Last Updated

10 Jun 2003

Source: USA Today,  Nov. 2, 2001

Congress considers updated disease-warning systems

By Steve Sternberg, USA TODAY

WASHINGTON — If an astute Florida doctor hadn't figured out that tabloid photo editor Bob Stevens had anthrax, many more unwitting people might have died of the disease. An early-warning system could save more lives, and some members of Congress set out Thursday to establish one. "What is truly worrying about this outbreak is the possibility that it is a prelude to a worse attack," says Rep. James Greenwood, R-Pa., chairman of the House subcommittee on oversight and investigations, which held its first hearing on public health surveillance. "The anthrax outbreak is our fire bell in the night. We may not get another warning."

The USA now relies on doctors to notify health departments about cases involving roughly 30 diseases, including AIDS, botulism, encephalitis, Lyme disease and anthrax. The system relies on doctors to file written reports, which often arrive late or incomplete. "It is the equivalent of relying on the Pony Express in the age of the World Wide Web," Greenwood says.

The committee considered several proposals to update the nation's disease surveillance system. Claire Broome of the Centers for Disease Control and Prevention described CDC's proposed National Electronic Disease Surveillance System, or NEDSS, a kind of electronic vacuum that will scan medical records, lab test results and local vital statistics reports for unusual cases or trends that might signal a public health crisis. CDC is launching the system in 20 states next year, with more to follow.

But critics say the CDC's system is too complex. "The NEDSS interface is hopeless for practicing physicians," says Alan Zelicoff of Sandia National Laboratories in New Mexico.

Zelicoff and several colleagues at the University of New Mexico and the state's health department have come up with their own approach, a Web-based service called RSVP.

Log in, pop up a Web page, fill in a few details about a perplexing case and two things happen: The system offers the doctor guidance on how to treat the patient, and it automatically notifies the local health department. Zelicoff says the simple system requires only a computer and standard Web browser. Zelicoff and his colleagues will provide free software.

Zelicoff says RSVP will accomplish most of the government's surveillance goals, including the instant reporting of deadly diseases. "I believe we have the 90% solution," Zelicoff said. The system, piloted in a handful of New Mexico hospitals, will soon grow into a network of 100 to 150 hospitals nationwide.

Other approaches include:

• Using insurance claims data for medical visits and prescriptions. Quintiles, a North Carolina firm, says it can tap into 3 million insurance claims daily to track disease outbreaks and can adapt the system for public health use for $5 million to $10 million.

• A computer system linking emergency rooms and hospitals with public health agencies. Called RODS (for Real-time Outbreak and Disease Surveillance), the 2-year-old system monitors 800 patient visits a day in hospitals in western Pennsylvania, says Michael Wagner of the University of Pittsburgh.

• A computer system in Boston that tracks emergency room and hospital admissions, automatically noting any unusual increases and sending a follow-up form to a specified person at the hospital. The form asks for more detailed information that can trigger an investigation, says Anita Barry of the Boston Public Health Commission.