GUARDIAN

Adoption of electronic medical records is on the rise, due to the Health Information Technology for Economic and Clinical Health Act and meaningful use incentives. Simultaneously, numerous HIE initiatives provide data sharing flexibility to streamline clinical care. Due to the consolidated data availability in centralized HIE models, conducting syndromic surveillance using locally developed systems, such as GUARDIAN, is becoming feasible. During the past year, Chicago has embarked on a city-wide HIE deployment campaign. Perhaps the most unique aspect of this endeavor is that the data warehouse for the HIE is intricately tied to the GUARDIAN syndromic surveillance system.

Objective

The objective is to describe the technical process, challenges, and lessons learned in scaling up from a local to regional syndromic surveillance system using the MetroChicago Health Information Exchange (HIE) and Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification (GUARDIAN) collaborative initiative.

Real-time disease surveillance is critical for early detection of the covert release of a biological threat agent (BTA). Numerous software applications have been developed to detect emerging disease clusters resulting from either naturally occurring phenomena or from occult acts of bioterrorism. However, these do not focus adequately on the diagnosis of BTA infection in proportion to the potential risk to public health.

GUARDIAN is a real-time, scalable, extensible, automated, knowledge-based BTA detection and diagnosis system.  GUARDIAN conducts real-time analysis of multiple pre-diagnostic parameters from records already being collected within an emergency department (ED).  The goal of this system is to assist clinicians in detecting potential BTAs as quickly and effectively as possible in order to better respond to and mitigate the effects of a large-scale outbreak.  

GUARDIAN improves the diagnostic process by moving away from simple trend anomaly detection and towards the development of a BTA-specific infectious disease expert system [1].  Through the capture and automated application of specific clinical expertise, GUARDIAN provides the focus and accuracy necessary for effective BTA infection diagnosis.  The continuity of this process improves the efficiency by which diagnoses of BTA infections can be made.