Health scare heads-up

Municipal, state and federal health agencies are devising a way to get warningsout earlier in emergencies such as bio-terrorism or the outbreak of a deadlydisease.

The Centers for Disease Control and Prevention, Atlanta, Ga., has paidfor local agencies to automate their operations as part of a five-year projectdubbed the Health Alert Network (HAN). With the Internet and e-mail, agenciescan send notices much more quickly, increase the number of key recipientsreceiving public health information and get help on the way sooner.

"The Internet has made it possible for health care agencies to streamlinetheir operations, and that is a change that we are encouraging," said KathrynSunnaborg, a public health administrator at CDC.

Historically, health officials relied on telephones or broadcast-faxsystems to deliver time-sensitive information.

The new network will eventually link local health care providers, policeand fire departments, municipal and state health departments, CDC and otherfederal agencies in a communications network.

CDC has granted money to help 37 states upgrade their information technologyinfrastructure. The agency is now focusing on how to deliver the messagesand expects to complete the project by the end of 2003.

A number of factors prompted the development of the network. First isthe ongoing threat of disastrous health problems, such as bioterrorism,improperly discharged chemicals and deadly food or water viruses includingE. coli. These problems cross city lines, state boundaries and nationalborders, yet often first appear at the local level.

Also, CDC and state and municipal agencies have long struggled to sharetheir research information on diseases such as cancer, diabetes and arthritis.And CDC wanted a way to electronically deliver materials to health officials— in a system that could support online training, among other things.

The project is expected to cost $1 billion over a five-year period.A combination of state, local and federal dollars will pay for it, withfederal support expected to cover 20 percent of the total, or $40 millionper year.

Constructing the network will be a significant undertaking. A CDC surveyin January 1999 found that 50 percent of local health agencies lacked high-speedInternet access. Forty-six percent did not have broadcast-fax capabilities,94 percent weren't prepared for bioterrorist incidents, and only 23 percenthad an emergency response plan to address issues such as bioterrorism.

The first phase of the program kicked off in 1999. It focused on improvingagencies' IT infrastructure.

CDC found a range of computer sophistication among the states. New Jersey,for instance, was ahead of the game. "The state has been quite aggressivein using technology to help improve agency operations," said Richard Matzer,a director at the New Jersey Department of Health and Senior Services.

In 1997, New Jersey built the Local Information Network and CommunicationsSystem (LINCS), which has goals similar to HAN's. A year later, the stateopened network connections at 24 county public health agencies and threecities: Jersey City, Paterson and Newark. Each was equipped with hardwareand software for Internet access and secure e-mail via a central servermaintained by the New Jersey Institute of Technology.

By 2000, each of New Jersey's 115 local health departments had connectedto LINCS. Last summer, the state health department used the network to relayinformation to local health departments concerning an outbreak of the WestNile virus.

"We find our new system a lot easier and much faster than telephonesor faxes, which we had relied on previously," said Daniel Regenye, LINCScoordinator at the Ocean County Board of Health.

Health care groups can also participate in the New Jersey ImmunizationInformation System, a statewide electronic registry of children and immunizationrecords designed to improve childhood immunization rates. State and municipalagencies are also developing a Community Health Alert and Information Network,which will connect public health departments with hospitals, laboratories,emergency responders, medical providers, schools and other community organizationsinvolved in public health incidents.

Minnesota was at the other end of the spectrum from New Jersey. Twoyears ago, the state surveyed 91 health agencies and found that 13 lackedbasic network functions, such as e-mail and Internet access.

"Funding is often an issue at the local level, and many of our agencieshad more pressing requirements than buying computer equipment," said MyrlahOlson, HAN coordinator for the Minnesota Department of Health. CDC gavethe state $670,000 so these agencies could upgrade their systems.

The Dakota County Public Health Department, which serves a populationof 325,000, was one of the recipients. The agency had Internet access, butmany of its local community providers, doctors and city agencies did not.

"We didn't have any easy way of relaying information to local healthcare providers," said Kathy Wick, disease prevention and control supervisorat the department.

CDC bought the department a broadcast-fax machine for $4,200. Now, personnelenter an alert once and it is automatically sent to every local agency.Previously, they had to contact each department individually.

HAN officials say their progress with local agencies has been note-worthy."There has been a high level of genuine enthusiasm among health departmentsabout the project," said Michael McGuire, HAN project manager at the OregonHealth Division. "It has not been a top-down, dictated mandate that theyhave been forced to carry out. They see the need and understand the potentialbenefits that HAN offers."

CDC helped 37 state health agencies, three metropolitan health departmentsand three Centers for Public Health Preparedness upgrade their systems.Also, CDC gave money and technical assistance to the Center for the Studyof Bioterrorism and Emerging Infections at St. Louis University's Schoolof Public Health. The school conducts research and provides training onpotential epidemics to the medical community and public health professionals.

Although much of the emphasis has been on infrastructure, health careagencies also have to put managerial checks in place to ensure that thesystem works.

CDC has been pushing local health departments to develop guidelinesfor the diagnosis, treatment and protective steps that should be taken inhealth emergencies. Agency officials are encouraging departments to do morethan just put procedures on paper — they want them to conduct simulationexercises so they understand how an emergency will play out. Most statesare just beginning this phase, which is an area of emphasis for 2001.

"We are meeting with local health care officials so they can help usdesign the proper notification procedures," said Oregon's McGuire, whoplans to oversee a test of the system by the end of the year.

The task is complicated because emergencies can happen at any time,so notifications must be deliverable 24 hours a day, seven days a week."We want to identify at least three persons at each agency so the likelihoodthat a notification will reach the proper person will increase," McGuiresaid.

Once those procedures are in place, then the issue will be maintainingthem. "We are encouraging state health departments to put checks in placeso they know of any changes among local administrators," CDC's Sunnaborgsaid.

Although the focus of HAN has been on slowing the spread of deadly diseases,the network has other potential uses. These include disease surveillanceand epidemiological investigation, electronic laboratory test reportingand professional workforce training through distance learning.

CDC has developed a handful of online training courses so health careadministrators can learn how to react to a health alert. At the 2000 PublicHealth Informatics-Distance Learning Conference, 500 public health professionalslearned about such programs, and more than 100 practitioners were trainedin the principles of public health informatics.

CDC is developing a certification program to ensure that health careprofessionals have the skills to conduct effective responses to bioterrorismand other high-priority health threats.

"While we are pleased with the progress to date, we are looking forwardto completing the network so health care organizations will be better ableto respond to any health emergency," Sunnaborg said.

Korzeniowski is a freelance writer in Sudbury, Mass., who specializes intechnology issues. He can be reached at [email protected]


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