In 1989, Ed Carubis got a job as a public health inspector for New York City's Department of Health. Some 13 years later, he's CIO of the department and heading up critical efforts to build technology that will protect the public from bioterrorism. Carubis and his team of 90 IT employees have developed a system to collaborate with hospitals, emergency workers, and the Centers for Disease Control to proactively monitor the outbreak of disease that's a model for cities across the country.

Most biological agents that might be used by terrorists manifest themselves in the early stages as flulike symptoms, which challenges health-care professionals and agencies such as Carubis'. In many cases, it takes too long to figure out that a growing health problem is an attack caused by biological agents and not a natural disease. "So how do we get ahead of the curve, do early detection, and provide even a day's worth of lead time?" asks Carubis, noting that in health care you can do a lot in a day.

The answer is better collaboration through technology, he says. After the Sept. 11 attacks on the World Trade Center, the CDC deployed more than 20 epidemiologists to work at some New York hospitals round-the-clock, monitoring for unusual activity that might indicate a bioterrorist attack. "That level of resource cannot be sustained over a long period of time," says Carubis, who mobilized his agency to automate the process.

The New York Health Department's system takes data in any form and does the back-end conversion work, Carubis says

Most hospitals have information systems that collect patient data as they enter the facility. So Carubis' agency asked 32 New York hospitals to routinely feed patient intake data to his department, which uses a data-integration application from iWay Software and a business-intelligence app from iWay's parent company, Information Builders, to combine and analyze the information. Because no data-formatting standards exist in the health-care industry, the health department accepts reports in ASCII format, as a file attachment, or in other forms. The health department uses integration tools to automatically convert the data into a common format because Carubis would rather work out integration issues on his end than ask hospitals to do any extra work. "We're saying, 'Give it to us however you have it, and we'll do all that work on the back end to transform that information and make it useful to us,'" he says.

The same data-sharing partnership applies to the city's 911 emergency system. As calls come into 911, the operator collects information that in some cases indicates a specific illness. The health department worked out an arrangement with the fire department to send the automated feed for the 911 system to its system on certain call types, Carubis says.

As information comes in from both sources, the agency uses business-intelligence and cluster-modeling tools to analyze it and watch for trends that would indicate a disease cluster is occurring in specific neighborhoods-a process known as syndromic surveillance. "When people around New York City are developing general flulike symptoms, which may not be an indication of flu season but a harbinger of something, this really has great value," Carubis says.

The agency also shares data with the CDC when outbreaks occur. However, Carubis says, there's no national standard for sharing data and building syndromic-surveillance systems. That may soon change. "The model is what's occurring here in New York City for the first time," he says. "There's tremendous interest in our system nationally."

Even without the issue of bioterrorism, the core goal of Carubis' team since he became CIO of the agency three years ago has been to use technology to address the needs and demands of their customers, the residents of New York. "The public isn't only our customer, they're our shareholder and they have an expectation," Carubis says. "They don't expect us to turn a profit for them; they expect us to protect their health."

Key to achieving that goal is business-intelligence technology that can be used to collect and analyze data that has been stored in the agency's database for years but that could be useful if shared with the public. One example is in restaurant inspections. The department conducts more than 100 weekly inspections, but until recently, the results have been stored in databases and not made public. Now, that data is being repurposed and posted on the Internet. "It's not only about making a restaurant owner more accountable, it's about making government more accountable," Carubis says. "That's difficult for people in government to embrace."

Photo of Carubis by Sacha Lecca