Software helps detect illness patterns

Last November, Hillsborough County, Fla., implemented an enhanced medical surveillance (EMS) system Ñ composed of a suite of software tools Ñ that uses emergency room data to detect potential bioterrorism events and naturally occurring disease outbreaks. The system flags abnormal patterns of illnesses, allowing the county to respond to developing medical emergencies faster than before.

Public health departments rely on physicians and laboratories to report a variety of infectious or communicable diseases when they are diagnosed. However, the diagnostic process can be slow, taking two days to three weeks, because physicians often need lab analysis to confirm a diagnosis.

Realizing that lives could be saved if illnesses could be identified quickly Ñ particularly in the event of a bioterrorism attack Ñ the county invested in a computer system that would allow it to track symptoms and recognize emerging outbreaks. The EMS system, called LEADERS (Lightweight Epidemiology Advanced Detection and Emergency Response System), was developed in 1993 by the Atlanta-based Centers for Disease Control (CDC); Redwood, Shores, Calif.-based Oracle; Chantilly, Va.-based EYT; Dallas-based ScenPro; and the U.S. Air Force as part of a U.S. Department of Defense project.

The Hillsborough County Health Department implemented the system at nine of its 14 hospitals. (The other five hospitals are specialty care hospitals and do not reflect the county’s general population.)

The system’s tracking capabilities begin in the emergency room: For every patient, a doctor or nurse records the patient’s symptoms and demographic data via a secure Web page. That information is sent to a central file server at EYT.

The Hillsborough County Emergency Dispatch Department extracts the raw data into a spreadsheet twice daily. Using software from Cary, N.C.-based SAS Institute, the department analyzes the data and reports aberrations in symptom frequency to the Health Department.

Next, the Health Department searches for patterns by analyzing individual patient demographics in those hospitals where aberrations are reported. If the department finds patterns that signal a public health concern, it conducts an epidemiological review.

For example, in December, the system alerted the county of an increase in gastroenteritis symptoms in children. As a result of the early warning, the Health Department queried staff members at local schools, day-care facilities and clinics. It found that some children at those facilities also were experiencing gastroenteritis symptoms.

Federal grants currently pay for the county’s use of the system, which totals about $60,000 annually. The system is in use at 43 hospitals in Florida and in 70 hospitals across the country.

Jordan Lewis is director of environmental health and epidemiology for the Hillsborough County (Fla.) Health Department.