Infectious diseases and toxins travel fast—and they tend not to pay particular attention to political or geographical boundaries. That means your health could be threatened by a deadly toxin, or a disease such as Sudden Acute Respiratory Syndrome (SARS), that could be spread in a setting as routine as an airline flight.

In thwarting these threats, time is critical—and greater coordination among public and private entities in the health care community is needed to ensure faster response. Good communication is key, both to identifying the nature of the threat and to mobilizing medical and legal resources to contain it.

Public health officials in the United States hope to duplicate their success (thus far) in holding off SARS. In the wake of the disease's outbreak, the federal government quickly added SARS to its list of "quarantineable" communicable diseases. That gave the government quarantine powers comparable to those instituted in Canada, Singapore, and other countries, as well as the authority to screen incoming travelers for SARS symptoms, thus enhancing a coordinated response to the outbreak. This process was completed in a matter of months. In contrast, the development of a similar plan for the HIV virus took years.

The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) are working together, with MITRE's help to ensure a speedy response to health threats here in the United States.

A team from MITRE's Center for Enterprise Modernization (CEM) is working with HHS and CDC to enhance the agencies' capacity for sharing information with each other and with other entities in the health care community. With better information sharing, public health entities hope to be able to identify toxins, infectious diseases, or other public health threats and speed the development of lab tests and surveillance and response measures that will halt their spread.

"SARS is an example of where a new standard was set for the sharing of health care data on a global scale," says Dr. Dale Nordenberg, associate director for informatics and chief information officer for the CDC's National Center for Infectious Diseases in Atlanta. "The WHO [the World Health Organization] and entities in the United States and other countries collaborated and shared real-time data related to the SARS outbreak in ways that hadn't really been done before. I think that's a good example of where we need to be heading."

To get to that point, public health interest groups will not only have to interact better with one another—no easy task, given that many of these groups compete against each other for business and government funding—but also, on a much greater scale, with law enforcement agencies and the defense and intelligence communities. Bringing such disparate players together is exactly what MITRE has been doing since its inception. CEM's team—which includes IT and health-care-policy experts, among others—brings extensive knowledge of these areas. The team can also call on MITRE's experience in integrating the functions of the agencies that now compose the Department of Homeland Security (DHS), which will work closely with both the HHS and the CDC to identify and address various public health threats.

"MITRE is staffed by people who have many years, and often decades, of experience in these agencies, and who are working on current projects in these agencies," says Nordenberg. "I think that our center and our agency will benefit from MITRE's involvement and MITRE's ability to help us potentially interact with these other agencies so that we will have a more effective program."

A Coordinated Response

As it has done for other agencies (many now part of DHS), CEM is building an enterprise architecture (EA) for both HHS and the CDC. An EA is a roadmap that enables an organization to develop a business plan and an IT infrastructure sufficient to meet its present and future mission. The EA will form the basis upon which DHS and CDC and its nine centers will share information and mobilize their resources to meet any public health threat.

But the agencies will also need to improve their information-sharing methods with outside entities, including hospitals, insurance companies, health associations, and pharmaceutical companies. To help bring this about, CEM is developing several Information Sharing and Analysis Centers (ISACs). In ISACs, representatives of the public and private sectors work together to identify and address potential cybersecurity weaknesses. While these groups have been used largely by financial institutions and utility and transportation providers, HHS officials believe the ISAC structure could be used for its needs as well, and so the CEM team is reshaping and dramatically enlarging the traditional idea of an ISAC for health care.

"The ISAC is addressing the enterprise-wide requirements for the health care community in the United States," says Gary Brisbois, homeland security program manager for CEM. "What HHS wants to do is make an ISAC something that is utilitarian across the entire health care community. It wants to address the health care community's delivery of services—securing supply chains, transportation, collaborative communications—as well as cybersecurity. It's really a collaborative information sharing environment in the very essence of those words."

Another component of CEM's work with HHS is the modernization of the HHS Command Center, which the agency uses as a crisis management center. If there was an outbreak of a major disease, the center would be activated and specialists would be brought in to address the crisis. CEM is refining the center's concept of operations with the goal of making it a model for similar enhancements in the CDC and the National Institutes of Health, among others.

Bringing the Pieces Together

What does HHS and the CDC hope to do with this enhanced information exchange network? The objectives are continuing to evolve, but one key goal is the development of an audit trail of suspected disease carriers traveling within the United States and abroad. The objective is to find the point of entry where a suspected carrier arrived in the country and where he or she might have carried the agent.

"Just being able to do that would be a quantum leap forward," says Brisbois. "Right now, we lose track of travelers at the point of entry into the United States for foreign travelers, and we've never been able to track domestic motions. Once that is done, then you have the inputs that you need for a whole series of sophisticated models to help define the spread of a particular contagion. And then you can do all sorts of analytic work as to what the ramifications are."

That's where the ISACs would come in. Once a disease has been tracked and identified, experts from the appropriate ISAC would be brought in to analyze the problem, contact experts from their own networks, and advise HHS or the DHS on how it should be handled.

Though the project is still in its early stages, CEM team members believe they have been able to bring together key elements of the public health community and forge a new spirit of cooperation.

"They're coming to the table to discuss how they can be involved," says Carol Miller, deputy program manager for the HHS/CDC project. "It will take some time, but once they feel comfortable with each other, they'll find ways to work together more effectively."

—by W. Russell Woolard

Related Information

Websites

• Department of Health and Human Services
• Centers for Disease Control
• Department of Homeland Security