U.S. Lacks National Bioterror Alert System

With concern about terrorism heightened last week as the United States invaded Iraq, the U.S. is nowhere close to having a national system for tracking symptoms that indicate a bioterrorism attack.

Health-care officials have made some progress at the local and regional levels developing detection systems--computerized reporting networks designed to give health officials the data to spot patterns of patient symptoms that suggest exposure to a biological or chemical agent or the emergence of a natural epidemic. But adoption of the systems is spotty at best.

Two big reasons are time and money. Hospitals and local and state governments face tight budgets with little room for development projects. "Unfortunately, unless a catastrophic event happens in their own back yard, or the feds step in and mandate the systems, those efforts will often be overlooked," says John Hummel, CIO at Sutter Health, which operates 33 California hospitals. Time is another constraint: Doctors and nurses are reluctant to spend more time on data entry, so the best systems tap existing data reporting.

There are a number of promising systems being developed by medical informatics researchers, but no de facto national standards have emerged for technology, for collecting and analyzing data, or even which data to analyze. Is emergency-room patient data the most reliable gauge or information from family doctors or pharmacies?

In Massachusetts alone, several bioterrorism surveillance projects are under way. For the last 18 months, public health officials in eastern Massachusetts have tracked symptom patterns among the 100,000 patients who seek care through Harvard Vanguard Medical Associates, a Boston medical practice. They use a system developed by the Harvard Consortium, a group of researchers that received a grant last year from the federal Centers for Disease Control and Prevention to develop a system that could serve as a national model. The model is slated for use by two other large HMOs in other states. Meanwhile, researchers at Children's Hospital Boston and other hospitals are developing detection systems to analyze other data streams. They're using a federal grant to work with other children's hospi-tals around the country to decide the best way to identify symptoms of bioagent exposure in kids.

Last week, HMO Kaiser Permanente unveiled a surveillance system being used at two Northern California facilities to help San Mateo County health officials detect bioterrorism. Kaiser would like to launch the system at other facilities inside and outside California if public-health departments agree to use the systems, too. "The bureaucracy involved with these systems is the biggest burden," says Dr. Eric Koscove, chief of the emergency department at Kaiser Permanente Santa Clara Medical Center. Kaiser Permanente's system is based on the Rapid Syndrome Validation Project, a system developed by Sandia National Laboratories and tested in several states.

Dr. Alan Zelicoff, a Sandia scientist who invented RSVP, says the lab is negotiating with a medical informatics company to market the system to state health departments. That could be one more step toward a national technology standard and a national network.