J. Andrew Teare
ISIS, MedARKS, ZIMS, and Global Sharing of Medical Information by Zoologic Institutions
The importance of high-quality records in zoos, with well-organized and standardized information, has long been recognized as a critical part of improving animal management practices within an institution.3 The importance of combining information from multiple institutions has, however, been less appreciated for many years. Each institution that contributes information increases the sample size for analysis and enhances the ability to detect events that are otherwise too rare to reach significance within the experience of a single institution. However, the ability to easily combine records from different institutions to create an integrated database is predicated on the assumption that the records adhere to a common standard.9 The advent of computerized records has driven the acceptance of single data standards in many industries, and universal electronic medical records in the human medical field is being widely cited as the tool that will improve health care while lowering costs. Indeed, sophisticated data mining is already being applied to large medical databases to detect drug interactions too rare to be detected during normal clinical trials.7
The International Species Information System (ISIS) was founded in 1974 to assist zoos and aquariums with meeting long-term conservation and animal management goals by providing information management services and a centralized database of zoo animal information. About 50 zoos in North America and Europe became the initial members of this network. Over the subsequent years, ISIS has grown to more than 800 member zoos, aquariums, and related organizations in almost 80 countries. Software design and development became an integral part of ISIS services, and ISIS users have created the world standards for zoologic data collection and management. Currently, the global Zoological Information Management System (ZIMS) database contains information on about 2.6 million captive wildlife specimens, encompassing some 10,000 species.
The ISIS database has always had a medical component, compiling hematology and blood chemistry result values and producing some of the earliest reference intervals for captive wildlife species. Starting in 1985, ISIS began developing MedARKS, a medical records database system to meet the needs of the zoologic community. The MedARKS software was neither the first software designed for zoo medical records2,8 nor the last,6 but it has been the most widely adopted, with more than 100 institutions actively using it in 2012. The ISIS member institutions using this product hold nearly 13 million medical records in a common format.
The MedARKS software includes tools to permit electronic transfer of medical information from one MedARKS institution to another. These tools allow the complete medical history of an animal to easily follow that animal to another institution and remain fully searchable at the next institution. The same data transfer tools also allow medical records from multiple institutions to be compiled into a single data set.
One of the earliest usages of MedARKS records was for the “Medical Management of the Orangutan” manual.13 This year-long effort gathered the medical records of 249 orangutans held at 41 North American institutions and then manually summarized that medical information by body system, with additional chapters on other topics. The anesthesia section was used as a “proof of concept” project for the value of standardized records, with only MedARKS records being used in the compilation and analysis of anesthesia information. A total of 131 anesthesia events were available in the MedARKS data format, and the data transfer tools allowed the cooperating institutions to submit their data electronically. Software routines automated the entire compilation and analysis process, allowing the summary to be produced in a matter of days.
The resulting report provided zoo veterinarians with a summary of the drugs and drug combinations commonly used in orangutan immobilizations at that time, along with the mean administered dosage (milligram per kilogram [mg/kg]) for each drug. In addition, the analysis revealed that complications during anesthesia occurred during just 10 of the 131 events and that males were much more likely to experience complications during an immobilization (8 of 10). As male events only represented about 40% (54 of 131) of the records in the database, this meant that male orangutans experienced anesthetic complications about six times more frequently compared with females. Few institutions could ever have generated sufficient orangutan anesthesia records to detect the increased risk of complications in male orangutans, but this became immediately obvious when anesthesia records from multiple institutions were combined for analysis. This is the sort of knowledge that may directly impact the medical management of a species and was an early demonstration of the practical value of standardized, computerized medical records in zoologic medicine.
Historically, expected results (or reference intervals) for diagnostic tests were unknown or poorly defined for many captive wildlife species. Relatively few published reference intervals for wildlife species were available, forcing clinicians to rely on extrapolation of knowledge derived from domestic animal or human medical practice. As a result, interpretation of diagnostic test results may be challenging. Providing appropriate hematology and serum chemistry reference intervals to zoo clinicians for captive wildlife species was a very early goal for ISIS. Meeting that goal has been, and continues to be, quite difficult, but ISIS has made significant progress in this area with the production of a number of publications.
The American Society for Veterinary Clinical Pathology guidelines recommends 40 results as the minimum for calculating a reference interval.1 This is a small sample size within the context of domestic animal populations, but a zoologic institution holding only 5 or 6 individuals of a long-lived species could take years to accumulate enough test result values to generate a valid reference interval for that species. Cooperation between multiple institutions is one solution for producing reference intervals within a reasonable period, when only a few test result values are held by any single institution. Even within the human medical field, in some situations (e.g., pediatrics), suitable samples are so rare that initiatives to compile results from multiple institutions have been used to gather enough data for calculating a reference interval.5 For a zoologic institution holding hundreds of different species, this cooperative approach becomes the only viable solution for producing reference intervals for a significant proportion of their collection.
ISIS has taken this cooperative approach to an impressive level with its series of publications containing reference intervals for a large number of captive wildlife species.10,11,12 Institutions using MedARKS submit results in a standardized format to a central database. The 1999 publication compiled information from 129 institutions, and the level of cooperation has risen with each subsequent publication, reaching 183 cooperating institutions for the 2013 publication. The current database contains more than 6.5 million results obtained from 348,000 blood samples. Despite this unprecedented level of cooperation, obtaining a sufficient number of results for any individual species is still challenging, with the majority of species in the database having results from less than 30 samples. The 2013 publication limited calculations to the 913 species and subspecies with at least 50 samples in the database. In keeping with the American Society for Veterinary Clinical Pathology (ASVCP) guidelines, reference intervals were only calculated for tests with at least 40 results (Figure 78-1). Clearly, limitations are imposed by amalgamating results from so many different institutions, but these reference interval publications are used on a daily basis by many zoo clinicians and are widely cited in the literature. This project remains another demonstration of the power of standardized records and the value of cooperative projects within the field of zoo medicine.
