The Importance of Sentinels - Utilizing Technology

Hat tip to Siam at P4P

Making technology work for us!

From 2002 until the present, the CDC has spent in excess of $5 billion to improve preparedness and response in the event of a major disease outbreak or a bioterror event.

The CDC Influenza Pandemic Plan outlines the agency’s information technology plans and systems that will support a nationwide response to an outbreak of a novel flu strain pandemic utilizing real-time data exchange and information management. Biosense provides analytical results to users approved to access data for their jurisdiction in a national early event detection and situational awareness system.  

Biosense, the CDC’s high tech system for surveilling the cases of influenza like illnesses gathering data from among 400 of 5600 participating U.S. hospitals and there is a current request for wider participation in the system from the states themselves in order to build a nationwide sentinel system.

Data Sources

Data is received into the system from 3 main sources and it is analyzed daily. Historical data is also available.

• Department of Defense Military Treatment Facilities - approximately 700 DoD medical facilities collected since May 2003. Since December 2004 an average of 98,000 daily records has been received into the system.
• Department of Veterans Affairs treatment facilities - approximately 1,100 VA medical facilities collected since December 2003. Since December 2004 an average of 151,800 daily records has been received.
• Laboratory Corporation of American test orders - approximately 31 testing locations and 1,100 patient service centers collected since June 2004. Since December 2004 an average of 137,600 daily records has been received.

All of the above data sources include patient age, sex, patients zip code, and facility identifier and zip code.

Once data is received experts from different agencies analyze it and map it to 11 syndrome categories

• fever
• gastrointestinal symptoms
• hemorrhagic illness
• localized cutaneous lesions
• rash
• respiratory symptoms
• severe illness and death
• a specific infection
• botulism-like illness
• lymphadenitis
• neurologic signs

Biosense - from the CDC site….

BioSense is the national, human health surveillance system designed to improve the nation’s capabilities for disease detection, monitoring, and real-time health situational awareness. This work is enhanced by providing public health real-time access to existing data from healthcare organizations, state syndromic surveillance systems, national laboratories, and others for just in time public health decision-making. BioSense data are analyzed through advanced statistical methods, and made accessible through the BioSense application. The application provides data, charts, graphs, and maps through a secure Webpage which can be accessed by CDC, authorized state and local public health partners and participating healthcare facilities.

Two examples of the “views” that are available from within the application….

Biosense for Public Health Departments

Value to the Public Health Community

BioSense is valuable to the public health community because:

• It provides simultaneous access to the same data at the same time to all levels of public health;
• This can decrease delays in recognition of a problem and enhance emergency response;
• Neighboring public health jurisdictions can share information if they choose to share data;
• A national system means broader data availability by combining local and national sources; and
• There is increased capacity for biosurveillance using existing clinical and diagnostic real-time data from hospital information systems.

This is invaluable data that we should all have at the local response level. Not only should we strive to detect initial events within our community but we should utilize all of the tools within our reach in order to have a thorough nationwide situational awareness. Early event detection will be the number determiner of the success of our non-pharmaceutical interventions.

Other CDC sentinel systems

More than 2000 physicians nationwide make up the current CDC sentinal system that monitors trends in influenza like illnesses within cities, states and regions. This system, however, is routed through the state departments of public health. Other systems in place that monitor the nation’s health are the Laboratory Response Network, Health Alert Network, Epi-X, a web based monitoring system, and the new CDC Alerting System, all which aid communication between federal, state, and local health departments and physicians nationwide. Other technology based systems in the CDC’s arsenal are Flufinder, which provides flu vaccine availability information and the Outbreak Management System, which currently assists health officials in four states in managing outbreaks within their jurisdictions. These CDC systems conform to the Public Health Information Network Data Standards (PHIN) which are based on Health Level Seven (HL7) specifications.

We should make use of these systems in the future. I applaud the CDC for developing Biosense and will advocate for its use within my local area. It certainly seems to be our best bet for an early warning system. Kudos to the CDC!

 Related links out
BioSense–a national initiative for early detection and quantification of public health emergencies.
BioSense: implementation of a National Early Event Detection and Situational Awareness System.
Exhibit 300 (BY2009) - PHIN: BioSense, Centers for Disease Control and Prevention
CDC plans BioSense contract
CDC seeks IT services for BioSense