Multijurisdictional Approach to Biosurveillance, Kansas City

an independent organization acting as a data clearing-house between the reporting laboratories and public health departments. The system ran in tandem with conventional reporting methods. Laboratory test orders and results were aggregated and mapped to a common nomenclature. Reports were delivered through a secure Internet connection to the Kansas City Health Department (KCHD); during the first 200 days of operation, 359 qualified results were delivered electronically to KCHD. Data were received more quickly than they were with conventional reporting methods: notification of chlamydia cases arrived 2 days earlier, invasive group A streptococcal disease cases arrived 2.3 days sooner, and salmonellosis cases arrived 2.7 days sooner. Data were more complete for all demographic fields, including address, age, sex, race, and date of birth. Two hundred fourteen cases reported electronically were not received by conventional means. B iosurveillance is the automated monitoring of information sources of potential value in detecting an emerging epidemic, whether naturally occurring or the result of bioterrorism. Information sources that can be monitored for early warning include purchases of nonpre-scription medication (1) and symptoms reported during ambulatory care (2). Although these sources offer opportunities for early detection, they may also lead to high rates of false-positive reactions. A more definitive tool for bio-surveillance is the electronic reporting of diagnostic results confirming the presence of a pathogen. Heightened concerns about bioterrorism have led public health organizations to reevaluate methods used to report diseases. Currently, most healthcare providers notify public health organizations of reportable diseases by telephone, fax, or mail (3). These techniques generally delay the communication of confirmatory test results and notification of the appropriate public health organization (4). Underreporting is a major concern with traditional disease surveillance strategies (5); even cases of severe diseases sometimes go unreported (6). In addition, substantial variability exists in the completeness of the information sent to public health; initial reports often include only the test result and the patient name. They lack demographic details that are useful to public health officials, requiring them to perform followup calls to get the additional information (7). These delays and inconsistencies may impair the ability of public health officials to detect or respond to a bioterrorist event. One solution to these deficiencies is to use an electronic system to report disease to public health authorities. Three approaches to electronic disease reporting are feasible. The first approach (Figure 1A) requires each healthcare provider to standardize clinical results (i.e., …