"Several federal, state, and local organizations, as well as health plans, practice groups, and hospitals, have been developing bioterror-event early detection systems pre- and post-September 11 and the anthrax letter mailings," says the grant's principal investigator Richard Platt, MD, acting chair of the Harvard Medical School and Harvard Pilgrim Health Care Department of Ambulatory Care and Prevention (DACP). "Initially, most bioterrorism-related illnesses have symptoms, like coughing, that can't be distinguished from the flu or other common infections. Therefore, the first sign of a bioterrorism attack might be an increased number of people who call help lines or contact their primary care doctor for these common symptoms. The CDC grant will allow our consortium to coordinate efforts to recognize such increases, building a platform that will also allow other health systems to join."
"The demonstration program will include a rapid response capability to notify public health officials of unusual occurrences as soon as the information becomes available," says Dr. Julie Gerberding, director of the CDC. "The results of this project will help us more fully develop systems that extend our capacity to detect and respond to a terrorism attack at the earliest possible moment, while ensuring appropriate care to all patients."
The consortium includes Massachusetts-based Harvard Pilgrim, a managed health care organization through which the grant will be administered, Harvard Vanguard Medical Associates, a large, private group practice, as well as Harvard Medical School faculty at DACP and Brigham and Women's Hospital. Also included are Minnesota-based HealthPartners Research Foundation, the research wing of the similarly named health plan, medical group, and center for health promotion, and Optum, a diversified health care company that will provide its experience with its national nurse telephone triage and health information service. Kaiser Permanente of Colorado, a member of Kaiser Permanente's nine-state health maintenance organization network, and the Washington, D.C.-based American Association of Health Plans, are also equal members of the consortium.
Four of the consortium members--Harvard Pilgrim, Harvard Vanguard, HealthPartners, and Kaiser Permanente, Colorado--currently operate regional syndromic surveillance programs or have surveillance programs for particular diseases, using health plan data, and many of their systems operate using some of the same general principles. The computer systems begin by examining daily patient complaints and diagnosis codes, which indicate the illness that's being treated. The systems then search for upper and lower respiratory illnesses, rashes, fevers, neurologic events, and sepsis, health conditions that are early symptoms of bioterror agents. Each day's results are compared to historical records to identify unusual numbers or geographic clustering. For example, a sudden spike in chest colds on a day in October is compared to the same relative time period going back several years to see if a similar pattern exists or if this event appears to be an anomaly. The data is then sorted by neighborhood to determine if a high number of reported illnesses are coming from one particular town or office.
The consortium will collaborate with the CDC, state and local health departments, the Department of Defense and other organizations currently developing similar systems. Their goal will be to develop data extraction and reporting protocols common to all institutions and to facilitate the participation of other health plans and medical groups that possess real time encounter level information.
"The team will develop a system that many different types of medical systems and health departments can use," says Platt, HMS Professor of Ambulatory Care and Prevention. "Importantly, health plans will not share information about individual patients. Instead, they will report patterns of illness among groups of people.
The consortium's experience in developing such systems regionally will benefit the overall process, which includes finding uniform syndrome definitions, developing protocols for real time aggregation of ambulatory encounter data, forming secure Internet connections to report aggregated information to a data center, defining cluster identification steps, and determining the reporting structure to public health system responders. The American Association of Health Plans will work with its member organizations to share system requirements and eventually to form linkages with member databases.
Additional contact information: Sharon Torgerson, 617-509-7458, (sharon_torgerson@hphc.org) Harvard Pilgrim Health Care
Editor's Note
Below Please Find Consortium Member Contacts and Links:
*American Association of Health Plans: http://www.aahp.org/
Contact: Susan Pisano, 202-778-3245, (spisano@aahp.org)
*Harvard Vanguard Medical Associates: http://www.harvardvanguard.org/
Contact: Peter Dreyfus, 617-654-7149, (peter_dreyfus@vmed.org)
*HealthPartners Research Foundation: http://www.hprf.org/docs/home.html
Contact: Christian Reese, 952-883-5304, (Christian.L.Reese@healthpartners.com)
*Kaiser Permanente of Colorado: http://www.kp.org/locations/colocations.html
Contact: Jacque Montgomery, 303-344-7410, (Jacque.Montgomery@kp.org)
*Optum: http://www.optumanswers.com/
Contact: Judy Tacyn, 703-394-7687, (Jtacyn@uhc.com)
*Centers for Disease Control and Prevention: http://www.cdc.gov/
*Harvard Pilgrim Health Care: http://www.harvardpilgrim.org
*Department of Ambulatory Care and Prevention: http://www.hms.harvard.edu/ambulatory/index.html
*Harvard Medical School: http://www.hms.harvard.edu
Harvard Medical School has more than 5,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 17 affiliated teaching hospitals and research institutes. Those HMS affiliated institutions include Beth Israel Deaconess Medical Center, Boston VA Medical Center, Brigham and Women's Hospital, Cambridge Hospital, Center for Blood Research, Children's Hospital, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital