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Containing Disease Outbreaks Requires Collaboration and Communication

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Jun 29, 2010 1:00 AM

Steven Leitch

Catherine Staes, Ph.D., and Matthew Samore, M.D., are collaborating on a public health project to create a statewide framework to communicate better when outbreaks, such as the cryptosporidium outbreak two summers ago, occur.

Microscopic parasites of the genus Cryptosporidium, commonly known as Crypto, is one of the most frequent causes of waterborne disease among humans in the United States. In a 2007 outbreak, 1,900 cases were confirmed in Utah.

Remember a few summers ago when several days after a fun trip to the local swimming pool, children came down with a host of not-so-fun symptoms (including severe diarrhea, fever, nausea, vomiting, stomach cramps, and dehydration) sometimes lasting up to a month? That was thanks to an outbreak of cryptosporidium. In just six months, the number of laboratory-confirmed cases reported to the Utah Department of Health (UDOH) jumped from an average of 16 per year to more than 1,900 in 2007.

Part of the problem was that the public didn’t find out about the outbreak until it was too late.  People weren’t getting diagnosed and doctors were slow to report confirmed cases to UDOH, so in turn, the health department wasn’t advising clinicians to be on the alert and order lab tests to confirm cryptosporidium in patients with symptoms. The outbreaks of H1N1 flu and West Nile virus are other examples that have heightened concern about the need for developing a seamless public health reporting system. 

Catherine Staes, Ph.D., assistant professor of biomedical informatics, is spearheading a project to automate the flow of knowledge between public health authorities and clinicians. She is collaborating with other researchers to create a statewide framework through the U’s center of excellence (COE) in public health informatics—named the Rocky Mountain Center for Translational Research in Public Health Informatics. Utah is one of only four centers nationwide chosen to receive funding ($5 million over the next five years) from the Centers for Disease Control (CDC). 

Public health informatics is the use of information gathered from electronic medical records and a wide variety of other sources to monitor and control disease and improve public health. “Most people understand the use of informatics on the clinical side [to enhance communication between physicians and patients], but aren’t familiar with how it can be used on the public health side [which involves communication to thousands, even millions, of people],” says the center’s director, Matthew Samore, M.D., professor of internal medicine.

The COE brings together researchers from informatics, social science, computer science, epidemiology, pediatrics to work with public health agencies to help solve vexing health problems. The center’s ultimate goal is to create a statewide set of interconnected data resources that would allow public health departments, health care facilities, clinical laboratories, health care providers, and schools to share critical information about disease outbreaks.

All the statewide partners now communicate on a more regular basis including weekly videoconferencing. “Everyone is now much clearer on who has what particular roles and the expectations of those roles,” says Staes. During the recent H1N1 outbreak, the Utah Department of Health, Intermountain Healthcare, and University of Utah Health Care each established its own guidance rules on how to test and treat patients. Now a team comprised of all these partners has created one recommendation for community clinicians. 

Taking the idea a step further, imagine the next cryptosporidium outbreak. When health information and technology applications are fully interoperable, a clinician could enter a patient’s symptoms, age, and location into the electronic medical record. If they corresponded with an outbreak, an alert would appear on the screen, advising the provider to order the appropriate labs and educate the family on how to avoid and prevent the spread of this disease (for example, keep your young children away from swimming pools). If lab tests confirmed crypto, it would be electronically reported to the state’s public health office so the outbreak could be detected, tracked, and controlled.   

According to Samore, who is also director of the Informatics, Decision-Enhancement and Surveillance Center at the Veterans Affairs Salt Lake City Health System, Utah was chosen to receive federal funding not only because of its national reputation in biomedical informatics, but also because of the collaborative environment and trust that exists among the many different health agencies and researchers required to coordinate such an effort.  “Technological strategies usually fail without cooperation.” 

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