Managing Outbreaks: The Technological Approach

Dr. Jean Challiner

April/May 2009

The recent report by the U.S. House Committee on Homeland Security entitled Getting Beyond Getting Ready for a Pandemic Influenza has highlighted that the U.S. is "not prepared as a nation to fully withstand the impact of such a devastating widespread biological event," and that "pandemic influenza would destroy the security of our nation and homeland."  While a number of actions have been taken to prepare for pandemic influenza, many organizations still "lack the sense of urgency and/or funds to continue preparing, or they are stuck endlessly preparing and are not yet ready."

A Sense of Urgency: The threat of pandemic influenza is well-overdue and needs to be treated with the same sense of urgency and planning afforded to other national security threats, as the consequences can be equally as devastating to both infrastructure and economy.  The report openly recognizes that the outbreak of pandemic influenza can be manageable if effective measures are taken to prepare for outbreaks in advance and a change in presidential leadership presents an opportunity to review and act upon the weaknesses identified in the national strategy.  The new administration's pledge to "wield technology's wonders to raise healthcare's quality and lower its cost" suggests a new emphasis on the role of computer-based tools to support both citizens and healthcare professionals.

These tools have a significant role to play in the management of pandemic influenza.  In my view, they will take us beyond getting ready to being prepared.  Telephony and Internet tools have the potential to provide ubiquitous advice for the public, empowering them to make decisions about their own health and also linking them to healthcare professionals, who can carry out an appropriate assessment and offer up-to-date and consistent advice and information.  This will serve to reduce public anxiety and will, in turn, help contain the outbreak and minimize risk.

A Pandemic Scenario: A glimpse of what can be achieved with these tools was demonstrated in 2006 when Australia's health and emergency services participated in the largest health exercise ever held in the country to test its preparedness for a pandemic influenza outbreak.  Exercise Cumpston was designed to assess Australia's border control, quarantine, and disease management strategies, national and local disease surveillance and response policies, decision-making structures, co-ordination mechanisms, and public communications strategies as outlined in the Australian Health Management Plan for Pandemic Influenza.

The exercise simulated the arrival of an international flight carrying sick passengers, the emergence of the pandemic in the community, and trialed the health system's capacity to contain and manage a pandemic.  Commonwealth, state, and territory governments participated, as well as medical associations, medical colleges, and a range of non-government and private sector organizations.

At the heart of the operation was a need to collect and analyze data relating to the number of likely carriers of the disease, the severity of the symptoms, and the location of each participant.  By utilizing health information and clinical decision support made accessible both on an IP-based network and over the Internet, call operators could be mobilized with immediate effect, beginning the process of collating information and managing the crisis without delay.

Call center operators were in a position to offer advice to patients to prevent the outbreak from spreading and to enable self-care and admission to the most appropriate healthcare center.  The information collected in the scripts by all call operators, along with data collected from other sources, provided invaluable management information for those responsible for the response to the faux pandemic.  While the exercise highlighted areas for improvement, it also showed the potential of technology to enable a swift and effective response to a crisis of this nature.

Providing Support Where It's Needed: Making the right tools available to support patients and healthcare professionals, as well as ensuring that there is the ability to collect and analyze information gathered, is an essential part of forward planning -- and this is where technology can lend a hand.

In an emergency, traditional access to healthcare is not always an option and in a pandemic situation, healthcare resources that cope at other times will be overwhelmed.  Technology can deliver Web and telephony-based self- assessment or healthcare professional assessment, direct care, offer up-to-date advice and guidance and, where appropriate, authorization for receipt of antiviral medicine treatment without the need for people to leave their homes.  Technology can also be used in a "command center environment" to help monitor the situation in real-time with the facility to rapidly change and update the instructions given out by Websites and call operators who are in direct communication with the public.  In addition, the technology can be utilized to exchange information with other agencies that may need to respond.  Such tools drive a more efficient management of resources and alleviate unnecessary pressure on emergency and primary healthcare services, leaving them to respond to those who need them most. 

The Online Citizen: In an environment where savvy and engaged citizens are increasingly looking to the Internet to assess their symptoms and seek health information, I believe that a familiarity with using technology for this purpose will make these interventions accessible and acceptable to a broad section of the public who might otherwise struggle to access the care and advice they need.  Unprecedented health and security incidents are, by their nature, unpredictable, and we must be prepared for every eventuality and be ready to use new ways and means of managing the situation.

Whether technology is utilized to streamline symptom assessment or to manage a pandemic outbreak, access to credible health information via the Internet enables government and healthcare organizations to act at the right time and in the right way to health incidents.  Preparation is everything -- having the tools to react quickly and effectively to these situations can really make the difference between life and death.

Dr Jean Challiner, with Clinical Solutions (770-813-2100) has extensive clinical experience gained over 20 years in both Primary Care and Accident and Emergency.  She has a Bachelor of Science Honours Degree in Physiology, a degree in Medicine and Surgery, and a Fellowship in Immediate Medical Care from the Royal College of Surgeons of Edinburgh.