Arbitrarily Selected Reading and Sites
Related to Medical Informatics
and Bioterrorism Detection
By Judith Broadhurst

Note: I may (or may not) add citations and links to this list if and when I have time.

A Google search for "early detection of bioterrorism attack in united states" returns only 5,220 hits, but a more refined search for "bioterrorism surveillance" produces 33,500 links. As of February 17, 2003, the New York Times had run 859 articles in its "Threats and Responses" series over the last year, alone. Stories from this month:

Health Data Monitored for Bioterror Warning, New York Times, January 27, 2003 (subscription or purchase required)

US Deploying Monitor System for Germ Peril, New York Times, January 22, 2003 (subscription or purchase required)

Other Articles

Science Journals Cutting Bioterror Data, AP Newswire, February 16, 2003
Editors of the world's leading scientific journals announced [yesterday] they would delete details from published studies that might help terrorists make biological weapons. The editors, joined by several prominent scientists, said they would not censor scientific data or adopt a top-secret classification system similar to that used by the military and government intelligence agencies. But they said scientists working in the post-September 11 world must face the dismaying paradox that many of their impressive breakthroughs can be used for sinister purposes. The new editing methods will be voluntary and will differ among the 32 publications and scientific associations that agreed to the effort. Those include the journals Science, Nature, Proceedings of the National Academies of Science, the New England Journal of Medicine and The Lancet.

US Seeks to Monitor Bioterror Attacks, Reuters Health, January 28, 2003 (story no longer online)
Excerpt: The Centers for Disease Control and Prevention is developing a computerized network to gather a broad variety of information on illnesses to provide an early warning of a bioterror attack. The system would gather data on visits to doctors' offices and emergency rooms, drugstore sales and calls to poison control centers in major US cities. Daily reports on fevers, headaches, diarrhea, vomiting, stuffy noses, coughs and rashes would be fed directly into central computers to be compared with normal seasonal, daily and regional fluctuations in known illnesses. That way, the theory goes, officials will find out quickly if there is a sudden surge in illness linked to a bioterror attack.

Shot in the Arm for Public Health: Weak Systems Require Reinforcement at All Levels, AHIMA Journal article, January 2, 2003
Bioterrorism is a real threat in the US and around the world. Today, our public health system is not robust enough to handle the surveillance and reporting activities needed to protect citizens, but efforts already in progress may be able to change that.

Knowledge-based bioterrorism surveillance, by researchers at Stanford Medical Informatics [including Justin Graham, MD, featured in the February 2003 issue of Health News Monitor newsletter], Stanford University, Palo Alto, California. In Proc AMIA Symp 2002:76-80 (PubMed in process)
Abstract: An epidemic resulting from an act of bioterrorism could be catastrophic. However, if an epidemic can be detected and characterized early on, prompt public health intervention may mitigate its impact. Current surveillance approaches do not perform well in terms of rapid epidemic detection or epidemic monitoring. One reason for this shortcoming is their failure to bring existing knowledge and data to bear on the problem in a coherent manner. Knowledge-based methods can integrate surveillance data and knowledge, and allow for careful evaluation of problem-solving methods. This paper presents an argument for knowledge-based surveillance, describes a prototype of BioSTORM, a system for real-time epidemic surveillance, and shows an initial evaluation of this system applied to a simulated epidemic from a bioterrorism attack.

Rapid deployment of an electronic disease surveillance system in the state of Utah for the 2002 Olympic Winter Games, researchers of the University of Utah Medical Informatics, Salt Lake City, UT. In Proc AMIA Symp 2002:285-9
Excerpt from abstract: In seven weeks, we were able to implement an automated, real-time disease outbreak detection system in the State of Utah and monitored 80,684 acute care visits occurring during a 28-day period spanning the Olympics. No trends of immediate public health concern were identified.
Also see: Surveillance System Gives Fast Alert

Better Plan Needed to Protect U.S. Agriculture From Bioterror Attack, joint press release from The National Academies, September 19, 2002

Government Agencies

CDC Bioterrorism Preparedness and Response Program

ESSENCE: Electronic Surveillance System for the Early Notification of Community-based Epidemics, Part of the DoD, Global Emerging Infections System (GEIS)
"Currently, ESSENCE downloads each day outpatient data from 121 Army, 110 Navy, 80 Air Force, and 2 Coast Guard installations around the world. Over 2700 syndrome- and location-specific graphs are prepared each day and automatically analyzed for patterns that suggest a need for further investigation." [Accessed February 17, 2003]

University Research

BioMedical Security Institute, a collaboration between Carnegie Mellon University and the University of Pittsburg's Center for Biomedical Informatics, established in 2000

BioSTORM (Biological Spatio-Temporal Outbreak Reasoning Module), Stanford Medical Informatics, Stanford University
A research program to develop and evaluate intelligent systems for epidemic detection and characterization. The BioSTORM project is centered in Stanford Medical Informatics at Stanford University. We collaborate with a number of groups including Veridian Systems, the Palo Alto Veteran's Affairs Hospital, the San Francisco Department of Public Health, and the State of California Department of Health.

Johns Hopkins University Center for Civilian Biodefense Studies and the Johns Hopkins University Applied Physics Laboratory