Modeling complexity is nuke lab’s specialty

Integrating health systems a happy outcome

When most people think of Los Alamos National Laboratory in New Mexico, a computer program that functions as a case management tool for TB probably doesn’t come to mind. Yet sophisticated software with public health applications is actually a house specialty of the laboratory.

Gary Simpson, MD, PhD, state TB controller of New Mexico and a booster of the Los Alamos program known as OpenEMed, is only half joking when he says, "They do stuff like this to let folks know they don’t just build nuclear weapons."

In fact, the nation’s nuclear-weapons program provides a big part of the impetus for software development at the national lab, though not in the way you might think. "We build software because we don’t do testing [of nuclear weapons] anymore," explains Dave Forslund, PhD, a Laboratory Fellow at Los Alamos and team leader of the group that built OpenEMed.

Chasing global warming, hantavirus

Making sure the country’s nuclear arsenal is fully functional, even though the weapons can’t be actually be fired for test purposes, is akin to "the boss telling you that you have to guarantee that the copy machine down the hall in the office will still make good copies 25 years from now, even though you can’t turn it on in the meantime to make sure," Forslund explains. "That means we have to model very complex systems."

Another such mandate at Los Alamos is the modeling of global warming. (Surprisingly, the Los Alamos forecast calls for lots of change, but not always warming.)

Then there’s the assignment to accurately predict bioterrorist events before they happen. "Right now, we’re basically dependent on one doctor seeing more than one patient with the same symptoms," he points out. "But now, the doc on the second shift in the ER may not even know what happened on the first shift. Everything depends on the same guy seeing more than one case."

That’s part of why the recent hantavirus outbreak went undetected for as long as it did, Simpson adds. To catch outbreaks faster, a project called RSVP (Rapid Syndrome Validation Project) is under way. RSVP, which uses OpenEMed, is a collaboration of Los Alamos and Sandia National Labs, New Mexico’s state’s health department, and the University of New Mexico Emergency Medicine Department.

Yet another project in the state will pilot the creation of an on-line immunization record. Here, collaborators envision using OpenEMed to keep immunization data from having to be input the three to five times they are now, says Forslund.

Web site offers free download

In the past, Los Alamos also collaborated with National Jewish Hospital in Denver to implement OpenEMed for managing complex multidrug-resistant TB cases. The lab has a contract with the City of Hope in Duarte, CA, to provide an OpenEMed package that can be used for clinical trials.

One thing that doesn’t interest the lab is making money off the systems it develops, Forslund notes. By going to the OpenEMed web site (www.openemed.org), anyone can download the most current version of the program for free. So far, about 1,400 people have done so.

Despite the enthusiasm of the locals, both public and private health care providers have traditionally been cool to approaches entailing open-standards electronic records systems, says Forslund. "We’ve been to the CDC five times [with OpenEMed] over the past six or seven years," he says. "But they’ve done a lot of software development of their own; I guess they’re a bit wary of competition."

The reaction from private industry has also been cool, he adds. "The big boys [in private health care] don’t want this stuff," he says. "If you have open standards, it’s harder to capture the market. They don’t want people to move out of their system."