Bioterrorism preparedness and response: use of information technologies and decision support systems
Evidence report/technology assessment (Summary)
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. Endorsement by the Agency for Healthcare Research and Quality (AHRQ) or the U.S. Department of Health and Human Services (DHHS) of such derivative products may not be stated or implied. AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care,
... duce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakersCpatients and clinicians, health system leaders, and policymakersCmake more informed decisions and improve the quality of health care services. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public-and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. To bring the broadest range of experts into the development of evidence reports and health technology assessments, AHRQ encourages the EPCs to form partnerships and enter into collaborations with other medical and research organizations. The EPCs work with these partner organizations to ensure that the evidence reports and technology assessments they produce will become building blocks for health care quality improvement projects throughout the Nation. The reports undergo peer review prior to their release. AHRQ expects that the EPC evidence reports and technology assessments will inform individual health plans, providers, and purchasers as well as the health care system as a whole by providing important information to help improve health care quality. We welcome written comments on this evidence report. They may be sent to: Acknowledgments During the preparation of this Report, Dr. Owens was supported by the Department of Veterans Affairs. We are grateful to our expert advisors for their thoughtful comments and guidance. We would like to give special thanks to Sara H. Cody, M.D., Santa Clara County Communicable Disease Officer, for her many valuable suggestions informed by her front line experiences. We thank the Stanford University research librarians who helped us design our search strategies: Rikke Greenwald (Lane Medical Library), Ann Latta (Social Sciences Resource Center), Joan Loftus (U.S. Government Documents Bibliographer) and Michael Newman (Falconer Biology Library). Finally, we extend our thanks to Cynthia Yock for her help reviewing articles, and Amy J. Markowitz, Susan Nguyen, Lyn Dupré, and Vandana Sundaram for their careful editorial review. v Structured Abstract Objectives. This project aimed to synthesize the evidence on information technologies and decision support systems (IT/DSSs) that may serve the information needs of clinicians and public health officials in the event of bioterrorism. Search Strategy. To direct literature searches, a conceptual model was developed that specifies the decisions and tasks of clinicians and public health officials in the event of bioterrorism. Searches of MEDLINE ® and of other relevant databases for articles describing or evaluating potentially relevant IT/DSSs were performed. Additional references were found from Internet searches (including 16 government agency Web sites), and bibliographies of retrieved articles. Selection Criteria. IT/DSSs were included that could potentially support the detection, diagnosis, management, prevention, treatment, guideline implementation, surveillance, reporting, and communication of information during a response to bioterrorism. Data Collection and Analysis. All peer-reviewed articles that met the inclusion criteria were blinded to the study authors, and 2 investigators independently abstracted study information. Information from Web sites was abstracted by a single investigator. Main Results. More than 20,000 citations and Web sites were reviewed. Of these, 251 articles, 36 government Web sites, and 54 non-government Web sites met selection criteria. From these, 217 IT/DSSs of potential use by clinicians and public health officials in the event of bioterrorism were described. They include 55 detection systems, 23 diagnostic systems, 18 management systems, 90 surveillance systems, 26 communication systems, and 7 systems that integrate surveillance, communication, and command and control functions. Most reports only described IT/DSSs; however, 79 studies evaluated 58 systems for at least 1 performance metric (e.g., timeliness). Few systems have been subjected to comprehensive evaluation. The sensitivity and specificity of rapid detection systems is not generally publicly available, complicating the interpretation of test results. None of the general diagnostic or management systems has been evaluated with respect to bioterrorism response. Syndromal surveillance systems collecting a variety of surveillance data have been deployed for both event-based and continuous bioterrorism surveillance, and evaluations are ongoing. Web-based communication systems are increasingly in use, but few have been formally evaluated. Current national efforts of particular promise include those to develop and evaluate systems that integrate the collection, analysis, and presentation of data from detectors, clinicians, laboratories, and hospitals to public health decision makers. Conclusions. IT/DSSs have the potential to help clinicians and public health officials make better decisions regarding detection, diagnosis, management, prevention, surveillance, and communication during a bioterrorism event. However, few of these systems have been evaluated rigorously, and most were not specifically designed to address threats from bioterrorism. Furthermore, many of the systems have not been described in peer-reviewed literature. The lack of evaluative studies creates difficulties in assessing the usefulness of IT/DSSs. We note, however, that lack of evidence about effectiveness is not evidence for lack of effectiveness.