TB Tests on Fast Track

INS deploys digital imaging technology, high-speed networking services.

The U.S. Immigration and Naturalization Service picks up about 20,000 newcomers to the country on any given day and detains them for about a month at hundreds of correctional facilities coast to coast. In the age of terrorism in America, the most widespread threat posed by the newcomers is not violence but a disease once thought eradicated in the United States: tuberculosis.

"We had to come up with a way of quickly detecting TB. It is an airborne disease, and you can get it by sitting next to someone whos coughing," said Geralyn Johnson, chief of staff at the U.S. Public Health Services Division of Immigration Health Services, in College Park, Md. "Before we had a new system in place, it took an average of five days to determine if a person was infectious. Now it can take as little as 20 minutes."

With a new digital imaging technology and secure, high-speed content delivery system in place at seven major detention centers, the INS and Public Health Service are able to conduct as many as 400 TB screenings a day.

Large waves of immigrants today come from countries with a high TB incidence, including Haiti and Mexico, according to Johnson. Traditionally, to screen detainees for TB, officials administered a skin test, which took 24 to 48 hours to read. If the skin test came up positive, a chest X-ray was taken, and if the X-ray indicated possible infection, a saliva culture was taken.

The traditional screening wasted time and resources because the skin test showed positive for people with TB and people who had been vaccinated against it, according to Johnson. More than two-thirds of the detainees tested positive from the skin test, she said, leading to many additional procedures.

Whats more, because the United States reined in the threat of TB generations ago, the expertise for diagnosing it became somewhat of a lost art, according to Johnson. With the threat of TB on the rise, health care officials sought a way to obtain consistent radiology reports from experts in the field.

In 1999, the INS began replacing traditional X-ray machines with digital imaging technology and later installed high-speed networking services provided by WamNet Inc., a content delivery and hosting provider in Eagan, Minn. At seven sites today, an X-ray-like machine takes a direct digital image of a detainees chest and converts it into an 8MB file. The file is routed over a LAN to a WamNet edge device consisting of a combination router, a processor and application software, according to Rick Mancilla, executive director of WamNet Healthcare Services.

The image is then transmitted over a T-1 line to the WamNet managed network and on to College Park, where it is analyzed by radiologists specializing in TB diagnosis. The WamNet network is a combination of the companys fiber and leased lines from major Internet backbone providers, Mancilla said.

WamNet application software, which is customized for the INS but can be tailored to other organizations needs, integrates the chest image with patient information. Other than the specialized software, the primary value added by WamNet is the high security management of the data from the edge device to the destination.

"The Department of Justice [which houses the INS] requires a high level of security," Johnson said. "WamNet will call us and tell us if there is a problem even before we know theres a problem."

Beyond the medical industry, the technology is applicable to the media business and law enforcement, which require management and distribution of immense data files. WamNet, which established a new government services office outside Washington last year, is promoting the system for border control. Remote sites could use it to transmit photographs, fingerprints or thermal images of vehicles or containers to a central location for analysis, Mancilla said.

The INS detained approximately 185,000 people last year, and the health care of all is managed by Johnsons division of the Public Health Service. For her, applications for the technology are almost endless. Johnson said she envisions deploying similar systems at U.S. embassies throughout the world to screen legal immigrants who might present falsified health care documents. "They sometimes buy a healthy chest on the street," she said.

In addition, similar systems could be installed to improve general health care for U.S. residents living in rural areas. "This is the future of health care," Johnson said. "It could bring the expertise of an infinite number of specialists to a hometown doctor. It increases our capacity at our little sites out in the middle of nowhere to offer full-service health care."

Last week, WamNet added private IP tunnel and port forwarding services to its enterprise network offerings. The new tunnel service enables companies to transmit data privately between WamNet edge devices, offloading it from their own networks to WamNets network. It also allows users to free up bandwidth on their own systems without sacrificing security or reliability.