Surveillance system links hospitals

Today the state will unveil a powerful new tool for safeguarding public health: a statewide electronic surveillance system that will monitor hospital emergency-room data for early signs of disease outbreaks and bioterrorism threats.

North Carolina hospitals with round-the-clock emergency departments will submit information to the state every 12 hours about symptoms in patients seen at their facilities. If needed, the state could get data as often as every 15 minutes.

That means for the first time ever, state public-health officials will have nearly real-time updates of emerging public-health threats. That will allow the state to respond more quickly, contain disease outbreaks sooner and save more lives, said Dr. Leah Devlin, the state health director.

"This is a constant, electronic radar," said Devlin, who will highlight the surveillance system at a news conference this morning at WakeMed North in Raleigh. "If something blips on the screen, we see it and we go looking for it. This is not a passive system."

North Carolina officials think the new system is the first in the nation to electronically gather clinical and demographic information from emergency rooms statewide. Now, 52 of the 113 hospitals in the state with 24-hour emergency rooms, including WakeMed North, submit data to the North Carolina Hospital Emergency Surveillance System. By this spring, all of them will.

The surveillance system cost about $3.4 million over five years. The state paid for it with federal money earmarked to improve the nation's ability to detect and respond to bioterrorism threats.

Instead of building an electronic reporting system from the ground up, which would have been more costly, the system uses software developed by a Durham company, MercuryMD. The company's hospital clients had been using the software to coordinate the care of patients with chronic illnesses, said Dr. Alan Ying, MercuryMD's chief executive.

The software can look for flu-like illnesses, gastrointestinal symptoms, respiratory-system complaints, fevers and rashes, among other medical symptoms. The program captures the patient's gender, age and county of residence, but no identifying information.

The system's use isn't limited to bioterrorism.

A couple of months ago, the state used it to track victims of Hurricane Katrina who were relocated to North Carolina. As a result, public-health officials were able to identify and treat a case of vibrio, a potentially deadly waterborne illness, after an evacuee sought treatment in a hospital emergency room.

Last week, the system helped state epidemiologists pinpoint a case of hepatitis A in Wake County. The information allowed the Division of Public Health to respond within 24 hours to contain an outbreak. Before the system, it might have taken weeks for the case to reach the division.

Physicians and diagnostic laboratories are required by law to notify the division by fax or mail when they diagnose certain communicable diseases. An analysis conducted by the Division of Public Health found that it can take four or five weeks from the time a patient is diagnosed for information about the illness to reach public-health experts. Many more people could be exposed to the illness in that time.

The electronic surveillance system will augment, not replace, existing communicable disease reporting systems, Devlin said.

Before the surveillance system, hospital emergency departments did not systematically report information about disease outbreaks. The new system builds on a test project established in 1999 by the Department of Emergency Medicine at UNC-Chapel Hill's School of Medicine and the Division of Public Health.

UNC will continue to be involved in the statewide surveillance project. Researchers in the department of emergency medicine are responsible for ensuring hospitals' reported data is in the proper format, among other tasks, before it is loaded into the state's database and made available to state epidemiologists.