ARES Corporation
ARES Corporation developed SYRIS, the SYndrome Reporting Information System, to meet the need for a real-time communication system that will allow our public health departments, medical communities, and health professionals to quickly respond to any perceived infectious disease threat. SYRIS fulfills the Public Health Department’s goal for a state-of-the-art, real-time, web-based early warning surveillance system enabling earlier identification and response to outbreaks of infectious disease and bioterrorism, thus preventing spread of the disease.
Situation
Currently, diseases of public health importance are reported once a diagnosis is in hand, generally requiring laboratory testing. However, even with the best of laboratory reporting, the data is received well after the patient is into the clinical course of illness (and infectiousness to others if the disease happens to be communicable). Alternatively, in the setting of a truly novel disease (such as SARS, monkeypox, Hantavirus, cryptosporidiosis – all of which have unexpectedly struck the United States), laboratory resources, in general, do not permit diagnosis since testing protocols and reagents are not available for new disease entities.
Once public health has received enough information to perform an analysis, it has few—if any—channels for rapidly communicating information to clinicians and other end-users of the data they have assembled and analyzed. Finally, most existing syndromic surveillance systems collect data only from hospitals and do not collect or use veterinary data. Since the vast majority of serious infectious diseases affecting the human population are zoonotic in origin (including, for example, novel subtypes or influenza), robust human disease surveillance requires equally robust veterinary surveillance
Solution
An innovative syndromic surveillance system, SYRIS is designed to integrate veterinary and human reporting by collecting data—via the internet—from clinicians when the patient is first diagnosed with a syndrome. By doing so, the system takes advantage of the clinician’s judgment, allowing public health officials to detect the first patient, rather than the statistically-significant one, and respond to the incident. SYRIS has been in use in western Texas for more than 3 years, now covering more than 1 million lives in an epidemiologically complicated, mixed land-use, urban and rural environment. In addition, the system is used by CDC’s Border Infectious Disease Surveillance System in California. Physician, veterinarian, and public health acceptance of SYRIS has been excellent because the information the system provides is of value to each community’s day-to-day practice, as well as for two-way communication in the setting of an emergency.
As an example of an ad-hoc emergency application of the software, SYRIS was implemented within minutes of the opening of Katrina evacuee medical clinics at Reece Air Force Base in western Texas, enabling rotating groups of volunteer physicians to receive up-to-the-minute information on patient status at intake as well as the time course of various clinical problems that might have led to either significant morbidity or epidemics within the evacuee site or in surrounding regions.
(For context, in other evacuee centers caring for victims of Hurricane Katrina, medical care was highly fractionated and situational awareness—particularly regarding unusual and potentially fatal infectious disease including Vibrio cellulitis and respiratory illness—was, with rare exception, absent on time scales required for meaningful intervention, leading to confusion and high morbidity among patients. Real-time communication among various health care providers and knowledgeable public health officials was essential but lacking in virtually every evacuee site.)
Better Health and Lower Costs
- There were no missed cases of serious infectious disease for which physicians were otherwise unfamiliar due to the unusual circumstances of the patient population as well as the care being provided for them.
- There was minimal waste of medical and diagnostic resources because physicians had timely information of the status of the population as a whole – as well as detailed information on individual clinical cases – enabling both effective and easy transfer of care as well as efficient communication of unusual symptom complexes.
- Equally important, the nearby cities were reassured that no novel communicable infectious disease was introduced into the community.
