Web app has a dynamic view of health

Hospitals and health officials can tap data on admissions, available medical facilities

At 9:25 a.m. on Sept. 11, the Centers for Disease Control and Prevention in Atlanta contacted Oracle Corp. to ask about getting a handle on critical care capacity at New York hospitals.

Within six hours a Web site had been set up with custom forms that were subsequently used by every hospital in the city to report available emergency and intensive care facilities. Within 15 hours, every hospital in the state had the Lightweight Epidemiology Advanced Detection and Emergency Response System available.

'New Jersey would have been next, but that wasn't needed,' said Luke Hannon, regional vice president for Oracle's North American consulting group. 'There were very few casualties being admitted.'

The Leaders system already had been used to monitor health care resources and infectious diseases during the 2000 Democratic and Republican conventions, the 2001 Super Bowl and last year's World Series games in Phoenix. But the World Trade Center attacks marked the first use of Leaders in response to terrorism.

'I found the system very useful,' said CDC's Dr. Tracee Treadwell. 'Different health departments use different programs to analyze their data,' and the Web site gave health officials a window into conditions across a wide range of facilities.

The Leaders Web applications were developed in cooperation with the Defense Advanced Research Projects Agency and the Air Force surgeon general.

'About five years ago, DARPA started to look at new types of threats, and bioterrorism was at the top of the list,' Hannon said.

When DARPA began investing in technology to detect and manage attacks, a consortium of companies formed to develop an integrated system.

Leaders uses the Oracle9i Application Server and database management system, and Java Enterprise Edition Developer software. ScenPro Inc. of Richardson, Texas, provided digital mapping tools for visually tracking medical incidents and resources in Leaders.

The application service provider is EYT Inc., formerly Ernst & Young Technologies, of Chantilly, Va. The company hosts the servers in an unmarked building accessible only with biometric and photo authentication.

Leaders can receive data from the Ruggedized Advanced Pathogen Identification Device, a biological and chemical detection system from Idaho Technology Inc. of Salt Lake City. It was called Encompass until about three years ago, when the Air Force and CDC became interested in developing it.

'We used it at the request of the Seattle Public Health Office' to monitor health resources during the 1999 meeting there of the World Trade Organization, which resulted in violent protests, Treadwell said. It was a client-server application at that time because not all hospitals had Internet access. CDC helped define requirements for the final product and develop analytical algorithms, Treadwell said.

Leaders can be used for health facility surveillance to provide early warnings of infectious disease or chemical outbreaks, or it can be used for drop-in monitoring during events or in disaster response.

Drop-in monitoring

To provide a continuous feed, a hospital loads a lightweight client application on its records system, which connects to Leaders over the Internet. Data translated to a standard format is stored in an Oracle9i database.

For drop-in monitoring during an event, hospital personnel manually enter data in Web forms created on the fly.

The suite, which only authorized health officials can use, consists of:
  • A Critical Care Tracking Module, which shows emergency personnel and dispatchers the available emergency rooms and intensive care units. It acts as a load balancer for emergency medical teams transporting patients.

  • An Incident Management Module for advance planning of roles and responsibilities in disaster response.

  • Medical Surveillance Modules that track the types of medical incidents reported by health providers, described in terms of syndromes defined by the Air Force and the CDC.

Reports generated from the medical surveillance data can help identify outbreaks of disease or reactions to chemical agents before they might be noticed at a single facility. Officials get a visual overview of medical events and facilities displayed geographically.

'When you're doing surveillance for bioterrorism, you're looking for infectious diseases,' Treadwell said. CDC has not seen any instances of bioterrorism, she said, 'but we have found infectious outbreaks.'

CDC is not the primary user of Leaders, however. 'We're not a regulatory agency,' Treadwell said. 'We're always invited' by local officials. But CDC can request assistance, as it did in New York, where hospitals voluntarily reported conditions to Leaders.

A military hospital in San Antonio and Walter Reed Army Medical Center in Washington provide continuous feeds to Leaders. Emergency rooms in Tampa and Seminole County, Fla., and in Northern Virginia use it to monitor critical-care bed availability for ambulance routing.

But Leaders gathers only statistical data, Hannon said: 'We're not collecting any personal information.'

Secure Sockets Layer encryption protects data moving between the Web server and users' browsers. Access is based on user name, role and password'a dispatcher in Arlington, Va., for instance, can access only data about critical-care beds in Northern Virginia hospitals.

About the Author

William Jackson is freelance writer and the author of the CyberEye blog.

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