title: Real-time syndrome surveillance in Ontario, Canada: the potential use of emergency departments and Telehealth.
abstract: OBJECTIVE
  The purpose of this paper is to review new bioterrorist and emerging infectious threats to public health in Ontario, Canada, and to propose a means of integrating a telephone-based health information service and emergency department triage with a first-line real-time, 24-h a day syndrome surveillance system. This automated system could be beneficial in detecting a bioterrorist threat as well as in detecting and monitoring disease outbreaks such as influenza, Norwalk, West Nile virus, Escherichia coli 0157 or severe acute respiratory syndrome.
  
  
  METHODS
  The Medline PubMed database was searched for articles relating to bioterrorism and syndromic surveillance from 1997 onwards. The websites of the Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Public Safety and Security, Centers for Disease Control and Canadian Population and Public Health Branch of Health Canada were searched for articles relating to bioterrorism and syndromic surveillance. Interviews were conducted with key informants from Telehealth staff, the public health services of Ontario and the Centers for Disease Control and Prevention, Atlanta, GA, USA.
  
  
  RESULTS
  Real-time syndrome surveillance is a new means of detecting disease outbreaks or possibly acts of bioterrorism at the first contact with the healthcare system. It has been used successfully to detect influenza outbreaks at an early stage. The system that is proposed would be a province-wide integrated early warning system for both bioterrorist events and emerging infections. It would use clusters of symptoms tied to temporal, demographic and spatial data to increase sensitivity and specificity.
  
  
  CONCLUSIONS
  Real-time syndrome surveillance is an evolving science. Emergency departments and Telehealth in Ontario lend themselves as first contacts to the healthcare system as excellent opportunities to perform syndrome surveillance. They offer the opportunity properly to identify at-risk patients for emerging infections by including contact and travel data into the symptom complex. This could identify at-risk patients early and lead to appropriate public health measures. The benefit of using Telehealth in Ontario is the provincial accessibility of Telehealth and the extensive data collected on one computerized system. Emergency departments should also have a uniform computerized triage data collection system to facilitate surveillance.
authors.affiliation: Sudbury Regional Hospital, Sudbury, Ontario, Canada. moorekieran@hotmail.com
authors.forename: Kieran
authors.initials: K
authors.lastname: Moore
mesh_terms: D023482:Bioterrorism / Q000517:prevention & control; D021821:Communicable Diseases, Emerging / Q000517:prevention & control; D003199:Computer Systems; D018563:Disease Notification / Q000379:methods*; D004196:Disease Outbreaks / Q000517:prevention & control*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D009864:Ontario; D011159:Population Surveillance / Q000379:methods*; D017216:Telemedicine / Q000458:organization & administration*