HHS has primary responsibility for coordinating the nation’s  response to public health emergencies, including bioterrorism. Surveillance—systems that facilitate the performance of ongoing  collection, analysis, and interpretation of disease-related data to plan,  implement, and evaluate public health actions. Supporting technologies—tools or systems that provide information  for the other categories of systems (e.g., detection, surveillance, etc.). For  example, CDC is currently implementing the Health Alert Network  (HAN), an early warning and response system that is intended to  provide federal, state, and local health agencies with better  communications during public health emergencies; additional details  are provided in appendix III. One example of a DOD system is the Electronic  Surveillance System for the Early Notification of Community-based  Epidemics (ESSENCE), which supports early identification of  infectious disease outbreaks in the military by comparing analyses of  data collected daily with historical trends; additional details are  provided in appendix III. Such  coordination ranged from a lack of contact with other agencies, to  awareness, to formal coordination, to joint development of initiatives. Yet,  despite these efforts, the identification and implementation of these  standards remains incomplete. An underlying challenge for establishing and implementing such standards  is that no overall strategy guides IT development and initiatives. The system increases the  interaction between CDC and public health laboratories. Consequently agencies may not be able to share successes or  lessons learned. The extent of coordination or interaction among the lead agency and other  related government agencies ranged from a lack of coordination, to  awareness, to formal coordination, to jointly developed initiatives. More specifically, it should  identify all federal agencies’ IT initiatives, using the results of our  inventory as a starting point;    set priorities for information systems, supporting technologies, and    define activities for ensuring that the various standards-setting  organizations coordinate their efforts and reach further consensus on  the definition and use of standards;    establish milestones for defining and implementing all standards;   create a mechanism—consistent with HIPAA requirements—to  monitor the implementation of standards throughout the health care  industry; and    address existing barriers and establish mechanisms for identifying and  prioritizing uses of emerging technologies that are appropriate for  ensuring continued improvements to the nation’s ability to prepare for  and respond to public health emergencies. Appendix I: Objectives, Scope, and Methodology

The objectives of our review were to    compile an inventory of current and planned bioterrorism information  technology (IT) initiatives at selected federal agencies and identify the  range of coordination efforts,  identify and describe the development and use of health care IT  standards for bioterrorism-related systems, and  review the potential use of emerging information technologies for  bioterrorism preparedness and response. Surveillance activities may be either active or passive. Communications

The purpose of communications and reporting systems is to facilitate the  secure and timely delivery of information in the midst of a public health  emergency to the relevant responders and decision makers, so that  appropriate action can be undertaken. It can be easily enhanced to collect biological agents in addition to  chemical agents.
Why GAO Did This Study

The October 2001 anthrax attacks, the recent outbreak of the virulent Severe Acute Respiratory Syndrome (SARS), and increased awareness that terrorist groups may be capable of releasing life-threatening biological agents have prompted efforts to improve our nation's preparedness for, and response to, public health emergencies--including bioterrorism. GAO was asked, among other things, to identify federal agencies information technology (IT) initiatives to support our nation's readiness to deal with bioterrorism. Specifically, we compiled an inventory of such activities, determined the range of these coordination activities with other agencies, and identified the use of health care standards in these efforts.

What GAO Found

The six key federal agencies involved in bioterrorism preparedness and response identified about 70 planned and operational information systems in several IT categories associated with supporting a public health emergency. These encompass detection (systems that collect and identify potential biological agents from environmental samples), surveillance (systems that facilitate ongoing data collection, analysis, and interpretation of disease-related data), communications (systems that facilitate the secure and timely delivery of information to the relevant responders and decision makers), and supporting technologies (tools or systems that provide information for the other categories of systems). For example, the Centers for Disease Control and Prevention (CDC) is currently implementing its Health Alert Network, an early warning and response system intended to provide federal, state, and local agencies with better communications during public health emergencies, and the Department of Defense is using its Electronic Surveillance System for the Early Notification of Community-based Epidemics to support early identification of infectious disease outbreaks in the military by comparing analyses of data collected daily with historical trends. The extent of coordination or interaction of these systems among agencies covered a wide range--from an absence of coordination, to awareness among the agencies with no formal coordination, to formal coordination, to joint development of initiatives. IT can more effectively facilitate emergency response if standards are developed and implemented that allow systems to be interoperable. The need for common, agreed-upon standards is widely acknowledged in the health community, and activities to strengthen and increase the use of applicable standards are ongoing. For example, CDC has defined a public health information architecture, which identifies data, communication, and security standards needed to ensure the interoperability of related systems. Despite these ongoing efforts to address IT standards, many issues remain to be worked out, including coordinating the various standards-setting initiatives and monitoring the implementation of standards for health care delivery and public health. An underlying challenge for establishing and implementing such standards is the lack of an overall strategy guiding IT development and initiatives. Without such a strategy to address the development and implementation of standards, agencies may not be well positioned to take advantage of IT that could facilitate better preparation for and response to public health emergencies--including bioterrorism.