CDC's Disease Detectives

Information technology staffers don't work
only behind the scenes at the Centers for Disease Control
and Prevention (CDC). Sometimes they're out on the front
lines with doctors and scientists investigating dangerous
health epidemics. When the West Nile virus outbreak hit
Mississippi in the summer of 2002, IT personnel from
CDC joined a team of investigators to study whether sprays
used to kill mosquitoes were inadvertently making residents
vulnerable to illness. When suspected water contamination
sickened residents in a small town in Michigan two years ago,
IT workers went with CDC scientists to investigate the cause.

In both cases, IT department personnel who specialized in
geographic information systems (GIS) helped researchers make
sense of the collected data by creating visual representations and
running simulations based on it.

In Mississippi, the CDC mapped routes
of trucks spraying the chemicals and of
wind conditions during the spraying, and
then correlated results with residents' urine
tests.

In the Michigan case, after the source
of the drinking water contamination was
identified, CDC staff ran a simulation of
how water flows through the town and
determined that the illnesses and the
contamination were not related.

"It's a graphical presentation of the data
that provides analytical capability," says Nabil
Issa, associate director of IS for the CDC's
National Center for Environmental Health
and the Agency for Toxic Substance and
Disease Registry.

"In Mississippi, we had to geographically
understand the neighborhoods sprayed and
not sprayed," Issa says, "and see if there were
any significant health differences. In
Michigan, we created a map and a simulation
of the water flow, so we could see where the
contamination would go if the contaminated
water were introduced at certain points."

Launched in 1946 to fight malaria, the
CDC has a mission to prevent and control
diseases, environmental health threats
and injuries, disabilities and workplace
hazards. Health professionals, as well as
the general public, rely on the CDC for up-to-date research and health information.
Technology plays an increasingly key role in
fulfilling that mission, CDC officials say.

The agency's Web site, which features
more than 150,000 pages of information,
averages 9 million unique visitors each
month. During last year's Severe Acute
Respiratory Syndrome (SARS) scare, site
visitor totals hit 17 million.

"Information," Issa explains, "is CDC's
primary weapon for detecting and fighting
diseases; it's our bread and butter. So
whether we're going out in the field to
collect and analyze information, or write
reports and disseminate the data,
technology is significant."

Since the September 11 terrorist attacks,
the CDC's mission has broadened. The
agency still focuses on research and serving
as a resource for information. However, for
the past two years, the agency also has
played a leading role in homeland security,
specifically in the fight against potential
bioterrorism, such as the Washington-area
anthrax attack in the fall of 2001.

When in February the poison ricin was
found in the Dirksen Senate Office Building
in Washington, CDC was part of a multi-agency team investigating the incident.
Early confirmation by the agency that the
white powder was ricin, but was not pure,
helped shape the response by the
Department of Homeland Security (DHS)
and law enforcement agencies.

Now, the CDC is investing heavily in
technology to prepare itself to handle
bioterrorism and other possible health
emergencies. The agency is in the midst of
an IT consolidation effort that is designed
to help it respond faster to emergencies and
save money.

The agency's IT staff supports 9,400
employees at CDC's Atlanta headquarters
and other offices throughout the United
States and abroad.

The CDC, which has an annual budget
of $7 billion, has earmarked $450 million
for IT spending in fiscal 2004, says CIO Jim
Seligman. By federal policy, a percentage of
all government purchases, including IT,
must be obtained from small businesses.
(See sidebar on page 39.)

Half Goes to States

Of the agency's $450 million IT budget, about
half goes to state health departments as grants
to help improve their technology, according
to Seligman. "We provide the money so state
health departments can enhance their IT
capabilities," he adds.

One current IT project, called the National
Electronic Disease Surveillance System
(NEDSS), is an e-government initiative to
provide a uniform way for the CDC to link
with state and local governments to share
public health data immediately. The link—via
the Internet and using encryption and
digitalcertificate authentication for security—
lets the CDC more quickly analyze cases of
diseases andgetanup-to-date overviewof the
nation's health trends to help detect emerging
health problems earlier.

Each state is required to collect health
data from its counties and to then relay the
information to the CDC. Currently, 30 states
are implementing NEDSS systems, while
others are working to support the NEDSS
standards in existing computer systems.
When completed, the NEDSS project will
speed the delivery of information.

