Traditionally, the primary method for collecting surveillance data was manual reporting of suspicious and notifiable clinical and laboratory data from clinicians, hospitals, and laboratories to public health officials (1). This system works fine for epidemic diseases such as avian influenza that take days or weeks to spread; however, new time critical systems are needed to combat bioterriorism related outbreaks. Such attacks can spread and infect thousands of people within hours.

The new systems feature automatic data extraction to collect and report syndromes rather than specific diseases. In addition the systems immediatley report ordered labratory tests rather than the actual results which can take hours to generate. These new methods can greatly decrease the response time in an emergency outbreak. As Doug Freeman, a professor at North Dakota State University, said, "The faster you can identify what you are dealing with and put a containment strategy in place, the less loss you are going to experience."

Even before the September 11th attacks, AHRQ had already begun funding research to handle bioterrorism cases. This has included research to determine the effectiveness of information technology in combatting bioterrorism. Using the Real-time Outbreak and Disease Surveillance (RODS) computer sytem, researchers at the Univerty of Pittsburgh have shown that early detection of infectious disease is possible. Several studies sponsored by AHRQ have used data from emergency room visits, laboratory tests, and patient demographic information to prove that the RODS system was able to detect acute respiratory illnesses and influenza far more quickly than standard methods of detection. The system is monitored by physicians who have public health, emergency, and infectious disease training. When patients begin exhibiting symptoms of a monitored disease more frequently than normal, public health departments are alerted. A web-based decision support system was designed by the Massachusetts Institute of Technology to link patient symptoms with potential organisms and a treatments.

Given the real threat of an anthrax outbreak, Congress has approved a bioterror budget of almost $1 billion for the CDC. Of the total $504 million the CDC spent on IT this year, a portion of this money is being used to develop computerized surveillance systems to safeguard the nation from bioterrorism. This new initiative called BioSense will collect data from many sources ranging from pharmacies to emergency rooms and will mine data for early indicators of a bioterrorism attack. This system will focus soley on the most likely pathogens to be used in a terrorist attack, such as anthrax and plague. Thousands of hospitals and healthcare practitioners are connected to the network and using the current BioSense surveillance meant for emerging epidemics. These pathogens take time to sicken people, but "weaponized" smallpox or anthrax can kill within hours, so daily dumps are simply not fast enough and the system needs to be redesigned to be suitable for combatting bioterrorism.

The agency is also using its increased funding to integrate many of its hundred-odd computerized surveillance programs. The new system will be called the National Electronic Disease Surveillance Systems (NEDSS). Due to the high costs associated with direct integration, the agency is focusing on developing universal data messaging and content standards for health information. States are being provided with funding to participate and the software is being put into public domain with the hopes that IT vendors will build the standards into their medical information software.

Currently the CDC gets its data through a very tiered process - once a practitioner makes a diagnosis of one of the 50 reportable diseases, they must report it to the local health department, who reports it to the state department, who then reports it to the CDC. Only some of these connections are automated and the thoroughness of the reporting is spotty. This new system will remove much of the human intervention as consistant automatic reports will be generated by electronic medical records and hospital information systems. Patient privacy will be protected in this system since no identifying information is send with the reports. Should this information be needed, the CDC will contact the providing institution directly. The CDC is currenlty far from reaching this goal of speedy, national data access and one of their first steps is to establish national health data standards. They hope electronic medical records will be in widespread use within the next decade and thus make this system a success.

Computing in BioTerrorism