Bioterrorism and Public Health:
Insights from NCID Professional offers half day tutorial May 21st at dg.o 2006
Karen Heyman
For the DGRC

Bioterrorism and Public Health:

At this year’s annual Digital Government Conference to be held in San Diego, David Bray will present a tutorial entitled, “Fighting Fear of a Bioterrorism Event with Information Technology: Real-World Examples and Opportunities.” Bray served for several years as the IT Chief for the Bioterrorism Preparedness and Response Program at the U.S. Centers for Disease Control and Prevention (CDC), where he coordinated the IT aspects of BPRP’s response to 9/11, anthrax, West Nile, SARS, monkeypox, and other disease outbreaks. In 2004, he received the CDC’s Director Award for his leadership in information systems. Bray is now working towards a PhD in Information Systems in the Goizueta Business School at Emory University.

This half-day tutorial session on May 21, 2006 will be an in-depth discussion on the intersection of national security, public health, and information technology; specifically how information technology can be used for both bioterrorism preparedness and response. The answer isn’t as simple as merely keeping up to date with the latest hardware and software developments, says Bray. There are political, geographical and social issues that all come into play at multiple levels of government.

Since the U.S. Constitution does not mandate a federal role for public health, it is under the jurisdiction of states by default. In several states, coordination for public health services is at the city and county levels. For the most part, this distributed structure works reasonably well. However acute infectious diseases and emergency response pose serious challenges.

 “With the effects of globalization, infectious diseases can spread quite rapidly,” says Bray. His intent is not to be alarmist, but to emphasize the importance of being able to rapidly collect, analyze, and act on data surrounding an emergency event. For public health professionals and other concerned officials, it’s not just a question of data collection, but team coordination. Coordination to a possible bioterrorism event involves several different parties, including clinicians, health officials, epidemiologists, laboratorians, law enforcement, and several others. Public health efforts must constantly be alert to anomalous events that may simultaneously show up in several different regions across the nation. This requires information system collaborations.

While some computer systems are in place to handle such specific data collection and analysis duties, Bray says that fully-automated information systems for public health surveillance are only in their infancy; the ones that do exist still require a great deal of enhancements. One of the biggest challenges, according to Bray, is that most systems have been custom-made for the purposes of individual agencies. It’s not just a problem of system integration, but of sharing vocabulary structures and definitions. Public health professions need a common descriptive vocabulary for exchanging data.

For example, typical epidemiological detective work means that dozens of random items discovered at the site of an outbreak need to be entered into a database. But what happens when one person calls an object “a pipe with biofilm,” and another records it as, “bacteria-covered tube”? An additional challenge for emergency response is that every few hours, elements captured in an ad-hoc database may change as the ultimate cause of an outbreak begins to become clearer. “Merging data collected from different local sites is a serious challenge,” says Bray. “When anthrax happened, it took several months of data-cleaning by a large team to be able to sort out fully what happened.”

The ideal solution involves defining a common, yet flexible vocabulary that would assist practitioners when initially starting and later merging their databases. Yet there are still pitfalls, warns Bray. Being able to share the data is but one challenge; another is being able to securely exchange it with multiple partners at local, state, and federal levels of government. For a response to a bioterrorism event, potentially over fifty different agencies are involved. While progress is being made so that different identity management systems can authenticate different users involved with a response, there remains the problem of getting the correct reports, to the correct users, in the correct time so that informed decisions can be made.

Another challenge is that public health places high importance on the protection of individual privacy; at the same time valuing open sharing of de-identified data. National security, on the other hand, places importance foremost on the protection of data and secrets, whereas individual privacies may be secondary. Bray believes that often information systems for bioterrorism and emergency response are “caught” between the demands of these two priorities. By law, Public health data received at the federal level must have any personal identifiers removed, yet often the federal level is trying to link together different data streams into a complete picture.

Bray’s tutorial will go in-depth on these and similar challenges and offer ideas on how IT can help to solve them. He will have time for audience questions during the presentation and discussion afterward. Attendees should come away with a realistic idea of what is currently being done, as well as how much still needs to be done going forward, “I hope people get an eye-opener in terms of the U.S. public health system works, its interplay with national security, and how you can help build and research solutions to solve some of these intriguing challenges,” says Bray.

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