Syndromic Surveillance For Bioterrorism Using Computerized ... - NCBI

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King County, Seattle, WA dOverlake Hospital MedicalCenter, Bellevue, WA. Abstract: We have built a surveillance system to facilitate early detection ofpossible ...
Syndromic Surveillance For Bioterrorism Using Computerized Discharge Diagnosis Databases Duchin JSb,c, Karras BT, Trigg LJ?, Bliss Da, Vo Da, Ciliberti r Stewart LC, Rietberg KC, Lober WBa aClinical Informatics Research Group, School ofPublic Health and Community Medicine, and bDivision ofAllergy and Infectious Diseases, University of Washington, Seattle WA cPublic Health - Seattle & King County, Seattle, WA dOverlake Hospital Medical Center, Bellevue, WA Abstract: We have built a surveillance system to facilitate early detection of possible bioterrorist attacks. Data are collected from emergency departments and a primary care clinic using computerized electronic discharge diagnostic databases. Heterogeneous data are transformed to XML (eXtensible Markup Language) for transmission to a central database system for analysis. Background: There is an identified need for active surveillance systems that can provide early warning of possible bioterrorist attacks on the local level, however, there is little in the literature on the development of surveillance systems to meet this needl2. Experience from a manual, clinician-based Emergency Department (ED) surveillance system used during the 1999 World Trade Organization Ministerial in Seattle suggested syndromic surveillance to be a potentially useful means of monitoring selected clinical illnesses in the ED setting3. Project Overview: Effective response to bioterrorist attacks depends on the reliability of early detection methods. The goal of the SSIC project is to develop an automated, regional surveillance system that will facilitate early detection of these attacks. Specifically, we will 1) demonstrate the automated collection of data from heterogeneous source systems, 2) normalize clinical syndrome data in a centralized database, and 3) demonstrate secure access to this data by remote workstations running aberration detection software to monitor population based events. Many of the potential bioterrorist agents are characterized by aerosol dispersion and respiratory infection, resulting in respiratory syndromes or influenzalike illness (ILI). Typical ICD-9 codes are: Viral syndrome (079.9), pneumonia-viral (480.9), influenza (487.1), Flu (free text), diarrhea-infectious (009.2), pneumonia (486), diarrhea (787.91), measles (055.9). Methods: The Clinical Informatics Research Group (CIRG) at the University of Washington is working in collaboration with Public Health - Seattle & King County (PHSKC) to develop a system to collect data on presenting symptoms and diagnoses of emergency departnent and primary care patients. The pilot project is being developed with the cooperation of three EDs (A, B, C) at unrelated hospitals, as well as a university-based primary care clinic (D).

1067-5027/01/$5.00 C 2001 AMIA, Inc.

North Seatle

Figure 1. Sentinel Site Distibution - Seattle Metro Area

At each site, data extraction software periodically queries its host for data on patients presenting with ILI symptoms, based on ICD-9 diagnoses consistent with ILI, and on free text searches of non-coded "chief complaint" fields. Search terms were based on the most likely clinical syndromes resulting from agents likely to be used in a bioterrorist attack4. Query results are converted to XML, transformed to a standard schema and then sent to the central database using a secure protocol. Collected data may be securely accessed from selected PHSKC workstations, which run CDC aberration detection software. Results: We have 2-5 years of ILI data, depending on the site, and harvest new data daily. We continue to build infrastructure to further automate syndromic surveillance, to widen our regional network, and to explore techniques for collecting data from heterogeneous information systems. Information: lober()u.washington.edu

http://cirg.washington.edu/projects/ssic

Support: Centers for Disease Control, WA State

' Waeckerle JF. Domestic preparedness for events involving weapons ofmass destruction. JAMA. 2000, 283(2): 252-254. 2CDC. 2000. Biological and Chemical Terrorism: A Strategic Plan for Preparedness and Response. MMWR 49(RR4): 1. 3Plough A. WTO enhanced surveillance project local and national collaboration leads to success. EPI-LOG Communicable Disease and Epidemiology News. Dec. 1999;(39)12. 4Franz DR. Clinical recognition and management of patients exposed to biological warfare agents. JAMA. 1997. 278(5): 399-411.

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