The Centers for Disease Control and Prevention (CDC) has awarded a $1.2 million grant to a consortium of investigators and health care organizations for a national bioterrorism “syndromic surveillance demonstration program,” a kind of computer early warning system that initially will sweep, in real time, 20 million patient records in all 50 states for clusters of symptoms associated with bioterror agents.
“Several federal, state, and local organizations, as well as health plans, practice groups, and hospitals, have been developing bioterror-event early detection systems pre- and post-Sept. 11 and the anthrax letter mailings,” says the grant’s principal investigator Richard Platt, acting chair of the Harvard Medical School and Harvard Pilgrim Health Care Department of Ambulatory Care and Prevention (DACP). “Initially, most bioterrorism-related illnesses have symptoms, like coughing, that can’t be distinguished from the flu or other common infections. Therefore, the first sign of a bioterrorism attack might be an increased number of people who call help lines or contact their primary care doctor for these common symptoms. The CDC grant will allow our consortium to coordinate efforts to recognize such increases, building a platform that will also allow other health systems to join.”
“The demonstration program will include a rapid response capability to notify public health officials of unusual occurrences as soon as the information becomes available,” says Julie Gerberding, director of the CDC. “The results of this project will help us more fully develop systems that extend our capacity to detect and respond to a terrorism attack at the earliest possible moment, while ensuring appropriate care to all patients.”
The consortium includes Massachusetts-based Harvard Pilgrim, a managed health care organization through which the grant will be administered; Harvard Vanguard Medical Associates, a large, private group practice; as well as Harvard Medical School faculty at DACP and Brigham and Women’s Hospital. Also included are Minnesota-based HealthPartners Research Foundation, the research wing of the similarly named health plan, medical group, and center for health promotion; and Optum, a diversified health care company that will provide its experience with its national nurse telephone triage and health information service. Kaiser Permanente of Colorado, a member of Kaiser Permanente’s nine-state health maintenance organization network, and the Washington, D.C.-based American Association of Health Plans, are also equal members of the consortium.
Four of the consortium members – Harvard Pilgrim, Harvard Vanguard, HealthPartners, and Kaiser Permanente, Colorado – currently operate regional syndromic surveillance programs or have surveillance programs for particular diseases, using health plan data, and many of their systems operate using some of the same general principles. The computer systems begin by examining daily patient complaints and diagnosis codes, which indicate the illness that’s being treated. The systems then search for upper and lower respiratory illnesses, rashes, fevers, neurologic events, and sepsis – health conditions that are early symptoms of bioterror agents. Each day’s results are compared to historical records to identify unusual numbers or geographic clustering. For example, a sudden spike in chest colds on a day in October is compared to the same relative time period going back several years to see if a similar pattern exists or if this event appears to be an anomaly. The data is then sorted by neighborhood to determine if a high number of reported illnesses are coming from one particular town or office.
The consortium will collaborate with the CDC, state and local health departments, the Department of Defense, and other organizations currently developing similar systems. Their goal will be to develop data extraction and reporting protocols common to all institutions and to facilitate the participation of other health plans and medical groups that possess real time encounter level information.