The CDC hopes to boost its IT budget
by an extra $100 million in fiscal 2005 for a
program to combat bioterrorism, according
to Seligman. A project called BioSense is in
President Bush's budget to Congress.
BioSense would gather and analyze data
from many healthcare sources to provide
early detection of bioterrorist attacks or
other disease outbreaks.

Similar in concept to the NEDSS project,
BioSense would electronically send health
data to the CDC from clinical laboratories,
hospital emergency rooms, health clinics,
and even pharmacies and grocery stores,
which would report over-the-counter drug
sales. For example, a sudden jump in sales
of flu medicine could indicate a problem.

"The goal is to capture the data and have
it come to the CDC as close to real time as
possible, at a minimum overnight," says
Seligman. Such information now takes days,
weeks and sometimes months to reach the
CDC. "We have to build partnerships with
all the institutions that have the kind of data
that would be good potential indicators of a
bioterrorism episode," he says.

Several healthcare providers are working
with the CDC on pilots of the project. The
infrastructure and protocols are in place,
and data is starting to flow, Seligman reports.

The agency's updated GIS technology
will also help in future bioterrorism efforts,
Issa says. During the 2002 Winter Olympics
in Salt Lake City, the CDC relied on GIS
technology to prepare a response in case
someone dumped poison into the city's
water supplies.

In December, Issa's IT staff introduced
faster, easier-to-use GIS technology. This
new system, called Spatial Epidemiology
and Emergency Management, ties together
databases that hold a variety of information,
including street maps, demographic data
from the U.S. Census, and the location of
schools and hospitals.

Web App Speeds Data's Use

Previously, it often took a team of two or
three GIS experts several days to make use
of the widely distributed data. Now, the
databases are linked via a Web front-end,
letting CDC staffers use a Web browser to
access the geographic and demographic
data within 15 to 30 minutes. Using the new
GIS technology, researchers can overlay the
geographic data on information collected on
the site of the emergency. "We're talking
about massive databases that will generate
maps on the fly," Issa says.

Future versions will automate tasks that
currently must be done manually and take
days to do. The second phase, available by
year's end, will quickly generate reports on
health data, comparing year and time, while
a third phase will let investigators generate
graphics and run simulations of data much
faster than before, he explains.

The technology also provides a Web-based form for data entry. Investigators,
armed with notebook computers, can send
the information back to headquarters over
a virtual private network via the Web, Issa
says. Previously, researchers had to e-mail
the information to headquarters or wait
until they returned to the office to upload it.

Along with improving its technology, the
CDC has consolidated its IT staff.
Previously, all 12 operating arms of the CDC
had their own IT staffs to manage hardware
and software. The CDC consolidated the
separate staffs into one unit last fall, reports
Judy Kenny, acting director of the
Information Technology Services Office.

The consolidated IT staff can run more
efficiently and cost-effectively, and serve
CDC employees better, she says. A future
goal is to consolidate the many computer
rooms that house CDC servers and network
equipment for easier management within
the next few years.

"We are changing into more of a global
organization and positioning ourselves to
better support our staff," Kenny says.

Consolidation of the agency's enterprise
infrastructure IT staff proved its value
before New Year's Day when the DHS raised
the security threat level from "elevated" to

"high."

On December 27, while on vacation in
Florida, Kenny got a call from CDC officials
informing her that she had 100 hours to help
build an off-site emergency office that would
expand CDC operating capabilities in case of
a terrorist attack. She flew home to Atlanta to
direct the IT installation at the site. Her staff
laid fiber and cable, and installed computers,
telephones, printers, videoconferencing
equipment and TVs. Meanwhile, workers in
the facilities department put up walls and got
the electricity in what had been an empty
warehouse. Everything was in place by the
deadline: noon on New Year's Eve.

"I knew the right people to call, and
everyone was very responsive and worked
together as a team," Kenny says. "That's one
of the advantages of having a consolidated
organization. You have centralized access to
all the resources you need in an emergency."

The CDC has adjusted to its new role of
providing homeland security, Issa says. "In
the past, we would have studies that were
not emergencies, and we could take a year
or two to analyze data and come up with
conclusions," he says. "After September 11,
it became important to react faster.
Everything is time-sensitive."