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The Biosurveillance Evolution
February 2007
In the emergency department at Rush University Medical Center in Chicago, staff at the triage desk enter a patient's chief complaint and demographic information into the emergency department information system. The complaint and selected demographic information such as sex, age and ZIP code, then are transmitted to a biosurveillance module within the ED PulseCheck system from Picis Inc., Wakefield, Mass.
The module, which Rush co-developed four years ago with the vendor, automatically categorizes the chief complaint as one of eight broad medical conditions. Vomiting or abdominal pain, for instance, is placed in the gastrointestinal illness category. The module then conducts a trend analysis of data, looking for unusual patterns, such as a spike in a specific condition within a localized region.
If a suspicious pattern, such as increased incidents of respiratory diseases, is found, an e-mail is sent to Julio Silva, M.D., associate clinical chairman of the department of emergency medicine at Rush.
Silva will pull up a graphical presentation of the data and decide if a call to the Chicago Department of Public Health is warranted. If called, the department will launch an investigation, as it did in 2005 when Rush identified a spike in gastrointestinal illnesses. In that case, complaints from several of the patients, it turned out, were from recent surgeries and not communicable diseases.
Three years ago, however, the biosurveillance done at Rush detected the onset of the flu season more than two weeks sooner than public health officials typically would have noticed, Silva says. "The sooner we have the information, the quicker we can act."
A hospital with early notice of a disease outbreak or bioterrorism event can ramp up supplies and staff, delay vacations, implement policies to discharge patients in the morning if possible to free up beds, and disseminate information to other hospitals, health agencies and the media.
Terrorism protection
Biosurveillance and its role in protecting the nation against terrorist attacks was a major factor in the Bush administration's push to build a national health information network and for congressional support for federal seed money for the project.
Some experts believe the deployment of biosurveillance networks is a precursor to a national health network because standards to promote connectivity between providers, public health agencies and emergency responders also are applicable to the NHIN.
But three years after President Bush announced plans for a national health information network-and five years after the anthrax attacks hit a nation already traumatized by the Sept. 11 terror attacks-biosurveillance activities remain in the early stages of development.
Many emergency departments collect chief complaint, syndromic and demographic data and transmit it to local and state health departments; a few send the data to the U.S. Centers for Disease Control and Prevention in Atlanta. Much of the data sent is not real-time or near real-time, and often is faxed to health agencies to be entered into computer systems.
Also, the information systems of local, state and federal health agencies do not interoperate, causing further delay in detection of natural disease outbreaks or bioterrorism.
Despite a "strong probability" of pandemic disease or bioterrorism, early detection remains difficult, says Elin Gursky, senior fellow at ANSER Institute for Homeland Security in Arlington, Va. The federally funded research center advises the Department of Homeland Security.
Information technology networking in the public health arena "still has a ways to go," Gursky notes. "An acute awareness culture among physicians also has a ways to go."
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