Cutting-edge system spots outbreaks before you do
Experts agree that the ED is on the front lines of tracking a possible bioterrorism attack, but until now, that tracking has depended on individual clinicians reporting their suspicions. New cutting-edge technology allows ED computer systems to tie into a public health network, according to William H. Cordell, MD, director of research for the department of emergency medicine at Indiana University and faculty physician at the Emergency Medicine and Trauma Center at Methodist Hospital, Clarian Health, both in Indianapolis. Cordell also serves as a consultant for Cincinnati-based New Wave Software, which has developed the Trip Wire Public Health Network.
According to Cordell, Trip Wire will provide a "missing link" to the existing public health infrastructure: the ability to monitor EDs in real time. "The network is ready to go today and could be rapidly installed and linked to existing public health computer networks," he reports.
Although the system has been presented to local, state, and federal public health agencies, the developers are waiting for funding to partner with public health agencies so pilot testing can begin.
To be used effectively, the software must be sponsored by a public health agency such as the Atlanta-based Centers for Disease Control and Prevention or a state board of health, says Lev Milaychev, president and CEO of New Wave Software. "The scale of this project is beyond the reach of an individual hospital because it requires government support and coordination," he explains.
Here are some benefits of the system:
• Clusters of illness can be monitored instantly.
Data already entered into ED computer systems, such as chief complaints, vital signs, and diagnosis codes could be sent to central public health monitoring systems, with identifying information deleted, Cordell explains. "Geographical areas could be monitored for clusters of illness, which could trigger further investigation by public health agencies," he says.
• Clinicians don’t have to enter any additional data.
Clinicians are inconsistent in actively entering data, Cordell says. "Consider the unreliability of the reportable disease mandates."
The system uses data already entered as part of patient care, analyzes trends, and automatically notifies authorities, says Milaychev. "The initial symptoms of some known and potentially some future bioweapons resemble those of the common flu," he notes. "So individual ED physicians will not realize the trend from the statistical pool of patients seen during a day, or even a period of several days, but the system will." For each given attribute such as "high fever," the system will monitor increases and alert public health agencies as needed, he explains.
• Communication between ED staff and public health is facilitated.
The system would allow messages to be broadcast to ED physicians and nurses, should a public health emergency arise, says Cordell. "For example, central monitoring agencies could flash a message on the screen that there is a cluster of more than 100 fevers in Anderson, IN. They could request that 10 tests for influenza and anthrax be obtained and mailed overnight to a central lab," he says.
All EDs in the network can exchange messages and information, Milaychev explains. "For example, the CDC can send a new symptom identification diagram to the whole network, or it can notify all neighboring counties if specific cases or trends have been spotted in the area," he says. If there were a chemical spill on the interstate at a given city, information about the chemical, the decontamination procedure, and the treatment could be broadcast to the affected community EDs, he says.
Because clinicians are constantly interacting with the ED computer network, they instantly would see the alert messages on their screen. "It would hit them in the face,’ as opposed to faxes or e-mails that may be missed for days or not picked up at all," says Milaychev.
• A public health network infrastructure could be established.
Today, the need is bioterrorism, Cordell says. Tomorrow, it could be an emerging infection," he says. "We need a network throughout the country that can track these things in real time." He points to existing systems that send laboratory data to public health agencies, such as the Regenstrief Indiana Passive Surveillance System, a network of EDs developed by the Regenstrief Institute at Indiana University School of Medicine. The system receives data from 11 EDs in central Indiana, comprised of 369,000 visits each year, and tracks laboratory results to check for infectious conditions such as smallpox and tuberculosis.
Marc Overhage, MD, associate professor of medicine at the Indiana University School of Medicine, says, "If the result indicates that one of these conditions is present, the system adds information about previous conditions that the patient may have had and how to contact the doctor who ordered the test, and sends it to the local and state public health departments."
Laboratory information is critical, but there is a time lag, argues Cordell. "What is missing is front-line clinical information, such as symptoms like diarrhea, fever, or skin vesicles, that might be a harbinger of a smallpox attack," he says.
Sources
For more information about Trip Wire, contact:
• William H. Cordell, MD, Emergency Medicine and Trauma Center, Methodist Hospital, 1701 N. Senate Blvd., Indianapolis, IN 46202. Telephone: (317) 962-8035. E-mail: [email protected].
• Lev Milaychev, New Wave Software, 10921 Reed Hartman Highway, No. 237, Cincinnati, OH 45242. Telephone: (513) 745-9700. Fax: (513) 745-0591. E-mail: [email protected]. Web: www.newwavesoft.com.
• Marc Overhage, MD, Regenstrief Institute for Health Care, 1050 Wishard Blvd., Indianapolis, IN 46202. Telephone: (317) 630-7400. E-mail: [email protected].
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