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Expanding the scope

Clinicians in the Children’s Emergency Department (ED) who helped develop a software program to track signs of bioterrorism have found that it also provides valuable information for predicting day-to-day emergencies.

Known as EDScope, the project started over the summer as part of the hospital’s continuing efforts at “syndromic surveillance,” or surveying hospitals and clinics for clusters of particular diseases that may signal a bioterrorist attack.

“The challenge has always been that people come into the ED individually, not all at once,” says Michael Shannon, MD, interim chief of Emergency Medicine. “So it was hard to determine if there was a change in the pattern of a given set of symptoms. EDScope lets us see those patterns and identify potential problems before they get out of hand.”

The software was developed by the Informatics Program, implemented by the Information Services Department, and gives ED staff a real-time look at the types of problems treated on a given day. The symptoms of each patient admitted to the ED are entered into the computer in 14 basic categories (such as rash or meningitis). Physicians, nurses and other staff can then consult a computerized readout—which is updated about every 15 minutes—that shows all the activity in the ED that day and for the previous week.

Here comes the amazing part: Ben Reis, PhD, from Informatics, and Miliken Tyler from ISD designed EDScope to compare the data for a given day with information from the more than 500,000 Children’s ED visits in the last 11 years. If the computer analysis finds, for example, that more people have been admitted for respiratory symptoms than is normal for that time of the year and day of the week, a red flag alerts staff that a pattern may be developing.

Since the system went into use, Shannon and his ED colleagues have also found they can use the information to predict more common emergency room activities with high accuracy. “We’ve always known that we got more trauma patients in the summer and patients with the flu in the winter,” says Shannon. “But with EDScope, we can predict what specific types of patients we’re likely to get on any given day next month or even next April.”

Ken Mandl, MD, who is faculty in both the Informatics program and the Division of Emergency Medicine, bridged the gap between the two very different disciplines, and recognizes the potential in this type of collaboration. “This is the first Informatics program that has been transferred with a clinical application,” he says. “We see it as a great model for how to take cutting edge research and development and implement it through ISD.”

“EDScope serves as a mutual learning exercise for both groups,” says Daniel Nigrin, MD, MS, chief information office. “ISD gains knowledge about new research and development, and Informatics learns what goes into the development and maintenance of a production-ready hospital application.”

For his part, Shannon would like to explore the use of the software at other hospitals in the area so the data is that much more useful. “Right now there’s no place else in the country that can do this, but our goal is to share information with other hospitals and create a network for identifying disease patterns.” —MC