The
Frontlines of Medicine Project |
| Recent national events, including the September 11th attacks on the World Trade Center and Pentagon, and subsequent distribution of anthrax by mail, have resulted in intense efforts to pursue improvements in surveillance for chemical-biological terrorism. The nation's emergency departments (EDs) are a potential source of surveillance information, and recent federal legislation has authorized funding for systems that utilize this source. Existing ED information systems, however, tend to be limited in their capacity and their ability to provide real time information to public health authorities. |
| An effective medical surveillance system can be viewed as a nervous system that contributes to the health of the nation. The system includes multiple components, including "afferent" limbs that collect information and act as sensors, a "processing" center that analyzes the collected information for trends and determines if action is needed, and "efferent" limbs that distribute information back to providers to cause them to adapt to evolving situations. Impediments or delays at any stage of the system may prevent effective interventions from occurring in a timely manner. Ideally all of the information in such a system should be standardized for interoperability and information flow should occur in a real time manner. |
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| The Frontlines of Medicine Project is a collaborative effort of emergency medicine, public health, informatics, and other agencies and institutions to develop non-proprietary, standardized methods for reporting emergency department patient data. The Project conceptualizes the rapid deployment of a non-proprietary, vendor-neutral, standards-based regional public health information infrastructure. This infrastructure, composed of inter-linked regional public health networks, could be used as a surveillance and "early warning" system to potentially detect chemical and biological terrorism. |
While the current focus of the Frontlines of Medicine Project is on emergency encounter data, the principles being developed will eventually apply to primary care practices and other settings likely to be sources of early warning of evolving infectious disease or injury patterns. The Frontlines of Medicine Project intends to become fully integrated with the evolving National Electronic Disease Surveillance System (NEDSS) as recommended by the Center for Disease Control and Prevention. Although syndromic surveillance is a high public health priority today because of the threat of terrorism, standardizing the transmission of patient data from the frontlines of healthcare - including emergency departments - could serve to improve the health of the public in other ways in the future. |
| An initial article describing the Frontlines of Medicine Project was published in the April issue of Annals of Emergency Medicine, and is available below. The Frontlines Project has held a consensus conference on April 28, 2002 in Washington DC, during which issues were identified and discussed and future plans were made. Frontlines participants are currently using a Delphi survey process to further delineate the data elements and preferred values for creating a standardized emergency encounter surveillance report. Plans are also underway to create pilot implementations of the Frontlines concept in multiple cities across the country, with formal evaluation of the result and ongoing improvement in the standardized process. |
The Frontlines of Medicine Project is described more fully in a manuscript published in the April issue of Annals of Emergency Medicine. Annals of Emergency Medicine is published by Mosby and is available below: This Frontlines of Medicine Project article is Copyright 2002 by the American College of Emergency Physicians. All rights reserved. The American College
of Emergency Physicians, the Annals of Emergency Medicine, and Mosby/Elsevier
grant permission for this article to be distributed in electronic 1. The content of
the file/article may not be modified in whole or in part. (view pdf document) Annals Of Emergency Medicine, The Frontlines of Medicine Project, April 2002 |
| Since the publication of the initial Frontlines paper, the Frontlines Project held a Consensus conference in Washington DC in late April, 2002, and a subsequent internet-based Delphi survey process was carried out over the summer and fall. This allowed for the definition of the data elements to be included in a standardized triage surveillance report, and to create a preferred “pick list” of codified values for categorizing the chief complaint data element. Every effort has been made to make these recommendations consistent with DEEDS (as published by the CDCP) and other relevant standards. An initial retrospective validation of the chief complaint values has been performed, and plans are underway for further prospective study. A formal document to provide details of this work is being prepared. |
| While the initial effort of the Frontlines project has focused on triage, a definition of a standardized emergency department disposition message will likely be the next step. Both the triage message and disposition message can then be sent to a web service to create a scalable national emergency surveillance testbed repository. Initial test bed implementations of this concept are ongoing. |
| Draft
versions of the Frontlines triage surveillance report data elements
and the preferred values for the chief complaint category data elements
are available below. Frontlines Emergency Triage Surveillance Report Frontlines
Chief Complaint Category Data Element Values Feedback can be submitted by clicking on the icon below.
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The
Frontlines of Medicine Workgroup Participants include: |
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Dominik
Aronsky, MD John C Moorhead,
MD, MS Jonathan
M. Teich, MD Joseph
F. Waeckerle, MD |