Time and budget constraints hamper efforts to track unusual medical symptoms
Marianne Kolbasuk McGee, InformationWeek
The bureaucracy is the main problem regarding the warning system, says Eric Koskov
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In the week that the US invaded Iraq, fears about biological terrorism increased, but it turns out that a national system that would monitor phenomena that may indicate a biological terrorist attack is still a distant vision in the US.
Various factors in the health system have indeed made progress in the development of warning systems at the local and regional level, such as computerized reporting networks that present health professionals with data regarding patterns of symptoms that have been discovered in patients and may result from exposure to a biological or chemical agent, or from the natural development of an epidemic. But adoption of these systems is patchy at best.
The two main reasons for slow adoption are time and money. The hospitals, the local government and the state governments operate according to tight budgets, which leave little room for development. "Unfortunately, unless a disaster occurs in their backyard, or unless the federal government steps in and requires these systems to be equipped, these efforts will be rare," says John Hummel, chief information officer at Sutter Health, which operates 33 hospitals in California. Time is another problem: doctors and nurses are not keen on devoting any more time to data entry, so even the best systems lack up-to-date data.
Medical information researchers are developing some promising systems, but actual national standards for data collection and analysis have not yet been established, and it has not even been determined what data should be analyzed. Is the most reliable index made up of data from emergency rooms, family doctors or pharmacies?
In Massachusetts alone, several projects are being worked on to monitor bioterrorism. Over the past 18 months, public health officials in eastern Massachusetts have tracked symptom patterns among 100,000 people seeking medical treatment at the Harvard Vanguard Medical Associates clinic in Boston. They used a system developed by the Harvard Consortium – a group of researchers authorized last year by the federal Centers for Disease Control and Prevention to develop a system that could serve as a national model. The model will also be implemented in two other large medical centers in other countries. Currently, researchers at Boston Children's Hospital and other hospitals are developing recognition systems that will analyze other streams of data. They have been authorized by federal authorities to work with other children's hospitals across the country to determine how best to identify symptoms of biological agent exposure in children.
Last week, Kaiser Permanente HMO unveiled a surveillance system being used at two Southern California facilities to help San Mateo Country Health officials identify bioterrorism. Kaiser is interested in operating the system in additional facilities, in California and abroad, if the health ministries also agree to use the system. "The bureaucracy involved in these systems is the biggest obstacle," says Dr. Eric Koscove, director of the emergency department at Kaiser Permanente Medical Center in Santa Clara. Kaiser Permanente's system is based on the Rapid Syndrome Validation Project, a system developed by Sandia National Laboratories and tested in several countries.
Dr. Alan Zelicoff, the Sandia scientist who invented RSVP, says that the lab is negotiating with a medical information company about marketing the system to state health departments. This could be another step towards the adoption of a national technological standard and the operation of a national network.
For information in Information Week
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