Beyond avian flu - biosurveillance's daily impact onimproving community care

With the nation focused on pandemic flu preparations, federal government officials are calling for a nationwide biosurveillance network to help identify a public health threat in real time. While few doubt biosurveillance can play a critical role in an outbreak, emergency departments are underfunded and overcrowded, pushing biosurveillance to the bottom of the technology wish list. But a closer look reveals that biosurveillance technology can make an immediate impact on public health, patient care, wait times and the bottom line.

In the wake of 9/11, the U.S. Department of Homeland Security (HS) and the Department of Health and Human Services (HHS) have been especially active in promoting the need for information networks to monitor, prevent and counteract epidemics-called "biosurveillance," "syndromic surveillance systems" or "disease surveillance networks.'' Information networks are crucial tools, enabling health officials to foresee potential outbreaks before they have a widespread effect on a population.

In recent years, three events in particular have elevated the need for biosurveillance technology. One is the 2001 anthrax attacks in the United States, which were an important factor behind the 2002 Bioterrorism Act. The other event that has made the need for alert and response systems more urgent was the 2003 SARS epidemic. While SARS barely deserves the title of 'epidemic' when compared with AIDS and tuberculosis worldwide, the condensed time it took to spread from China to Canada made it a perfect case study for next-generation alert and response systems. Finally, the ongoing threat of avian flu as a pandemic has galvanized governments and health agencies worldwide to improve the reporting of potential infectious diseases.

State preparedness funds are limited and spread across many activities falling under the "disaster preparedness" heading, leaving little money for activities seen in many hospitals as necessary, but low value.

But many current initiatives face a perception problem among clinicians and hospital staff. The obvious benefits of detecting pandemic flu and bioterrorism attacks are clear. Public officials are calling for a grand initiative to develop a large-scale surveillance system with little regard for the implications of such an initiative on an already overwhelmed healthcare system.

Hospital IT staffs already are overworked, dealing with the ramifications of HIPAA legislation and electronic medical record initiatives, leaving little enthusiasm for another massive project that appears to have minor day-to-day payoff to the hospital. The key to making a national biosurveillance network useful on a daily basis is to develop systems that provide useful short-term benefit to the facilities.

Emergency department administrators across the country are challenged with serving public health needs while simultaneously preparing their departments for disasters and keeping costs down. Since staff in the department are frequently overworked because of medical and nursing shortages, it is difficult for them to notice a change in patient populations. By the time the change is recognized, it is often too late to attempt prevention or prepare for the influx of patients. Emergency departments often do not have information in real time that will help them to determine potential public health emergencies for purposes of prevention and preparedness.

Hospitals in Chicago are among those leading the nation in biosurveillance programs, with the roots in Chicago's 1995 heat wave. A retrospective study found that emergency departments across the city had seen an increase in heat-related emergencies three days before it was noted to be a public health emergency. Officials determined that if the information had been available in real time, hospitals could have reacted immediately by alerting public health officials, preparing for the increased numbers of heat-related patient emergencies and preventing deaths.

Soon after, public health officials and the city's emergency room physicians began working with healthcare technology company Picis to develop a system to gather important data from emergency departments in real time. The data, which could be accessed by heads of emergency departments and by public health officials, provides important decision making data that goes beyond epidemiological, to include resource management, staff safety and public notification.

So what's the use of a biosurveillance monitoring system when not detecting once-in-a-lifetime pandemic events? Emergency physicians with the systems stress the system's utility to address important aspects of departmental operations on a daily basis, including the technology's ability to address the most pressing issues in the department: overcrowding and wait times.