Report of the Frontlines of Medicine Project = Consensus Conference

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Report of the=20 Frontlines of Medicine Project Consensus=20 Conference

Hernan F.=20 Gomez, MD

University of=20 Michigan

SAEM=20 Representative to Frontlines Conference

It was = my pleasure=20 and honor to have served as the SAEM

representative for=20 the Frontlines of Medicine consensus confer-

ence. = The meeting=20 was filled with many fine and nationally promi-

nent = speakers from=20 within emergency medicine, and key individ-

uals = from high=20 profile federal agencies such as the CDC. The

Honorable Tom=20 Sawyer, Member of Congress (14th District,

Ohio) = eloquently=20 discussed issues involving legislation, health-

care, = and=20 preparedness, including the need for high speed inter-

net = access to all=20 hospitals for effective communication and data

collection. As may=20 be discerned by the title of the program =E2=80=93 rep-

resentation in=20 this conference was clearly in our area of interest.

The = Frontlines of=20 Medicine Project (http://www.frontli-

nesmed.org/) is a=20 newly inaugurated effort to develop a nonpro-

prietary, and=20 standardized =E2=80=9Copen systems=E2=80=9D approach for = collect-

ing and = reporting=20 emergency department data for the purposes

of = biological and=20 chemical surveillance. The aim of this form of

surveillance is to=20 capture in real-time data from emergency

departments from=20 around the country for the early diagnosis and

treatment of=20 disease. By pooling multiple key forms of data from

multiple = sites and=20 sources within the emergency medicine

domain, = disease=20 may be recognized early and thus optimize the

opportunity to=20 save lives. There are similar initiatives being

planned = within=20 various agencies, and the proactive Frontlines

planning = from=20 emergency medicine leadership is good news to

emergency medicine=20 as a whole. The framework constructed by

the = Frontlines=20 leadership will allow emergency medicine clini-

cians to = determine=20 the nature of information technology (IT)

design = of ED-based=20 surveillance infrastructure which may then

promote=20 communication (vertical and horizontal) with local and

federal = public=20 health agencies.

The = emergency=20 department is such a key area of data col-

lection = that it=20 would be reasonable to assume that the emergency

medicine = world=20 would likely find themselves incorporated into

other = surveillance=20 systems if we were to simply play the role of

passive = observers.=20 The Frontlines Project allows emergency

medicine = clinicians to play an active role in design elements in a

surveillance=20 program aimed to link individual (and very busy)

departments with=20 public health and other vital decision making

agencies.

This = project is a=20 collaborative effort of emergency medicine

(including=20 emergency medical services and clinical toxicology),

public = health,=20 emergency government, law enforcement, and

informatics.=20 Recent national events including the disaster of

September 11,=20 2001 and subsequent anthrax distribution by mail

have = intensified=20 efforts to improve surveillance for chemical and

biological=20 terrorism. The leadership of the Frontlines Project have

proactively=20 organized this effort with the recognition that emer-

gency = departments=20 are uniquely positioned as surveillance sites

because = they=20 universally contain the following ideal characteris-

tics: = a) they are=20 open 24 hours each day, b) are ubiquitous in dis-

tribution c)=20 continuously treat large numbers of patients of all

ages d) = direct=20 out-of-hospital emergency medical services e)

have = been heavily=20 involved in nuclear, biological, and chemical

preparedness=20 issues for a number of years prior to September

11. The = leadership of this effort are to be congratulated for = taking

the = initiative of=20 placing emergency medicine in a central role in

determining how=20 surveillance and data sharing, and ultimately

(vertical and=20 horizontal) communication should be planned in the

emergency=20 medicine domain.

A = proposed system=20 that would be seamless and shared

between = emergency=20 medicine and public health would be a step

in the = right=20 direction for improving historical problems with col-

laboration=20 between emergency medicine and public health.

Impedances to=20 effective collaboration are detailed in a recent

review = (Pollock=20 et al. Emergency medicine and public health: new

steps = in old=20 directions. Ann Emerg Med 2001; 38:675-683). The

benefits of=20 sharing health care data among emergency depart-

ments = and with=20 public health agencies are being investigated by

several = agencies.=20 Examples include: Indianapolis Network for

Patient = Care,=20 which includes an automated transfer of data from

hospitals to=20 public health authorities. Sandia National laborato-

ries = have shown=20 feasibility of collecting emergency encounter

data to = detect 6=20 primary syndromes that might be consistent with

bioterrorism=20 (Zelicoff A et al. The Rapid Syndrome Validation

Project = (RSVP) a=20 technical paper. Sandia National Laboratories.

Available at:=20 http://www.cmc.sandia.gov/bio/rsvp/pub.html).

Dr. Dan = Pollock=20 and Lawrence P. Hanrahan described an

overview of CDC=20 activities such as the National Electronic

Disease = Surveillance system (NEDSS) project, and the Health

Alert = Network=20 (HAN). It was clear from this overview that the

Frontlines=20 Project may be designed to fully integrate with these

systems. NEDSS is=20 a public health initiative which provides a

standards-based,=20 integrated approach to disease surveillance

and = connects=20 public health to the rather unwieldy clinical infor-

mation = systems=20 infrastructure. HAN is a HERSA component for

hospital=20 preparedness and is in part dedicated to effective inter-

facing = with NEDSS=20 and area hospitals.

