Hospitals, health agencies track illness online
To improve its awareness of disease outbreaks, the Milwaukee Health Department is using an online communications network to send health alerts to local hospitals and to collect statistics about the symptoms of emergency room patients. The network is part of the department’s plan for responding to bioterrorism events, and it has helped the department scan for potential cases of severe acute respiratory syndrome (SARS) in the city.
In 1993, an outbreak of cryptosporidiosis affected approximately 400,000 Milwaukee residents. Public health officials did not have a well-organized way of rapidly detecting or characterizing an outbreak, says Seth Foldy, Milwaukee’s health commissioner. “The traditional way you hear about problems in public health is through formal, mandated reporting of diseases,” he says. “But Cryptosporidium, kind of like SARS today, was an emerging infection. People weren’t very aware of it, and regulations did not require reporting it.”
Following that outbreak, the department began looking for an early warning system that would help it respond to similar events. In 1999, the department learned of a Web-based program created by Mequon, Wis.-based EMSystem that allowed emergency rooms to communicate with ambulances about whether the hospitals could accept more patients. Several Milwaukee hospitals were using the network, and they invited the Health Department to join in to post alerts about illnesses the hospitals might expect to encounter. The network is a subscription-based service paid for by participating hospitals and hosted by the vendor.
That year, the department distributed warnings about summer heat waves on the network so emergency room employees could be prepared for patients suffering from heat exposure. The department also used the system to collect information from emergency rooms about the numbers of patients who needed treatment for heat-related illnesses or injuries.
Since then, the department has expanded its use of the network to collect information about specific illnesses, such as SARS. In March, the department created an online form that triage workers in 12 emergency rooms completed for all patients who came in with fever. Every 24 hours, the hospitals summarized data from the forms to report to the Health Department how many people had fever, and how many people had fever and respiratory symptoms. “It gives us a crude look at the kinds of symptoms people are walking into emergency rooms with, which is very helpful to try and assure that we don’t have SARS or another respiratory illness moving through our community,” Foldy says.
The department has incorporated the online application into its bioterrorism response plans. In addition to vaccinating personnel to respond to smallpox and planning for mass vaccinations for anthrax, the department gathers information from state and federal health alert networks and distributes it to local hospitals through the Web-based system. “If a situation like [an anthrax release] happens, we are going to have to communicate to everybody the alert and instructions [for treatment],” Foldy says. “We post model medical orders on the Web site recommending treatment and who should be treated. The only way to get everyone doing the same thing at the same time is to use the Internet in a creative way.”
