DHS lays the groundwork for biosurveillance

If bird flu erupts in the United States, the Homeland Security Department's access to real-time data will be vital in spotting its emergence.With that in mind, DHS is developing the National Biosurveillance Integration System to track and combine data it will receive electronically from several agencies' public health, food, animal, air and water monitoring systems.The ambitious system, designed to give DHS a national biosurveillance picture, is a critical piece of the administration's strategy for responding to a pandemic such as avian flu. But the technology, policy and culture change associated with the system will present challenges for DHS.The system is designed to aggregate and integrate information from local, state and federal agencies' bio-monitoring systems and combine it with data from the intelligence community, said Kimothy Smith, DHS chief veterinarian, chief scientist and acting deputy chief medical officer.He recently described the system for the House Homeland Security Committee's subcommittee on the prevention of nuclear and biological attack.'By integrating and fusing this large amount of available information, we can begin to develop a baseline or background against which we can recognize anomalies and changes of significance indicating potential biological events,' Smith said.The resulting analysis will let DHS make decisions on how it should respond to biothreats. The biosurveillance system also will send back situational awareness to the agencies that provided the bio-data.DHS expects to award a contract in mid-summer and implement the NBIS Version 2.0 six months after the award, Smith said. The contract will last up to five years.The value of the contract is estimated at about $11 million, according to market research firm Input of Reston, Va.DHS began testing a version of the biosurveillance system in December to provide some operational capability.Agencies will connect with the system through interfaces or standards that let the systems talk with each other. Ideally, they will be interoperable, Smith said.For example, DHS will support standards that result from the health IT efforts of the Health and Human Services Department and its public/private advisory group, the American Health Information Community, for real-time biosurveillance reporting, he said.'All of the progress that has been made in those regards will have a downstream benefit for NBIS,' he said.It will be challenging for the system to accept large quantities of diverse information in various formats, standardize the data and prepare it for use with data from other sources, Smith said.Public health professionals integrate data to generate patterns in baseline activity, so they can detect clusters that aren't normal, said Nicholas Guzman, an associate professor at the George Washington University School of Medicine in Washington, D.C., and a biosurveillance expert at the university's Homeland Security Policy Institute.'It will be difficult to integrate algorithms in a way that minimizes false positives and integrates disparate systems in a way that they validate data, and from that create actionable information,' Guzman said.NBIS will sift information from sources such as the Centers for Disease Control and Prevention's BioSense system, which collects common symptoms from hospital emergency rooms and pharmacy transactions, and the BioWatch system.BioWatch provides early warning of a biological attack so first responders can deploy and administer countermeasures, said John Vitko Jr., director of DHS' biological countermeasures portfolio in the Science and Technology Directorate. For three years, it has used air samplers throughout selected cities with filters retrieved daily for genetic analysis at a nearby Laboratory Response Network lab.BioWatch has detected few 'true positives,' or samples that were actually the bio-events that they initially indicated, but most were small amounts of naturally occurring organisms stirred up by unusual environmental conditions, Vitko said. BioWatch depends on consultation with local and state officials.Despite the value of a national biosurveillance picture, the centralized focus of NBIS might not allow enough local and state input to explain variations in health data that DHS will receive from BioSense, said David Siegrist, interim director of the National Security Health Policy Center at the Potomac Institute for Policy Studies in Arlington, Va. Providers transmit the health information in small data fields under Health Level 7 data standards. The enhanced BioSense-Real Time system, however, will add more diagnostic data, he said.'There could be a disconnect between whether the local public health officials think they have an outbreak and whether the centralized NBIS thinks they have an outbreak,' he said.Local officials often have additional sources of relevant data to help determine how seriously to take the variations in data.'All outbreaks are local, and local experts need to be called upon to determine if there is an outbreak, and in a similar manner to what's currently done in the BioWatch program,' Seagrist said.