fight epidemics of new diseases such as severe acute respiratory syndrome (SARS) as well as provide alerts of bioterrorism attacks.

While some cities such as New York developed such systems after the Sept. 11, 2001, terrorist attacks, the U.S. as a whole lacks a cohesive, standards-based system, according to Janet Marchibroda, CEO of the Washington-based eHealth Initiative Inc., which represents the health care-based consortium. But eHealth hopes to change that soon.

In June, eHealth and the New York-based Markle Foundation will kick off a three-month test of a Web-based National Healthcare Collaborative Network designed to electronically collect patient data from hospitals and automatically distribute it to public health agencies.

Nine hospitals from across the country, along with a number of local, state and federal agencies, plan to participate in the project, she said. Roughly 80% of the vendors in the health care industry also plan to participate.

Dr. Russell Ricci, general manager of IBM's global health care division, said automated syndromic surveillance -- the ability to capture information about symptoms such as high fever and respiratory problems -- would be a key component of the pilot project. Besides emergency room data, Ricci said, the program will also work to capture information about sales of over-the-counter medicine, because "drug store chains know a flu epidemic is coming before emergency rooms, based on the sales of tissues," Ricci said.

According to Ricci, the pilot project will show how sophisticated data mining techniques can be applied to the health care industry, which doesn't have an automated system to gather such key public health indicators. Ricci said the project would also demonstrate how to tie together stovepiped hospital information systems using industry-standard, off-the-shelf tools. Those tools are essential for the exchange of data in an industry replete with systems that can't share data with one another, he said.

Dr. Seth Foldy, health commissioner of the city of Milwaukee, welcomed the eHealth pilot project but said, "this is not going to be easy. ... Maybe eHealth can build a business case and demonstrate that it is possible."

Early warning syndromic surveillance systems provide information that diagnosis-based systems can't, he said. Diagnosis-based systems can often take days -- too late to provide an early warning of a coming epidemic. By contrast, syndromic systems can discern a problem much earlier, Foldy said.

Tracking SARS

Currently, Milwaukee uses a Web-based syndromic surveillance system that is part of emergency room management software developed by two organizations: the Frontlines of Medicine Project in Mequon, Wis., a nationwide collaboration of emergency physicians and medical informatics specialists, and the EMSystem division of Infinity Healthcare, also in Mequon.

Foldy said Frontlines added a SARS Surveillance Program (download PDF) to its emergency room system earlier this month. The program illustrates how the national system envisioned by eHealth might work.

The SARS component consists of a Web-based form, which emergency room personnel download to track and record SARS-types symptoms as well as recent travel by patients to SARS areas, such as China. If a patient has SARS-type symptoms and has recently traveled to areas where SARS outbreaks have occurred, they are instructed to call the state health department immediately, Foldy said. At the end of each day, hospitals upload the data they collect to the health department.

Dr. Ed Barthell, chief medical officer for EMSystem, said hundreds of its users in 28 regions across the country have downloaded the form. Infinity provides application service provider-based emergency room software to major cities such as Denver, Phoenix, Minneapolis and Orlando. EMSystem clients access information through a J2EE Web browser, with information stored in an Oracle database housed on both Intel- and Sun-based servers, Barthell said.

Tigi Ward, an epidemiologist and the public health coordinator for surveillance in the Lubbock, Texas, public health department, learned earlier this year the value of the city's syndromic surveillance system, the Rapid Syndrome Validation Project (RSVP) (download PDF), developed by Sandia National Laboratories, in Albuquerque, N.M.

In January, a researcher at Texas Tech Health Sciences Center reported that 30 vials of plague bacteria in his lab were missing. Though the researcher later admitted inadvertently destroying the vials, the incident raised fears of a potential bioterrorism attack.

Ward said she quickly turned to RSVP -- a PC-based program installed at the health department and emergency rooms throughout the city. Checking the symptoms reported by RSVP, Ward said she quickly determined that "the community was not at risk."

"I start and end my day with RSVP, because it quickly gives me the electronic lay of the land," she said.

Ward said the RSVP software -- also in use by public health departments in Massachusetts, New Hampshire, New Jersey, New Mexico and Texas -- allows her to quickly scan symptoms reported by emergency room physicians, alerting her to "unusual" occurrences within specific areas.

Bioterrorism fears push New York to act

Fears about a bioterrorism attack impelled the New York City Department of Health and Mental Hygiene to develop its own syndromic surveillance system (download PDF) shortly after the attacks on the World Trade Center, said Rick Heffernan, director of data analysis in the Department's Bureau of Communicable Diseases. While hospitals in New York had information that could provide an early warning of a bioterrorism attack, the information was so isolated that "people were seeing the trees but not the forest," Heffernan said.

With backing from the New York-based Sloan Foundation, the city scrambled to set up a syndromic surveillance system, which started to electronically gather information from emergency rooms citywide in October 2001, he said. Now, the system can capture data from 74% of the hospitals in the city and 2.4 million emergency room visits a year.

Unlike Milwaukee, New York has automated what Heffernan calls "data harvesting" so clinicians don't have to manually send data to the health department. In fact, 40 emergency rooms transmit their data using file transfer protocol.

But raw data needs analysis, and for that Heffernan said New York turned to SatScan software originally developed by the National Cancer Institute to track cancer clusters geographically. New York runs the small SatScan program as an executable file within a health department statistical software package from SAS Institute Inc. in Cary, N.C. SatScan takes emergency room data and plots it by ZIP code, allowing health officials to zero in on clusters of symptoms that could indicate an epidemic or bioterrorism attack long before traditional methods, Heffernan said.

New York's syndromic surveillance system is so powerful, Heffernan said, that if the SARS outbreak had first occurred there instead of Asia, the city would have had a good chance of identifying it long before hundreds of sick patients started to flood emergency rooms.

Copyright © 2003 IDG Communications, Inc.

7 inconvenient truths about the hybrid work trend
Shop Tech Products at Amazon