In Montana this week, officials conducted a statewide test that used telemedicine to determine the state's bioterrorism readiness. In North Carolina, emergency departments are sending data real-time to state and local public health epidemiologists to monitor potential disease outbreaks. Meanwhile, the federal government is working on a system that can instantly track the number of beds available at hospitals in a community. These are just some of the examples of information technology's role in monitoring diseases and bioterrorism that a group of panelists presented Wednesday on Capitol Hill.
On the national level, the government has developed a free resource through the National Library of Medicine that can help emergency workers quickly identify various substances and the symptoms that may appear in patients exposed to them. Emergency workers can use a wireless device to access information on various hazardous substances, which can be accessed by name, color, odor or other indicator. The WISER resource, which is currently available in a prototype version, can be accessed on Palm handhelds, on laptops or via the Web. The NLM plans to make a version available for pocket PCs.
Meanwhile, the government is also utilizing global information systems technology to help detect potential health threats and monitor outbreaks. GIS can help allocate resources, track demographic data and give public health officials a better understanding of the communities where a health threat may occur, Bill Henriques, GIS coordinator for the Agency for Toxic Substances and Disease Registry, told congressional staffers and other participants at the Steering Committee on Telehealth and Healthcare Informatics. For example, if a local creek had high levels of lead, officials could use GIS technology to determine how many children live in the area that might be affected. Another use of GIS technology involves monitoring blood supplies and hospitals' bed capacity, which would help guide public health officials during an emergency.
Although the government does not yet have a way to monitor hospital bed capacity in real-time, it does have a system that would automatically e-mail hospital administrators to determine their current bed capacity, Henriques said. The government also is working on a system to help track SARS outbreaks.
At the state level, health officials are working on the North Carolina Emergency Department Database, a system that collects information daily from participating hospitals. The information includes patients' conditions, symptoms, diagnoses and other relevant data, which is sent online to a central repository where the data is standardized. State public health officials use the information for surveillance. Currently, 12 hospitals in the state are participating, but that number is expected to reach 15 by the end of the month, according to John McLamb, chair-elect of the Health Care Information and Management Systems Society's National Preparedness and Response Task Force. The system, which tracks an average of 800 daily visits, does not require hospital EDs to do any extra data entry, said McLamb, who is also director of informatics at the University of North Carolina Medical Center.
Other states and cities have developed or are developing similar systems. Fourteen hospitals in the Cincinnati area will participate in a system that monitors ED patients to help health officials track signs of a bioterrorist attack. The alert network is expected to be ready in July.
Meanwhile, Sen. Kent Conrad (D-N.D.) on Wednesday unveiled a plan that would encourage the use of telehealth to respond to terrorist attacks and other public health emergencies. The bill would create a task force to advise the government on the technical, medical and logistical barriers to creating a national emergency medical telecommunications network.
The legislation, called the National Emergency Telemedical Communications Act of 2004, would also authorize $150 million over three years to several states to create regional telehealth systems. The systems would link emergency first responders with public health departments, hospitals and experts on bioterrorism and other relevant disciplines. The systems would then gather information and send up-to-date alerts to first responders and other health care providers. Conrad has not yet introduced the bill, according to a spokesperson for the senator.
Despite the increased focus on biosurveillance, some in the health care community have questioned the efficacy of such systems. A recent study in the Annals of Internal Medicine found that "few surveillance systems have been comprehensively evaluated," and that "clinical and public health decision making based on these systems may be compromised" (Bravata et. al, Annals of Internal Medicine, June 2004).