A member of the Texas Department of Health (TDH) was taken aback in 1999 when she asked for the e-mail address of a local health department and was told the department had no e-mail or Internet access, or computers for that matter. That turned out to be the case with a good number of local health departments throughout the state.
She wondered how local health departments could respond to a bio-terrorist attack without the ability to quickly gather and distribute information. Her concern eventually spurred the state efforts to equip local health centers with a secure and reliable communications network, which is essential for responding to the release of contagious disease agents.
The project put Texas in position to capitalize on Health Alert Network (HAN), a nationwide initiative led by the Centers for Disease Control and Prevention (CDC) that facilitates high-speed, two-way communication between the federal, state and local governments about infectious diseases, environmental health dangers and potential bio-terrorist attacks.
The Web-based system now connects 64 local health departments across the state and has positioned Texas as a pace setter in this area.
"In the covert release of a contagious disease agent, rapid communication is essential for early detection and response," said Mike Mastrangelo, project director for the Texas Telecommunications Infrastructure Fund Board. "Hours and days could mean the difference between 10 or tens of thousands of casualties."
The network equips each of the 64 sites with continuous Internet access for the vital sharing of information, something lacking in about half the local health departments in the state, Mastrangelo said. Officials intend to eventually serve 90 percent of the state's population through local health departments that are linked to hospital emergency rooms and law-enforcement agencies. Making those connections could take two to three years, they said.
Connectivity With Hospitals
Local health departments participating in the HAN project may receive as many as five Dell computers, which includes any combination of laptops or desktops. Each of the sites also has a Dell server that runs the network communications and the specialized Web portal. The equipment provides local computing capability as well as access to broadband communications networks. In addition, 17 of the sites have interactive two-way video conferencing capabilities, and the plan is to double that number to provide mechanisms for interactive training, administrative work and bio-terrorism planning.
Partnerships with health science centers and schools of public health are in the works, as well. Those organizations will provide content and training over the network, which will soon have satellite downlink capabilities.
Satellite downlinks are vital during national emergencies because the CDC sends out much of its information via satellite broadcast. The new capabilities also will facilitate distance learning, because most remote education programming for bio-defense comes from the Public Health Training Network and CDC through satellite broadcast.
"We've made some progress but we have a lot of work to do," Mastrangelo said. "Our effort so far has been to lay those communications links, and now we have to start thinking about the content that will start to flow over those links. We're just now beginning to reach out to partners who can provide that type of material like the medical schools and schools of public health and so forth."
So far, the network provides a "base-level" of communications for alerts, distance learning and surveillance, but the project still a long way to go before Texas officials feel comfortable about responding to a bio-terrorism scenario.
"We anticipate that during an actual event, recommendations on how to respond and treat people will change," Mastrangelo said. "We need to rapidly disseminate the new treatment and response protocols."
And they need connectivity with hospitals, too. In the event of a covert release of a biological agent, officials must analyze data from patient complaints and patient illnesses to determine what the agent is and how to treat it.
"So much of the response protocols that we have are really sort of consensus documents by experts, and we anticipate that in an actual event we will do a lot of learning on what are, in fact, the best responses to make," Mastrangelo said. "If this rapid learning goes on, then what's necessary is to rapidly disseminate that information across the country, and the only way you can do that is with modern computing and telecommunications equipment."
Industry Standard Technology
The network is built with industry standard technology as opposed to "proprietary architectures designed specifically for this purpose," said Bryan Wood, vice president and general manager of Dell's government segment. "That really brings a number of benefits, not the least of which are the rapid ability to scale and the reliability - and perhaps more importantly, it's cost effective and efficient."
Adherence to industry standards also points to future interoperability, Mastrangelo said. "Off-the-shelf technology meets the needs for fast deployment. Industry-standard technology means that as we bring on new partners, interoperability of equipment will be more likely. We need to build on the base of the health network to include more partners to assure continuity of operations during a national emergency and to build reliability into the system."
Ultimately, Texas officials want the network to facilitate communication not only with e-mail and faxes, but also through wireless devices such as cell phones, pagers and PDAs, enabling health officials across the state to analyze data more quickly.
Of course, achieving that vision will demand more funding.
"What we're facing now is we need to convince our political leadership that we can take advantage of this tremendous infrastructure by tying it all together logically and getting a real jump start in that connectivity with hospitals," said Wayne Farrell, district director of the Bell County Public Health District.
So far, the network has taken advantage of a $52 million grant the state received through the CDC. In addition, five local health departments recently received $800,000 each from the Texas Telecommunications Infrastructure Fund Board. But as far as the connectivity some officials envision for the future, the case has yet to be made.
"We're doing the best we can to educate some of our state leadership to work toward that goal," Farrell said. "The shortfall that we have right now is the local connectivity to law enforcement, and at this point we can't really identify a funding mechanism to bring on those local law enforcement agencies."
But at least now there's a clear plan for connectivity, something that was lacking in 1999. "We're still in the Pony Express age," Mastrangelo said. "But I anticipate that five years from now we'll have a lot of applications that we're really just dreaming about now."