"The implementation is largely a process of installing the software once, but it also entails a change management process; it means getting the system's users trained and the data converted."
The Internet makes this physically easier to do. "You don't have to invest in private networks," he says. "The architecture is such that typically there'll be just one copy of the software that sits on a server in the provincial capital, but the people using it are all over the place."
The British Columbia Ministry of Health is acting as the lead jurisdiction, working with IBM to build and integrate the various system components. Separately, Infoway is working with other provinces and territories on allocating funds, planning and implementation of the project.
All the systems are on track to be available by mid-2007, but the various jurisdictions are in different stages of planning, says Beasley, with Quebec most recently having been approved to go ahead with implementation.
From Sphinx to Phoenix
After funding dried up for the IBM Sphinx project, Canada's health surveillance program in 2001 took the form of CEOSC, the Canadian Enteric Outbreak Surveillance Centre.
Provinces and territories used this Web-based application to report directly to Health Canada on outbreaks of food and water-borne disease, says Sockett. "It had nothing else around it."
Today, the revised CIOSC continues to provide front-end public health workers the ability to provide rapid alerts on outbreaks in their jurisdictions, but PHAC has added alerting functions for respiratory and zoonotic diseases to cover things like avian flu, he adds.
Two-way communication means PHAC can both send and receive alerts to and from the provinces and regional jurisdictions and there's a built-in capacity to identify the level of urgency.
Alerts can be sent from within the application not only by e-mail but also by telephone and pagers.
To enhance the Canadian Early Warning System (CEWS), PHAC hopes to collect data on over-the-counter sales of anti-diarrhoea drugs or cold relief drugs.
This information can be linked within CNPHI to analytical tools that create maps right down to the local level, says Sockett. A health unit can see by the colour on a map whether or not the pharmacies in their jurisdiction are reporting higher than normal dispensing of anti-flu drugs, for example.
"And by linking this information to things like emergency room visits and telephone calls to nurses - by putting two or three of these databases together into the same system, putting them on maps with graphs - we can give people a very rapid, eyeball indication that there's a public health issue that needs to be addressed."
In the case of a real threat, health workers can use the CNPHI management site to set up collaboration centres for sharing information and to schedule meetings.
"If there's a salmonella outbreak, for example, we can do something called pulsed field gel electrophoresis - it's like a DNA fingerprint of the bug - and we have a component that links into CNPHI and to colleagues in the United States.
"This allows us to post the DNA fingerprint and ask whether anyone is seeing this specific bug and if there are any clues on where it came from. We're also able to link other information into the equation, like diagnostic technologies."
Sockett says PHAC uses the system literally on a day-to-day basis, sending alerts that range from food poisoning to outbreaks of flu-like illnesses and zoonotic diseases like West Nile.
A more general alert system accommodates other disease entities, like sexually transmitted diseases, or even very specific non-disease categories. Sockett points to the case of a Toronto New Year's Eve party that turned sour when family and friends drank punch from a container that had previously contained windscreen washer fluid.
Planning to test the plan
King says PHAC has yet to carry out a fully comprehensive pandemic exercise - one that would test every aspect of the national pandemic preparedness plan right from the local health authorities through to the national authority.
Such a large-scale undertaking would be costly and could paralyze the public health system for the duration of the exercise, notes King. She adds that with proper planning and time, disruption could be held to a minimum.
Some aspects of the plan are being tested as large table-top exercises. A national forum is co-hosted annually by the Centre for Emergency Preparedness and Response, and Public Safety and Emergency Preparedness Canada.
The idea is to evaluate Canada's group response to an influenza pandemic, explains Frank Welsh, a director at PHAC's Centre for Emergency Preparedness and Response.
The centre uses emergency management software called E Team to record and exchange information, from a company called NC4 Public Sector LLC (National Center for Crisis and Continuity Coordination) in Laguna Niguel, Calif.
PHAC is also developing and implementing a geospatial information system to map an event, track how it's expanding from a geographical standpoint and perhaps better predict where to apply resources, says Welsh.
Some key questions to emerge in the exercise were how best to share information, how to effectively manage the flow of information, and were there new technologies out there, beyond the traditional teleconferences and e-mails, to share information more cleanly and quickly?
The Sphinx may have died a quick death, but the principle concepts were more than ideas blowing in the wind, as Socket says. Managing and sharing information in the most effective, rapid ways can help to prevent the next pandemic. At worst, it will leave us better prepared to deal with it.
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