System serves as bioterror sentry

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.

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