Officials declare health net needs

Top federal health officials told a House subcommittee Dec. 14 that they're

stepping up efforts to bolster national communications networks to fight

bioterrorist threats, such as the recent anthrax incidents. But an array

of state and local health officials testified that their agencies can't

do that without significant financial investments in the public health infrastructure.

"We're woefully way behind is the best way to put it," said Michael

Covert, president of the Washington [D.C.] Hospital Center, in an interview

after the hearing of the House Reform Committee's Technology and Procurement

Policy Subcommittee.

The hearing centered on a March 2001 report by the Centers for Disease

Control and Prevention that outlined several recommendations to improve

the public health infrastructure.

CDC set a 2010 goal to:

* Provide all health departments with continuous high-speed Internet

access.

* Establish protocols for data collection, electronic reporting and

information exchange.

* Offer online access to medical data and treatment guidelines.

* Develop a capacity to send and receive real-time, sensitive health

information via secure electronic systems and broadcast emergency health

alerts.

Edward Baker, director of CDC's Public Health Practice Program Office,

said the agency was making "substantial progress to define, develop and

implement nationwide a set of strategies and capacities required at the

local, state and federal levels." But he also acknowledged that much more

needed to be done, especially enhancing communications systems and messages.

The Health Alert Network (HAN) — the communications backbone for rapid

deployment of health information, two-way communication and education —

was activated four hours after the first terrorist attack on Sept. 11, Baker

said. Since then, CDC issued more than 175 updates to about 7 million health

professionals and the public through a variety of channels, he said. In

his testimony, he reported that 13 states have directly connected all their

counties to HAN via high-speed continuous Internet access, and the other

37 states have reached about 68 percent of their counties.

He said HAN — along with the National Electronic Disease Surveillance

System, an integrated system to detect, track and report diseases, and the

Epidemic Information Exchange (known as Epi-X), a secure, private network

for health professionals to share intelligence on disease outbreaks and

health events — are three initiatives that will complement one another.

But the latter two systems are in various stages of development due to their

complexities.

Carol Sharrett, health director for Fairfax County, Va., said that during

the anthrax crisis, CDC initially released information slowly, which caused

"both anxiety and inconsistency in patient care." If smallpox had been used

instead of anthrax, the slow transmission of information would have been

"devastating" because the disease would have spread rapidly, she said.

Experts say communication among officials at the federal, state and

local levels, as well as between public and private health agencies and

doctors, is vital.

"The local health department, in many ways, is the linchpin of bioterrorism

preparedness," said Paul Wiesner, director of the DeKalb, Ga., County Board

of Health, speaking on behalf of the National Association of County and

City Health Officials.

Covert, who testified on behalf of the American Hospital Association,

said it could cost more than $11 billion to begin addressing some of the

public health infrastructure issues.