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Last Updated

13 Nov 2002

Source: Akron Beacon Journal, January 10, 2002.

Hospital ERs could detect bioterrorism

Akron doctor pushes effort to link computers to spot disease outbreak

BY Cheryl Powell, Beacon Journal medical writer

Picture a real-time "weather map'' for the nation's emergency rooms -- one that could eventually save lives.

There's a blip on the screen in New York. Smallpox symptoms are detected.

An alert in Cleveland. A possible flu epidemic.

Still another blip. Multiple victims from the crash of a commercial jetliner in Florida.

A select group of emergency physicians is pushing to create just such a map -- a national public health surveillance system -- by linking computerized records from emergency rooms nationwide. And an Akron ER doctor is among those leading the effort.

Dr. Brian Keaton, an emergency physician at Summa Health System who helped computerize the ER there, is working with several other doctors to start discussion and build support for the plan.

The issue has generated intense interest since Sept. 11, when the seemingly unrealistic threat of bioterrorism suddenly became real to Americans.

"The emergency department is kind of the canary in the coal mine,'' the 47-year-old Keaton says. "Anything that happens in the community is first going to show up in the ER.''

As one of the newest members of the American College of Emergency Physicians' prestigious board of directors, Keaton is in a position to help develop a national ER monitoring policy.

"Especially with bioterrorism, the biggest thing is to be able to recognize and isolate it,'' says Keaton, who also serves as medical director of EMS (emergency medical services) in Munroe Falls, where he lives. "You need to have early warning.''

Some technologically oriented ER physicians had envisioned creating a national health surveillance system well before Sept. 11 and the bioterrorism fear that followed. A few areas of the country have started regional ER monitoring programs through the Internet or a secure server.

"Today, the need is bioterrorism, but tomorrow, the priorities might shift,'' says Dr. William Cordell, a clinical professor and research director at the Indiana University School of Medicine's Department of Emergency Medicine.

"What we need to do is develop a public health information infrastructure that will serve not only in identifying bioterrorism attacks, but also other public health needs,'' Cordell said.

Possible functions

Such a system, for example, could help track flu cases, infectious-disease outbreaks or traumas, allowing government health departments and hospitals to be better prepared.

The idea is to start by feeding data from the 450 or so emergency rooms nationwide that already put patient information into computers. A program could be used to analyze the data for similar symptoms.

Cordell is working with New Wave Software Inc., a Cincinnati company that has developed one such program called the Public Health Weather Map. With this system, clusters of symptoms instantly show up on a map of a country -- sort of like the way signs of a storm appear on a weather map.

"That's been a dream of mine -- to feed back public health information so it comes back looking like a weather map,'' Cordell says. "We need to dramatically shorten the feedback cycle.''

Other software companies nationwide also have or are developing programs that can analyze ER data at a central clearinghouse.

The technology definitely exists, Keaton says. Only about 15 or so vendors make computer systems for running ERs, so creating a system to link data from those systems wouldn't have to be incredibly difficult.

"The technology is fairly straightforward when you get the collaboration arranged,'' says Dr. Edward N. Barthell, an emergency physician in Milwaukee. "I think clearly people are taking a new look at their attitudes about collaboration, given this new environment we're looking at.''

Possible concerns

Still, questions remain:

Which software will be used to interpret the information? Who will run it? How will patient privacy be protected? And, perhaps most importantly, will hospitals be willing to share the information, particularly in highly competitive markets?

"The question is, do we have the political and regulatory will to make it happen?'' Keaton says.

To start addressing some of the issues, Keaton is working with Barthell and Cordell to organize a national meeting in April in Washington, D.C., on creating a health surveillance system.

Along with emergency physicians and software vendors from across the country, lawmakers and representatives from the U.S. Centers for Disease Control and Prevention, the federal Homeland Security Council and the American Hospital Association could be among those in attendance.

Most likely, a government agency such as the CDC would need to run the system, Keaton says. The CDC has been interested in the issue since 1994 and has started pilot projects in North Carolina and Oregon that link some ERs to those states' health departments, says Dr. Daniel A. Pollock, a medical epidemiologist with the CDC's National Center for Injury Prevention and Control in Atlanta.

The threat of bioterrorism may persuade lawmakers to fund a national program, Pollock says.

"Problems rise on public agendas when there are crises or issues that suddenly command attention,'' he says. ``It's an opportunity to move forward more quickly, with a greater understanding. . . . If we had had this conversation six months ago, it might not look as pressing as it looks right now.''