Current Technology Is Inadequate For Bioterrorism Response

A study of health care technology released this summer concludes that while information technology could help clinicians respond to bioterrorism events, current IT systems are inadequate to meet those challenges.

The report, “Bioterrorism Preparedness and Response: Use of Information Technologies and Decision Support Systems,” was released in August by the Agency for Healthcare Research and Quality (AHRQ), part of the Department of Health and Human Services.

According to the report, information technology and decision support systems (software that analyzes data and attempts to predict the impact of an operations decisions) have potential to help clinicians and public health officials respond to a bioterrorism event. It adds, however, that most of these systems were not designed to deal with bioterrorism, and they have not been adequately described or “evaluated rigorously.”

Part of the problem, according to Eduardo Ortiz, a physician who is a senior service fellow with AHRQ, is that “health care in general lags way behind other [industries] in the use of information technology.” The other part is that until recently, the United States had not experienced a significant bioterrorism threat, he says.

“That didnt surface until the anthrax scare,” Ortiz says. “Then people said, Oh my God, were really not prepared to respond to this kind of thing.”

Ortiz also points out that communication between disparate computer systems “is a big issue in public health.” Most public health agencies, he notes, “dont have sophisticated IT systems running. Even when places do have IT systems, most tend to be stand-alone systems that just work in the county or state; they dont cross state lines.”

The bottom line, he adds, is that “the majority of health care systems are not up to speed. They speak different languages.”

In an effort to remedy that situation, AHRQ is working with other health care organizations to get common standards for electronic communication, says Ortiz. The need for standards, he notes, “is one of the key things that everyone is finally recognizing. When I call something anthrax, any system has to recognize it as anthrax.”

He adds that privacy safeguards, in compliance with the Health Insurance Portability and Accountability Act, also need to be part of the standards equation.

In terms of decision support systems (DSS) for use in bioterrorism events, Ortiz says this is something his agency has been working on. “Theres so much information out there all the time; it really overwhelms the capacity of the human mind,” he explains. “Smart systems help you make decisions and they recognize things that you might miss. They can detect patterns that a human may not [normally] detect. Such a system could also prompt me and let me know that [a situation] could be bioterrorism-related.”

Decision support systems, according to Ortiz, “harness the power of computers, which dont forget. Weve seen that they help physicians make better decisions.”

The AHRQ study noted that three of the general diagnostic DSSs it evaluated “typically performed better than physicians in training, but not as well as experienced clinicians.”

Further, the study said, the need for clinicians to manually enter patients signs and symptoms into a diagnostic DSS is eliminated in a few systems that automatically collect patient data from an electronic medical record.

Unfortunately, the report added, none of the reports of diagnostic DSSs it reviewed dealt specifically with diseases arising out of bioterrorism events.

DSSs can be useful in other areas, providing treatment reminders, guidelines for certain diseases, correct dosages, and medication administration times, says Ortiz. In a bioterrorism situation in particular, he notes, DSSs could be “very helpful” in diagnosing and treating diseases that are otherwise rarely seen.

In the area of information management, Ortiz points out that “the majority of health care systems are still doing things in paper form,” adding that improvements are needed to “the infrastructure of the whole country” in order to effectively deal with bioterrorism.

“We need to start building in some specific bioterrorism pieces, and we have to start building and testing these systems in terms of bioterrorism effectiveness,” Ortiz states. “Dont just assume something is going to work. It could actually be bad and have unintended consequences.”

The study also examined reports on 55 detection systems “that collect and identify potential biothreat agents within environmental and clinical samples.” Most of these systems have been developed by the military, and there were few, if any, reports on their effectiveness, sensitivity and accuracy, the study said.

In addition, most of these systems test for only one bioterrorism agent and can only examine a limited number of samples at one time. The systems also “cannot test for many of the most worrisome agents (e.g., smallpox),” the study noted.

“Theres a lot we dont know about the military-developed systems,” says Ortiz. “The problem is that if you dont know what the biothreat is and your system only detects one thing, it might be something else. Ideally, we want to be able to detect multiple threats simultaneously.”

Chief among the barriers to better bioterrorism technology systems is the need for an updated infrastructure, a need that is not sufficiently funded, says Ortiz. “Public health systems arent awash in money. There are lots of budget cuts and competing priorities,” he explains.

“Now that we have the IT capability,” he continues, “we need to learn how to use it.” He adds that the case for funding of bioterrorism systems also needs the backing of health care organizations and academic health care leaders.

Ortiz notes that after the anthrax scares of 2001, the federal government doled out $1 billion to the 50 states to help them develop bioterrorism preparedness. He adds that in 2003, Health and Human Services “is supposed to be increasing that figure to $3 billion.”

How long will it take the U.S. to update its systems in order to be prepared to deal with bioterrorism? “Were more prepared now than we were a year ago,” says Ortiz. “Youre never really completely prepared, because bioterrorism is a rare and unexpected situation. The goal is to be as completely prepared as possible.”


Reproduced from National Underwriter Life & Health/Financial Services Edition, November 4, 2002. Copyright 2002 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.