Improving the nation's public health surveillance systems--the reporting mechanisms by which physicians and hospitals track the occurrence of infectious diseases--will be critical to crafting a more meaningful plan for detecting and responding to an attack involving biological weapons, public health officials told a panel of the House Committee on Energy and Commerce Thursday. What's more, creating a more effective national reporting system will be expensive and it will be complicated. Dr. Arthur Davidson, director of public health informatics in the Denver (Colo.) Public Health Department, said, "Even if we had perfect information systems, the poorly skilled public health worker may lack the knowledge to put that information to good use. Similarly, medical and public health sectors that address medical aspects of a biological or chemical terrorist attack sorely lack knowledge and planning to deal with such an incident." Davidson presides over a sophisticated network of health surveillance data collected from the 911 medical response system, an acute care hospital, a regional trauma center, 10 neighborhood health clinics, 13 school-based clinics, the public health department and a regional poison control center. But many municipalities and most rural areas do not have --and cannot afford--such sophisticated information networks. Davidson said his department's investment in information technology has exceeded $100 million in the last five years. By almost any measure, the emergence of anthrax in Florida last month showed that the public health system can work relatively well. When Robert Stevens, the first person to contract inhalation anthrax in 25 years, sought treatment at an emergency room in Florida, his physician diagnosed the obscure disease relatively quickly and immediately reported it to state and federal authorities. But as anthrax spread to New York and Washington, it became clear to many health care officials that the disease might just as easily have gone undetected for a much longer period of time, potentially jeopardizing lives as subsequent victims might not have received the best treatment for the disease. Effectively monitoring disease patterns, or patterns of unusual symptoms, is necessary to identify a natural outbreak or a terrorist attack early enough to implement the best treatment and containment programs. The Centers for Disease Control and Prevention in Atlanta are in the process of implementing the National Electronic Disease Surveillance System (NEDSS), which is intended to create electronic links between critical institutions, such as laboratories, and the CDC to track vital health statistics. While CDC has provided funding and support to all 50 states to begin implementing NEDSS, it is far from operational. The first 20 states are scheduled to begin operating the system in 2002, said Dr. Claire Broome, senior advisor to the CDC director. Dr. Anita Barry, the director of communicable disease control for the Boston Public Health Commission, said that data-mining may become an important tool in detecting important patterns from surveillance systems. Under a five-year, $1 million grant from the CDC, Boston has developed a system for monitoring all emergency room and acute care facilities through an automated, electronic reporting system that provides the health department with data in real time. "Without federal funding, we could never have designed this system," Barry said. Federal agencies must direct more funding to local communities, where the needs are great, she said. Both Barry and Davidson cautioned against developing reporting systems that require over-worked doctors and other personnel to fill out more forms--such systems are "completely unworkable," Barry said, as health care systems are already stretched to the breaking point. Rep. James Greenwood, R-Pa., chairman of the subcommittee on oversight and investigations, which held the hearing, said, "What is truly worrying about this recent [anthrax] outbreak is the possibility that this is a prelude to a worse attack and that this effort was designed more to test our capabilities and probe our weaknesses, than to cause sustained damage." "One has to wonder, in [poet Ralph Waldo] Emerson's words, whether 'things are in the saddle and ride mankind,'" said Greenwood.