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Disease trackers get $4.5m US grant

A team of Boston researchers yesterday won a $4.5 million federal grant to establish a novel computerized tracking system designed to rapidly identify disease outbreaks by peering directly into patient medical records and hunting for worrisome diagnoses.

The initiative, championed by doctors at Harvard Medical School and Children's Hospital Boston, aims to supplant an archaic system relied on for decades to detect clusters of infectious illnesses, such as hepatitis, salmonella, and newly emergent maladies such as Severe Acute Respiratory Syndrome, or SARS. Now, it can take as long as two weeks for state disease investigators to receive laboratory reports on illnesses that in the interim can gain a dangerous foothold.

If the experiment underwritten by the US Centers for Disease Control and Prevention succeeds, it would herald a new era in public health, long mired in technologically backward practices that hinder swift intervention.

''With this system, we would be starting with a lot more information and a lot sooner," said Dr. Alfred DeMaria, top disease tracker at the Massachusetts Department of Public Health. ''In my generation, you'd go to the emergency room and go through 600 intake sheets and try to find something. It wasn't a very efficient way of doing things."

But specialists in patient privacy said that despite assurances by researchers that their computer networks will be secure, the recent spate of identity-theft cases sends a cautionary note about whether information gleaned from medical records can truly be shielded.

''We've seen countless examples of credit card records being stolen and identity theft in the past nine months -- it's been an incredible epidemic," said Robert Ellis Smith, publisher of Privacy Journal, a newsletter chronicling the ramifications of technology on privacy. ''Why would it be any different for medical records? They could be used for blackmail or just malicious curiosity."

The researchers receiving the CDC grant, Richard Platt and Kenneth Mandl, said that assuring patient privacy is paramount in their efforts and that patient data will be encrypted. ''We always err on the side of privacy," said Mandl of Children's Hospital. ''At times, we even sacrifice efficiency for privacy."

The physicians stand at the vanguard of a national movement to identify outbreaks of disease in real time. It has gained considerable momentum -- not to mention financial backing -- amid concerns that germs could be converted into tools of bioterrorism.

Already, the two doctors have pioneered systems that look for suspicious clusters of coughs, sniffles, and stomach aches reported by patients at emergency rooms and in the offices of Harvard Vanguard Medical Associates physicians. Now, with the CDC grant, they aim to expand their initiative to look for specific diagnoses in the records of about 300,000 Harvard Vanguard patients.

''For the public health system to work for us, it needs to be able to talk to and hear from physicians in a very efficient way," said Platt, chairman of the Department of Ambulatory Care and Prevention at Harvard Medical School.

Today, in most places, that conversation is the technological equivalent of a carrier pigeon in a time of satellite telephones. Physicians are required under state law to alert health authorities when they suspect a patient is stricken with one of about 80 diseases.

That notification often happens in an entirely passive fashion: A lab test is ordered and the results arrive, sometimes weeks later, at the Department of Public Health. By then, a small outbreak might have erupted into a wildfire.

''Public health reporting systems have been impacted by underreporting in the past," said Robert Spengler, director of the CDC's Office of Public Health Research.

The three-year federal grant will be used to create a system that daily culls patient records stored on computers at their doctors' offices, gleaning information on diagnoses and lab tests.

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