Bioterrorism Alerts: Immune Systems

Health officials are working toward a sophisticated IT network that could detect the early warning signs of bioterrorism, whether it's inhalation anthrax, smallpox, pneumonic plague or something else entirely.

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In those programs and dozens of similar ones in the works, there's more than a little braggadocio involved. "This one's the best," Zelicoff says, by way of greeting this reporter when I called for an interview.

And there's more than a little overlap too. "I see a lot of efforts out there that are redundant," McLamb says. "If people who are doing the same thing would get together, they wouldn't have to reinvent the wheel."Pocketbook PersuasionWith so many projects being developed by so many entities, the ultimate success of any national bioterrorism surveillance system will depend on one thing: whether those systems can ever talk to each other. And if there's one thing that everyone involved agrees on, it's the need for standards.

The federal government has taken one big step in that regard. In March, the U.S. Department of Health and Human Services along with the departments of Defense and Veterans Affairs jointly released the first set of uniform health information standards for exchanging clinical data electronically across the federal government. When developing new systems, all federal agencies are now obligated, among other things, to use the Health Level 7 messaging formata set of drug-ordering guidelines already adopted under HIPAAand a group of codes for laboratory results.

Ultimately, though, public health is a very local activity. It's you, your doctor, your exam room, your lab test results. When it comes to reaching the state and local health departments that interact with all the players, the federal government has a lot less control than one might expect. "Typically, if there's an outbreak of a disease at the local or state level, they will handle it locally or invite the CDC in on an as-needed basis," the CDC's Seligman says. "We offer our assistance, but ultimately it's their call."

The one way that the federal government does have power to persuade is with its pocketbook. And that's where the CDC's National Electronic Disease Surveillance System (NEDSS) comes in. This system lays out a sort of meta-standard for both health-care information and IT standards. All state health-department systems must be NEDSS- compatibleat least they do if they want a piece of the $918 million in bioterrorism grants that the CDC is handing out this year.

This pocketbook persuasion could pave the way for electronic medical records in the health-care industry. "These standards that make national disease surveillance work are the same standards that we'll need if we're going to move forward to a day when you can ask a doctor to send your medical records electronically to a new doctor," Gartner's Klein says. But the work also highlights just how difficult the journey will be.

Pennsylvania is one of the few states that has already adopted the system. There, the state Department of Health built a NEDSS-compliant application that allows doctors to go to a secure website to report a disease. As soon as a doctor hits "save," the information is available to public health investigators.

Development was no small task, says Mary Benner, CIO and IT director for the Pennsylvania Health Department. The state had to consolidate some 6,000 data fields from 100 forms to 600 actual data elements in the database, and also work out problems with providers on antiquated operating systems trying to use the digital certificates that enable secure, encrypted communications.

Now, the biggest challenge is getting doctors to register. Since July 1, when the system went live, the department has received 57,000 cases of reportable diseases electronically. It also gets several hundred reports a week in paper form. "Some [doctors] are very enthusiastic, and others don't have a computer in their office and don't want one," Benner says.

With that kind of reluctance and the ongoing challenge of getting the industry to adopt a set of standards, a national bioterrorism surveillance system seems far off, indeed. Right now, truly effective public health surveillance must await the resolution of a national debate on how homeland security will play out in a country that has always prided itself on its freedoms. And that debate will increasingly depend on how well technology balances the public's need to know with the individual's right to privacy.

"We have to decide as a nation how much security and privacy we need when those two things are in a trading relationship," says Pittsburgh School of Medicine's Allswede. "What we're doing in terms of information technologyand where it has to progressis a microcosm of that larger sociological change."

Copyright © 2003 IDG Communications, Inc.

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