NYC gets a jump on disease outbreaks

Long before the 2001 anthrax incidents, New Yorkers had dealt with public health dilemmas.The Spanish influenza epidemic of 1918 to 1919 decimated whole neighborhoods. The summer of 2000 brought the city’s first death from West Nile virus. So New York was perhaps better prepared than most jurisdictions for the anthrax attacks.About two years ago, the city’s Health Department began building a syndromic surveillance system to monitor disease symptoms such as headache, fever and rash, said Ed Carubis, the departmental CIO.It started by monitoring emergency 911 calls through ambulance dispatch data. “It gave us an early jump on flu season,” Carubis said.Next the department added data from emergency department visits. “We get records of patients’ chief complaints,” he said.The newest data layer being monitored is drugstore sales of over-the-counter drugs and some prescription medicines.“It’s like a tremendous data mining operation,” Carubis said.The system started with 911 calls because they involved people in the most immediate distress, he said. The second layer was for emergency departments whose patients are at least well enough to travel without ambulances. The third layer, pharmacy sales, monitors people who are well enough “to go to the pharmacy to self-medicate but not yet sick enough for the emergency room,” he said.The department might soon add attendance records from city employers. For example, a sharp rise in absenteeism at the Port Authority could indicate an outbreak, Carubis said.Thirty-eight hospitals, more than half of all those in the city, are now reporting to the system, Carubis said. It had to be easy to use for already overburdened nurses and hospital clerks. But the different data sources—911 calls, emergency departments, pharmacies—had diverse formats.“When we started two years ago, people were faxing the data,” he said. Now most of it comes via encrypted e-mail and Web forms using Secure Sockets Layer protocol.The department chose the iWay Bioterrorism Response Suite from iWay Software, a unit of Information Builders Inc. of New York. Written in Java, iWay translates the motley syndromic data for storage in a Microsoft SQL Server database.City epidemiologists and other health officials interpret the data and take preventive measures when necessary.