Biology Reference
In-Depth Information
captured data from 111 hospitals almost everyone had their own system;
sometimes we were lucky enough to have the same vendor covering sev-
eral hospitals and you can have a group approach, but in many cases it is
hospital by hospital to build a system, monitor it, and come back to get it
running again when there is a problem.
Depending on the compatibility between the hospital's computer net-
work and software and that of NC DETECT, the ease of implementation
varied widely. The average time between an initial test and a live date on
the NCHESS ELERT system is approximately 251 days. Changes to the NC
DETECT or the hospital's software can also cause technical problems that
can add additional time to implementation. One informant reported that it
took 6 weeks for his hospital to get his system working again after the ED
implemented a change in the software used for tracking medical records.
The format of the triage notes has also posed a technical challenge for NC
DETECT. The triage note is in free-text format, meaning that whatever the
triage nurse posts can be downloaded into NC DETECT. It is common for
nurses to include “negatives” in the triage note, for example, “patient reported
no fever, no nausea, no dizziness,” or more commonly to save time, “patient
reports no fever, nausea, dizziness.” In the first example, it is relatively easy
to write a program to understand that the “no” meant the absence of dizzi-
ness but much more difficult in the second example. Despite the limitations
of the triage notes, the fact that the majority of hospitals never or rarely enter
triage notes was a problem in the view of some users. A few informants
suggested having a more standardized approach to posting triage notes to
address some of these concerns.
The cost of implementing and maintaining the system was viewed by
some key informants as a barrier. Informants perceived the contract with
UNC DEM as relatively expensive to support, but believe that the benefits of
NC DETECT are clear and compelling enough to warrant its expense. DPH
uses bioterrorism funds granted by CDC to support NC DETECT; however,
the level of funding from that source is expected to decline over time.
11.3.6 What Factors Have Facilitated the
implementation of biosurveillance?
There were a number of important factors that facilitated the development
of NC DETECT. Foremost among these was the vision and commitment of
public health leaders, hospital stakeholders, NCHICA, and policymakers to
pass a law mandating the participation of hospitals with 24-hour EDs. Key
informants agreed that without the law, building a statewide system would
have been much more difficult.
A second facilitating factor pointed out by key informants was the high
level of technical expertise of the UNC DEM. At the time the system was
being developed, syndromic surveillance was still a novel concept, and the
