System serves as bioterror sentry
- By Dibya Sarkar
- Jul 29, 2002
New York City Department of Health and Mental Hygiene
Right after the attack on the World Trade Center last September, the Centers
for Disease Control and Prevention sent physicians trained in epidemiological
outbreaks to New York City. For several weeks, the physicians, stationed
in emergency rooms throughout the city, monitored individuals coming into
the ERs around the clock.
"At that point we didn't want to rule out a [bioterrorism] payload facilitated
with the World Trade Center," said Ed Carubis, the city Health Department's
chief information officer. "But that model is pretty resource-intensive
and difficult to sustain for a long period of time. So when [the CDC physicians]
pulled out in October, we needed to replace it with another method for continuing
on this surveillance activity in emergency rooms."
The Health Department, in conjunction with technology from local company
Information Builders Inc., is developing a sophisticated surveillance mechanism
able to receive complaint data, such as fever, rash or even a broken leg,
from the emergency rooms of 38 hospitals in any electronic format. The system
then standardizes that information and analyzes it with customized algorithms
to spot potential problems.
The system, being rolled out in phases, also collects data from point-of-sale
purchases from a major pharmacy.
"It's really about looking at what information is available out there
now in existing databases that if we have access to and are able analyze
it, it can potentially be used to give us somewhat of an earlier warning
of possible disease outbreaks in the city," Carubis said. "So if something
of a [bioterrorism] nature were to occur, we could use this system to give
us an early indicator, allow us increased surveillance, and begin to investigate
more closely geographically what may be going on."
Three years ago, the Health Department, in collaboration with the New
York Fire Department, began piecing together a surveillance system by collecting
911 emergency call data to look for "hot spots" by location.
"It does probability analysis on whether that spike of increasing cases
geographically is statistically significant and a cause for follow-up,"
Carubis said. "We've been able to use this information for the past three
years to predict the onset for flu season in New York City by about two
weeks earlier than the traditional surveillance methods."
After Sept. 11, the Health Department began reaching out to hospitals
to capture their emergency room data. Carubis said it wanted to be flexible
in terms of how it received information from the hospitals, which have different
systems, to encourage reporting.
With Information Builders' iWay Software, hospital IT departments send
complaint data via the Web through a variety of formats, including Microsoft
Corp. Excel spreadsheets, Extensible Markup Language documents and other
standards, using different transport protocols, such as FTP and Web services.
He said such information and its analysis has helped spot potential
disease outbreaks earlier than with traditional methods.
"Then as we move to the use of pharmacy data, we're pushing the bar
back even further to the point where someone may not yet be feeling ill
enough to go get medical attention at an emergency room or even their own
physician but are trying to self-medicate by purchasing over-the-counter
medication," he said. "The system's value is not only in looking for potential
spikes or increases but also when other traditional methods of surveillance
are indicative of an outbreak, we can go to the system now as a resource
to rule out potential community exposure."
Carubis said the city is working with other health jurisdictions for
a regional model and may try to collect additional datasets, such as tying
into attendance systems of major employers in the city.
He said the city would continue to expand the program, adding other
hospitals and possibly other providers to the system.