The = ultimate=20 objectives (largely met in the conference) were

to: 1) = introduce=20 and establish the Frontlines project as a net-

working = resource=20 for healthcare providers, public health authori-

ties, = health=20 information systems experts, government officials

and = agencies, and=20 professional associations interested in the

application of=20 syndromic surveillance in emergency medicine

and = related=20 fields 2) introduce a defining approach to the appli-

cation = of=20 syndromic surveillance data collection from multiple

frontlines sites=20 (emergency medicine departments, clinics, physi-

cian = offices,=20 veterinarians, schools or worksite absenteeism, etc.

3) = establish an=20 initial version of XML-based messages to be uti-

lized = in pilot=20 projects for sending surveillance data from emer-

gency = departments=20 to regional surveillance entities and finally 4)

facilitate future=20 activities for ongoing communication of related

activities among=20 stakeholders and possible funding of pilot proj-

ects = to validate=20 initial recommendations.

The = effort may=20 be summarized as the beginning of a proac-

tive = effort on=20 the part of the emergency medicine leadership to

control the=20 design and IT infrastructure that will one day be the

part = of=20 day-to-day preparedness operations in the modern 21st

century=20 emergency department. We can passively let other

organizations do=20 this for us, or we can design it to maximally fit

our = needs and=20 integrate a Frontlines system that would maxi-

mally = fit the=20 needs of emergency medicine and ultimately mini-

mize = morbidity=20 and mortality in the face of the unthinkable.

Page = 2

Conference=20 Participants

Edward = Barthell,=20 MD, Executive vice President Infinity HealthCare, Inc., Craig

Feied, MD, Director of Informatics, National = Center for=20 Emergency Medicine

Informatics,=20 Dennis G. Cochrane, MD, Emergency Medicine Associates,

Morristown=20 Memorial Hospital Residency in EM, William H. Cordell, MD,=20 Director,

Division of=20 Research, Indiana University School of Medicine, John C. = Moorhead,

MD, MS, = Professor, EM and Public Health & Preventive Medicine, Oregon=20 Health

and = Science=20 University, Dept of EM, Mark Smith, MD, Chairman, Dept of = EM,

Washington=20 Hospital Center, Charles Sneiderman, MD, PhD, Research = Medical

Officer, Office=20 of High Performance Computing and Communications, National

Library = of=20 Medicine, Christopher W. Felton, MD, President, EMSystem, = Infinity

HealthCare, Inc.,=20 Michael Collins, BS, Senior Software Engineer, Infinity

HealthCare, Inc.,=20 Mohammad N. Akhter, MD, MPH, Executive Director, APHA,

Brent = R. Asplin,=20 MD, MPH, Health Partners Research Foundation, Erik Auf der

Heide, = MD, MPH,=20 Disaster Planning and Training Specialist, Agency for Toxic

Substances and=20 Disease Registry, Carlos Camargo, MD, DrPH, Director, EMNet

Coordinating=20 Center, Dept. of EM, Stephen K Epstein, MD, MPP, FACEP, = Clinical

Operations=20 Director, Dept of EM, Beth Israel Deaconess Medical Center,=20 Virginia

Foster, = PhD, MPH,=20 Epidemiologist, Department of Defense-Global Emerging

Infections=20 Surveillance and Response system (DoD-GEIS), Capt. Arthur = J.

French, = MD, US=20 Coast Guard EMS Physician Liaison, National Highway Traffic

Safety=20 Administration, Michael Gillam, MD, Director EM Informatics,=20 Evanston

Hospital, Chair=20 ACEP Informatics Section, Hernan F. Gomez, MD, Medical

Toxicology, Univ=20 of Michigan, Dept of EM, Jonathan A. Handler, MD, Director = of

Emergency=20 Medicine Informatics, Division of EM, Northwestern = University,

Lawrence P.=20 Hanrahan, PhD, MS, Chief Section of Epidemiology and = Toxicology,

Bureau = of=20 Environmental Health, Brian F. Keaton, MD, Board of Directors,=20 ACEP,

EM = Informatics=20 Director, Dept of EM, Summa Health System, Linda Lawrence,

MD, = Chief,=20 Emergency Medicine, Andrews AFB, Scott Lilibridge, Special

Assistant to the=20 Secretary for national Security and Emergency Management,

Dept of = HHS, Dan=20 Pollock, MD, Medical Epidemiologist, National Center for = Injury

Prevention and=20 Control, CDC, Helga E. Rippen, MD, PhD, MPH, Director, = Science

& = Technology=20 Policy Institute, RAND, Mhomas O. Stair, MD, Research = Director

Emergency=20 Department, Brigham and Women=E2=80=99s Hospital , Joseph F. = Waeckerle,

MD, = Editor in=20 Chief, Annals of Emergency Medicine, C. Peter Waegemann,

Chairman Centre=20 for the Advancement of Electronic Health Records. In = addition,

the = Honorable Tom=20 Sawyer, Member of Congress, US House of Representatives

(14th = District,=20 Ohio) was present during key portions of the=20 conference.