(ARA) - An innocent life was lost when Robert Stevens, a 63-year-old Florida man, died last year of pulmonary anthrax. America and her citizens, still numb from the chilling September 11 attacks, were awakened to the horrific reality of weaponized bacteria. The silent killer had arrived unobtrusively, in an envelope delivered by U.S. mail. Today, public health officials at the federal, state and local levels are mobilizing to transform biosurveillance systems across the country, citing the critical need for cross-jurisdictional data integration to facilitate earlier and more rapid detection of potential biological dangers.

“Clinicians are now a pivotal part of the national bioterrorism defense,” says Dr. Rex Archer, director of the Kansas City, Mo. Health Department. “Our roles are as critical as that of the military. It may not be what we all signed up for, but we have all been drafted.”

A former military leader concurs. Dr. John S. Parker, a retired Major General now serving in the civilian sector as an executive for Science Applications International Corp. (SAIC), commented on the nation’s readiness and health care providers’ role in enhancing preparedness.

“Are we ready for a major chemical, biological or nuclear attack?” says the 37-year military veteran and biological defense expert. “We are. But it wouldn’t look like a symphonic triumph. With the integrated involvement of astute health providers with the requisite skill and training to diagnose and treat biological threats, we can do it better. It is health care’s knowledge base that will pick up atypical disease in the clinic or emergency department, and information technology that will facilitate the rapid recognition of such patterns.”

The nation has seen the emergence of several sophisticated biosurveillance systems in diverse organizations. In military and civilian hospitals, LEADERS (Lightweight Epidemiology Advanced Detection and Emergency Response System) and ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) are on watch. At the University of Pittsburgh Carnegie Mellon, RODS (Real-time Outbreak Detection System) is on guard. RSVP (Rapid Syndrome Validation Project) is at work in emergency departments in New Mexico. And, under the leadership of the Centers for Disease Control and Prevention, NEDSS (National Electronic Disease Surveillance System) is working to improve public health preparedness across the country. These are just a few examples of the growing recognition of information technology to better protect the nation’s health.

Such collaborative efforts are well under way in Kansas City, where Archer and his staff have served as fundamental contributors to the development of a biosurveillance system that more effectively captures health data to speed analysis and detection of potential health threats. In partnership with Cerner Corp., a developer of health care information technology solutions, the Kansas City Health Department sought to streamline and automate the data collection and review process, as well as facilitate cooperation and collaboration among area health providers to alleviate challenges that currently impede public health efforts.

The resulting solution, called HealthSentry, automatically collects critical biological information about disease outbreaks from health care organizations including hospitals, emergency departments, clinics and physician offices. For example, the solution analyzes laboratory tests ordered by doctors and the results of those tests, quickly assessing whether an unusual number of ordered tests indicate a potential outbreak. If a critical result is identified, the system automatically alerts public health officials by pager and e-mail. At any time, officials can log onto a secure Internet site to investigate cases. Once there, they can view reports and a geographic depiction revealing where the disease is clustered or spreading.

The network, launched in March, now links nearly two dozen health organizations in the greater Kansas City area. It has already collected and aggregated data related to more than 550,000 area patients and their more than 1 million health encounters since the system went live, resulting in the identification of 2,000 reportable isolates. The system’s paperless nature has increased reporting levels, improved accuracy and elevated timeliness.

In the traditional paper-, phone- and fax-based communications system of health care organizations, public health efforts, while diligently performed, often are simply too slow and reactive to be effective. Archer described a typical outbreak timeline, spanning exposure, incubation, self medication, a visit to a physician, physician actions, lab results, diagnosis, case report generation and case report receipt by public health. The process can easily take 12 days or more.

With the information technology system, officials can much more effectively capitalize on early warning signals, such as physician orders -- versus test results -- or the depletion of telling medications from pharmacy shelves. Such systems even have the potential to collect and analyze data from so-called “novel” sources, such as veterinary laboratories, retail supermarkets or business absentee records.

On average, the Kansas City Health Department’s network is detecting potential threats three days earlier than the traditional process, a critical improvement that can make a dramatic difference in the ability to protect a populace.

“Most biological weapons have been selected because, if you don’t start treatment before people are symptomatic, successive treatment has minimal impact,” says Archer. “Since biological agents take time to grow in the body and grow at different rates, some of the first people to become sick give us early warning signals for those who have been exposed but have not yet become ill.”

Courtesy of ARA Content