System Helps Doctors Spot Unusual Health Trends

By studying information in an online database shared by six hospitals, New Mexico health officials learned that Type B influenza was the most common strain last winter. Armed with that information, doctors began waiting for a lab test before starting an expensive drug treatment, because Type B didn't respond to that medication.

Battling the annual flu bug and dealing with a crisis such as the anthrax infections have a lot in common. Researchers at Sandia and Los Alamos national laboratories in Albuquerque, N.M., developed the software and expect a $1 million grant to cover the hardware costs of putting it in 150 hospitals in five states.


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Using the Web to report symptoms linked to infectious diseases is designed to heal a major vulnerability in the U.S. health-care system: Information is generally isolated hospital by hospital, and an unusual disease is only reported once the diagnosis is confirmed. That adds to the time it takes to spot a trend of an illness. This system focuses on symptoms and uses a rules-based software program to alert doctors and the state Health Department Offices in Santa Fe, N.M., when there's a spike in a particular condition.

"If one doctor in one emergency room saw one patient with unusual symptoms, he might not be too concerned," says Reynolds Salerno, a senior member of the technology staff at Sandia. "But if the public-health officials noticed that five doctors in different hospital saw five patients with the same unusual symptoms, it would be a red flag."

The system, called Rapid Syndromic Validation Project, works this way: Emergency room physicians enter a patient's demographic information, such as age, ZIP code, and sex, plus symptoms such as fever, rash, and blood counts into a networked PC. The information can be entered in less than a minute and is sent to local public-health officials, who can monitor patterns of similar symptoms being reported by other physicians in a region. Doctors also have access to trend data, such as recent spikes in similar symptoms in a certain area. A physician who suspects an emergency also can notify public-health officials immediately via an icon that calls, E-mails, faxes, or pages an official on call.

The Java-based validation project is built from software developed by the Los Alamos National Laboratory to connect rural New Mexico hospitals to the Internet. (The open-source software is available free at SourceForge .net.) The thin-client system requires a PC in the hospital, a Web connection, and a Web server.

The project isn't foolproof. It takes extra effort from busy emergency-room staff. It takes monitoring by public-health officials who need to know the symptoms of a disease they might never have seen before. Another version of the software, called Be Safer, is in development to be more user-friendly and able to spot more trends. However, the New Mexico test already has had some success in combating influenza and hepatitis A.

Sandia officials say such a system not only would help health-care officials react to a biological attack but would also serve as a deterrent. If the health-care system looks prepared to quickly locate and isolate a biological attack, it makes a less-tempting target. To get there, the industry needs to share information more quickly. Says Salerno, "Every hour counts."


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