Evaluation of Syndromic Surveillance

Syndromic surveillance is commonly supported by information generated from electronic health record (EHR) systems and sent to public health via standardized messaging. Before public health can receive syndromic surveillance information from an EHR, a healthcare provider must demonstrate reliable and timely generation of messages according to national standards. This process is known as onboarding. Onboarding at the Tennessee Department of Health (TDH) focused heavily on human review of HL7 messages. However, the visual inspection of messages was time-intensive and delayed efforts to provide constructive feedback to participating healthcare providers. To ease the quantity of manual review done during the onboarding process, TDH created an application to assist in the process of reviewing syndromic surveillance messages.

Objective:

To show how the creation of a software tool and implementation of new processes improved the efficiency of syndromic surveillance onboarding at the Tennessee Department of Health.

In early 2017, HAV outbreaks were identified in San Diego County (490 cases) and Santa Cruz County (73 cases) in California, affecting primarily the homeless and/or illicit drug users. As of October 10, 2017, LAC had identified 12 outbreak-related HAV cases. Due to LAC’s proximity to San Diego County, and its own large homeless population, the syndromic surveillance team of the LAC Department of Public Health created a syndrome category and began querying its ED data to monitor for any increase in HAV-related visits.

Objective:

To create a hepatitis A virus (HAV) syndrome category with which to monitor emergency department (ED) visits for situational awareness during a currently emerging Hepatitis A community outbreak in Los Angeles County (LAC), and to evaluate its usefulness.

Falls are a leading cause of fatal and nonfatal injury in NC. As the size of the older adult population is predicted to increase over the next few decades, it is likely that the incidence of falls-related morbidity and mortality will increase in tandem. In order to address this public health emergency, the Injury and Violence Prevention Branch (IVPB) of the NC Division of Public Health has partnered with the Carolina Center for Health Informatics (CCHI) in the Department of Emergency Medicine at the University of North Carolina at Chapel Hill to perform falls surveillance activities. This abstract describes some of the specific research and surveillance activities currently ongoing in NC.

Objective:

To describe how a successful partnership between state public health and a university organization has used epidemiologic data, such as mortality, hospital discharge, and emergency department (ED) visit data, to inform falls prevention activities in North Carolina (NC).

Systematic syndromic surveillance is undergoing a transition. Building on traditional roots in bioterrorism and situational awareness, proponents are demonstrating the timeliness and informative power of syndromic surveillance data to supplement other surveillance data.

Objective:

To assess evidence for public health impact of syndromic surveillance.

Traditional surveillance methods have a major challenge to estimating the burden of disease due to underreporting. Participatory surveillance techniques can help supplement to monitor and detect foodborne outbreaks while reducing the impact of underreporting. As there is a low participation rate in Singapore, this study aims to better understand the barriers and facilitators to reporting and assesses what improvements can increase participation.

Objective:

To better understand the barriers and facilitators to reporting and assessing what improvements would increase participation.

Pilot projects help determine utility and feasibility of a system, but even if considered successful, cost could prevent further scale-up. When evaluating a surveillance system pilot, cost and benefits are key factors to examine. In Cote d’Ivoire and Tanzania, Ministry of Health (MoH) and non-governmental partners receive funding under the Global Health Security Agenda to strengthen disease surveillance for earlier detection and improved response to potential infectious disease outbreaks. To this end, Community based surveillance (CBS) projects were implemented in 2016 as a means for early warning of potential events to facilitate a more rapid response. Currently, these CBS projects are being evaluated collaboratively with the primary stakeholder, the host country government (HCG), as lead, and partners such as CDC providing technical assistance. In other instances, partners may conduct an evaluation and share the results and recommendations with the HCG; however, if the HCG is not actively engaged as the primary executor, outcomes may not be endorsed or implemented. Therefore, these evaluations were approached from an owner’s (HCG) perspective. In this way, the governmental agencies develop capabilities to conduct similar activities in other areas, reduce dependencies on outside entities, and promote enactment of resulting recommendations.

Objective:

We used experiences in multiple countries to determine that owner engagement is critical for successful evaluations of surveillance system viability.

Syndromic surveillance uses near-real-time emergency department and other health care data for enhancing public health situational awareness and informing public health activities. In recent years, continued progress has been made in developing and strengthening syndromic surveillance activities. At the national level, syndromic surveillance activities are facilitated by the National Syndromic Surveillance Program (NSSP), a collaboration among state and local health departments, the CDC, other federal organizations, and other organizations that enabled collection of syndromic surveillance data in a timely manner, application of advanced data monitoring and analysis techniques, and sharing of best practices. This panel will highlight the importance of success stories. Examples of successes from state and local health departments will be presented and the audience will be encouraged to provide feedback.

Objective:

This panel will: 

• Discuss the importance of identifying and developing success stories
• Highlight successes from state and local health departments to show how syndromic surveillance activities enhance situational awareness and address public health concerns
• Encourage discussion on how to further efforts for developing and disseminating success stories.

Syndromic surveillance uses near-real-time Emergency Department healthcare and other data to improve situational awareness and inform activities implemented in response to public health concerns. The National Syndromic Surveillance Program (NSSP) is a collaboration among state and local health departments, the Centers for Disease Control and Prevention (CDC), other federal organizations, and other entities, to strengthen the means for and the practice of syndromic surveillance. NSSP thus strives to strengthen syndromic surveillance at the national and the state, and local levels through the coordinated activities of the involved partners and the development and use of advanced technologies, such as the BioSense platform. Evaluation and performance measurement are crucial to ensure that the various strategies and activities implemented to strengthen syndromic surveillance capacity and practice are effective. Evaluation activities will be discussed at this session and feedback from audience will be sought with the goal to further strengthen evaluation activities in the future. 

Objective:

The objective of this session is to discuss syndromic surveillance evaluation activities. Panel participants will describe contexts and importance of selected evaluation and performance measurement activities in NSSP. Discussions will explore ways to strengthen evaluation in syndromic surveillance activities in the future.