Cover of Bioterrorism Preparedness and Response

Bioterrorism Preparedness and Response

Use of Information Technologies and Decision Support Systems

Evidence Reports/Technology Assessments, No. 59

, MD, MS, Project Director, , MM, UCSF-Stanford EPC Coordinator, and , MD, MS, Principal Investigator. Section Contributors: , MD, MPH, , MD, , BA, , MD, , BA, and , MD, MS, MPH. Investigators: , PhD, , MD, PhD, , MD, , MD, , MD, , MD, , MD, PhD, , MD, and , MS.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 02-E028ISBN-10: 1-58763-114-8

Structured Abstract


This project aimed to synthesize the evidence on information technologies and decision support systems (IT/DSSs) that may serve the information needs of clinicians and public health officials in the event of bioterrorism.

Search Strategy:

To direct literature searches, a conceptual model was developed that specifies the decisions and tasks of clinicians and public health officials in the event of bioterrorism. Searches of MEDLINE® and of other relevant databases for articles describing or evaluating potentially relevant IT/DSSs were performed. Additional references were found from Internet searches (including 16 government agency Web sites), and bibliographies of retrieved articles.

Selection Criteria:

IT/DSSs were included that could potentially support the detection, diagnosis, management, prevention, treatment, guideline implementation, surveillance, reporting, and communication of information during a response to bioterrorism.

Data Collection and Analysis:

All peer-reviewed articles that met the inclusion criteria were blinded to the study authors, and 2 investigators independently abstracted study information. Information from Web sites was abstracted by a single investigator.

Main Results:

More than 20,000 citations and Web sites were reviewed. Of these, 251 articles, 36 government Web sites, and 54 non-government Web sites met selection criteria. From these, 217 IT/DSSs of potential use by clinicians and public health officials in the event of bioterrorism were described. They include 55 detection systems, 23 diagnostic systems, 18 management systems, 90 surveillance systems, 26 communication systems, and 7 systems that integrate surveillance, communication, and command and control functions. Most reports only described IT/DSSs; however, 79 studies evaluated 58 systems for at least 1 performance metric (e.g., timeliness). Few systems have been subjected to comprehensive evaluation. The sensitivity and specificity of rapid detection systems is not generally publicly available, complicating the interpretation of test results. None of the general diagnostic or management systems has been evaluated with respect to bioterrorism response. Syndromal surveillance systems collecting a variety of surveillance data have been deployed for both event-based and continuous bioterrorism surveillance, and evaluations are ongoing. Web-based communication systems are increasingly in use, but few have been formally evaluated. Current national efforts of particular promise include those to develop and evaluate systems that integrate the collection, analysis, and presentation of data from detectors, clinicians, laboratories, and hospitals to public health decision makers.


IT/DSSs have the potential to help clinicians and public health officials make better decisions regarding detection, diagnosis, management, prevention, surveillance, and communication during a bioterrorism event. However, few of these systems have been evaluated rigorously, and most were not specifically designed to address threats from bioterrorism. Furthermore, many of the systems have not been described in peer-reviewed literature. The lack of evaluative studies creates difficulties in assessing the usefulness of IT/DSSs. We note, however, that lack of evidence about effectiveness is not evidence for lack of effectiveness. Many of the systems we reviewed may be useful for response to bioterrorism and are reasonable candidates for further evaluation. Such evaluations would clarify their value both for response to bioterrorism and for the other purposes for which they were designed.