Since the Sept. 11, 2001, terrorist attacks, the U.S. medical community has been on high alert preparing for Anthrax and other biological attacks, as well as dealing with actual outbreaks of new diseases such as SARS and the West Nile virus.
To fight this two-front battle of threat and outbreak, the medical community is turning to syndromic surveillance, a new breed of business intelligence technology that searches for patterns in patient data. The goal is to recognize the signs and mobilize against a potential disease outbreak.
Early pioneers in this space are Sapphire Consulting, a systems integrator, and Emergency Medical Associates, a not-for-profit consortium of emergency-room physicians that serves 16 community hospitals in New Jersey and New York. Both organizations have collaborated to build a system of dashboards and alerts that monitor patients conditions as theyre reported to emergency rooms.
Sapphire, a Business Objects S.A. Platinum partner, specializes in projects that bring data out of printed reports and make it more actionable in the enterprise. EMA provides member hospitals with a team of emergency-room doctors and a patient-information software system.
"We realized after Sept. 11 that if there is a bioweapons attack, most patients are going to go to the emergency department for care rather than their primary care physicians," said Jonathan Rothman, director of data management at EMA. "We had 3.2 million patients in our data warehouse. So we looked at various methods we could use to place patients in syndromic groups."
As part of the syndromic system, EMA uses Business Objects namesake product to query patients files in the data warehouse, assigning them to syndromic groups based on their presenting complaints. This classification is done using methodology that EMA helped to develop working in concert with the Centers for Disease Control, the Department of Defenses ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) Program, and the New York City Department of Health and New York State Department of Health.
"We looked at false negatives and false positives and tweaked the data," said Rothman. "Then we developed an interface with Business Objects to read the patients complaints and place them into the right syndromic group."
Thresholds of cases can be set, beyond which a potential epidemic—or bioattack—may have taken place. Once the system has been fully deployed to the Web, most likely by years end, doctors will be notified automatically by e-mail. The e-mail will link to dashboards that doctors can drill down into to look deeper into the data that triggered the alarm.
"Doctors usually see about three patients an hour in the emergency department," said Rothman. "But at the end of the day, they really dont talk to each other about what they worked on. What syndromic surveillance does is draw data from a large geographical area. And if the doctor sees that the gastrointestinal cases he treated are two times the standard deviation, then maybe theres something going on."
So far, the system has not detected any epidemics or bioterror attacks, though one of its hospitals did treat anthrax patients in the fall of 2001. What they have been able to respond to, however, thanks to the system, is a spike in asthma attacks that were brought on by the unusually wet spring in the Northeast.
"We were able to make sure we had enough staff and enough [anti-asthma] drugs on hand," said Rothman, who monitors the data until the Web-based system is deployed.
The syndromic system, which Sapphire and EMA developed using Business Objects Application Foundation, and a data warehouse thats built on Oracle 8i reside at EMA headquarters in Livingston, N.J. The data warehouse is updated nightly, allowing Business Objects software to generate reports.
In addition to extending these reports to the Web so doctors can access them remotely, EMA is looking to link the syndromic surveillance system to so-called mobility systems such as emergency response systems, Rothman said. He expects this to happen in three to six months.