A recently deployed syndromic surveillance project has forged new communication links between the community hospitals in Grey-Bruce and the Grey Bruce Health Unit (Health Unit). ECADS – which stands for “Early CBRN” (Chemical/Biological/Radiological/Nuclear) Attack Detection by Computerized Medical Record Surveillance – is a new electronic software application designed to identify emerging outbreaks of illness in the community. Each of the 11 rural hospitals in Grey-Bruce are ECADS participants, as is the Owen Sound site of Grey Bruce Health Services (GBHS) which houses the server.
ECADS uses data as reported by patients who visit area hospital Emergency Rooms (ER). Based on an archive of illness profiles, the technology assigns ER patients’ chief complaints into one of eight illness categories or syndromes – respiratory, gastrointestinal, constitutional, rash, hemorrhagic, botulinic, neurological, and “other”.
Data received from all area ERs is analyzed at the GBHS central processing site four times during each 24-hour period. When a predetermined probabilistic threshold of illness is exceeded in any illness category, the system will generate an alert. When this happens, the Health Unit determines the authenticity of the alert by reviewing the particulars.
A recently released ECADS respiratory alert prompted the Health Unit to suspect that Pertussis (whooping cough) may be involved. Local ERs received a Physician’s Advisory
that provided preliminary notice that children with these symptoms may not be isolated random cases, but part of a suspected Pertussis cluster. ER personnel were also requested to obtain specimens for laboratory confirmation of the disease.
The value of ECADS to provide an early warning of community-wide illness was demonstrated recently by a retrospective simulation conducted by Richard Davies. Dr. Davies used patient data from the Walkerton, Ontario outbreak to show that the outbreak could have been identified up to three days earlier than it was. This offers a significant opportunity for hospitals and public health to diminish the impact of an emerging public health threat and to strengthen outbreak identification and control protocols with other partners and the greater medical community.
This project has been in place at GBHS for six months, but its real-time simultaneous ability to provide advanced warning of outbreaks of illness in the community may prove invaluable. This technology has allowed the roles of the community hospital and the Health Unit to provide an enhanced approach to identifying and managing potential threats to public health.
Dr. Hazel R. Lynn is the Medical Officer of Health at the Grey Bruce Health Unit.
