In bird flu watch, CDC searches for warning signs

The Centers for Disease Control and Prevention plan to start streaming real-time emergency room data from hospitals to help detect an avian flu outbreak or bioterrorism attack, and 11 cities could be part of such a system by the end of this year. Another 20 are expected to join by the end of 2006.

Dr. Blake Caldwell, senior adviser at CDC's Coordinating Center for Health Information and Service, said this effort, which has $79 million in funding in the fiscal 2006 budget, will fulfill a promise by Mike Leavitt, secretary of the Department of Health and Human Services, to have such a system in place by the end of 2006.

Caldwell said the CDC BioSense system will automatically pull real-time disease diagnosis data from emergency rooms to a central CDC repository via secure Internet connections. The data will include information on medical complaints, such as fevers or respiratory infections, that might indicate an avian flu outbreak, Caldwell said.

The system will then send the data to a CDC data center where detection algorithms will sift through the data to pinpoint disease clusters or outbreaks.

This information will correlate with automatic biosurveillance detectors operated by the Homeland Security Department under its BioWatch program. That information will be added to data that BioSense already collects from hospitals run by the Department of Veterans Affairs and the Pentagon, Caldwell said.

She emphasized that this will be real-time data, and hospitals will stream new information at least every 15 minutes.

She added that CDC is still negotiating data-sharing agreements with hospitals nationwide that will participate in the first phase of the expanded BioSense project this year. Caldwell would not identify them until they sign agreements next month.

CDC, she added, is negotiating with hospitals in Atlanta, Baltimore, Boston, Chicago, Denver, Indianapolis, Los Angeles, Philadelphia, Phoenix, San Diego and Washington, D.C., for the first phase. She declined to identify the 30 cities participating in BioWatch for security reasons.

The BioSense project, although national in scope, pales in comparison to a similar project under way in Indiana. Dr. Shaun Grannis, a research scientist at the Regenstrief Institute in Indianapolis, said he is spearheading a four-year, $4 million initiative to connect all 114 hospitals in the state to a disease surveillance system. More than 40 hospitals already connect to the system.

This system, like BioSense, also collects symptom information in real time, Grannis said, and feeds it to a central repository in which detection algorithms can help public health officials identify outbreak patterns on a street-by-street basis. Grannis said it would take a major effort, costing at least $200 million, for CDC to deploy such a system nationwide.

Tigi Ward, public health coordinator of surveillance for the Lubbock, Texas, Public Health Department, said she believes she has found a better and faster way to detect disease outbreaks, including avian flu.

The Lubbock health department uses a real-time system based on clinician reporting rather than a data-mining system such as BioSense. With the Lubbock system, Ward said, clinicians enter a set of symptoms "long before they have come up with a diagnosis and before lab results are in."

Although some doctors might be reluctant to use a system that requires them to take time to directly input data, Ward said, clinicians can enter data in seconds. The health department correlates this data in real time and displays it using geographic information system software.

Ward said the Lubbock system works so well that the city was able to pinpoint the exact date when flu season started last year. Lubbock uses Ares' Syndrome Reporting Information System software.

As the world faces a potential avian flu epidemic, the country's top state and local officials say the United States is woefully unprepared for a pandemic, and they urge a steep increase in funding.

Dr. Rex Archer, director of the Kansas City, Mo., Health Department and president of the National Association of County and City Health Officials, said the Department of Health and Human Services needs to shift its focus from stockpiling vaccines to rebuilding a neglected public health infrastructure. State and local public health departments need billions of dollars in preparedness funding, he said.

Dr. Georges Benjamin, executive director of the American Public Health Association, urged additional investment in public health information technology systems. He said many of those systems have become obsolete. A large amount of money was pumped into public health IT after an anthrax attack against Congress in 2001.

-- Bob Brewin