Community Survey

The International Society for Disease Surveillance (ISDS) community comprises a large pool of global expertise. Essential to the ISDS mission of advancing the science and practice of disease surveillance is understanding and setting priorities for research and best practices in public health monitoring. To this end, an ISDS workgroup developed an online survey to identify and prioritize the technical and policy issues of the ISDS community. Through analysis, the Survey will identify respondents' perceptions of opportunities in the area of analytical methodologies.

Objective

The objective of the '2013 Biosurveillance Technical Opportunity Prioritization Survey' (Survey) is to gather input from the ISDS community on the current landscape and prioritization of data sources and analytical issues in the field of biosurveillance.

With the recent emphasis on public health preparedness, health departments are identifying new ways to prepare for emergencies. There has been a significant increase in the number of syndromic surveillance systems operating in recent years. These systems are based on real-time information from hospital emergency departments that is transmitted and analyzed electronically for the purpose of early detection of public health emergencies. Like other states, Rhode Island sought to enhance its traditional surveillance activities through the implementation of such a system. Rhode Island implemented the Real-time Outbreak and Disease Surveillance (RODS) system, developed by the University of Pittsburgh’s Center for Biomedical Informatics. Data from three hospitals were collected as part of the pilot implementation of the Rhode Island RODS system. Personnel at both hospitals and the Department of Health, trained in surveillance-related areas such as infection control and epidemiology, received access to RI RODS. As part of the evaluation framework, Rhode Island desired to assess system user attitudes and opinions towards the new system.

Objective

This paper presents results of a survey assessing syndromic surveillance system initial user satisfaction and attitudes regarding syndromic surveillance.

In 2007-2008, the authors surveyed public health officials in 59 state, territorial, and selected large local jurisdictions in the United States regarding their conduct and use of syndromic surveillance. Fifty-two (88%) responded, representing areas comprising 94% of the United States population. Forty-three (83%) of the respondents reported conducting syndromic surveillance for a median of 3 years (range = 2 months to 13 years). Emergency department visits were the most common data source, used by 84%, followed by outpatient clinic visits (49%), over-the-counter medication sales (44%), calls to poison control centers (37%), and school absenteeism (35%). Among those who provided data on staffing and contract costs, the median number of staff dedicated to alert assessment was 1.0 (range 0.05 to 4), to technical system maintenance 0.6 (range zero to 3); and, among the two-thirds who reported using external contracts to support system maintenance, median annual contract costs were $95,000 (range = %5,500 to $1 million). Respondents rated syndromic surveillance as most useful for seasonal influenza monitoring, of intermediate usefulness for jurisdiction-wide trend monitoring and ad hoc analyses, and least useful for detecting typical community outbreaks. Nearly all plan to include syndromic surveillance as part of their surveillance strategy in the event of an influenza pandemic. Two thirds are either "highly" or "somewhat" likely to expand their use of syndromic surveillance within the next 2 years. Respondents from three state health departments who reported they did not conduct syndromic surveillance noted that local health departments in their states independently conducted syndromic surveillance. Syndromic surveillance is used widely throughout the United States. Although detection of outbreaks initially motivated investments in syndromic surveillance, other applications, notably influenza surveillance, are emerging as the main utility.

Syndromic Surveillance utilizes health-related symptom data to monitor disease outbreaks. Its’ potential for prompt detection of disease outbreaks and strengthening of rapid public health response is anticipated. As a result, syndromic surveillance is widely employed by many local and regional health care agencies across the country in both routine monitoring of disease outbreaks as well as in special national events. However, the efficacy and effectiveness of syndromic surveillance are yet to be substantiated. In Florida many localized Syndromic Surveillance have been deployed by county health departments with little oversight or coordination of any state and federal agencies. Furthermore, many aspects including the design, operation, and funding characteristics of these systems are not well known and information and practice are not shared, hindering the potential for regional networks with shared data source, networked platform, expanded geographic coverage. This survey aims to establish an inventory of Syndromic Surveillance in the State of Florida and helps identify issues common among these systems.

Objective

To gather inventory information on syndromic surveillance deployment and utilization in the State of Florida; To identify issues in developing, operating, and sustaining local systems; To assess needs for system evaluation in order to establish efficacy and effectiveness of syndromic/disease surveillance in the state.

Syndromic surveillance is the surveillance of healthrelated data that precedes diagnosis to detect a disease outbreak or other health related event that warrants a public health response. Though syndromic surveillance is typically utilized to detect infectious disease outbreaks, its utility to detect bioterrorism events is increasingly being explored by public health agencies. Many agencies believe that syndromic surveillance holds great promise in enhancing our ability to detect both planned and unplanned outbreaks of disease and have made significant investments to develop syndromic surveillance capabilities.

For instance, the Centers for Disease Control and Prevention has invested in Biosense and the Department of Defense has invested in the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) which it has deployed in partnership with the Department of Veterans Affairs. The Department of Homeland Security has invested heavily in the National Bio-surveillance Integration System which integrates a broad spectrum of bio-surveillance information including data from Biosense and ESSENCE. The University of Pittsburgh has also developed a prominent tool and is considered a thought leader in this space.

Despite the significant investments in the area of syndromic surveillance, the technology is young and the relatively small field remains fragmented. As a result, there is limited public information that addresses the field as a whole.

Objective

The objective of this assessment is to research, develop and maintain a national syndromic surveillance registry that describes each system’s configuration. By collecting current information on the leading systems we will gain a greater understanding of the syndromic surveillance landscape and capabilities.

The impetus for the development of many first syndromic surveillance systems was the hope of detecting infectious disease outbreaks earlier than with traditional surveillance. Various data sources have been suggested as potential disease indicators. Researchers have analyzed many of these, including those resulting from behaviors that change due to illness, such as purchasing medications, missing school or work, and using health care call centers or the internet to obtain health information. To define the prodromal behavior of patients presenting for care of acute illnesses, we initiated a pilot survey in the emergency room and acute care clinics at Walter Reed Army Medical Center.

Objective

This study describes the results of a survey given to patients to determine if any changes occurred in their behavior secondary to the illness that could potentially be tracked and used to detect a disease outbreak.

“The ultimate measure of whether a surveillance system has achieved the optimal balance of attributes lies in its usefulness.” No one is better qualified to comment on usefulness than the users. As system developers, we are well advised to consider the opinions of users when building, evaluating, and considering revisions to surveillance systems. 

Health Monitoring Systems, Inc. is a for-profit company that provides biosurveillance capabilities to public health agencies and hospitals using a software-as-a-service model.

Objective

This paper describes results from a survey of public health department users of biosurveillance. The survey solicited input regarding sophistication of analytic methods, perceived value of potential data sources, and utilization resulting in timelier public health interventions.

Hypertension (HTN) is a highly prevalent chronic condition and strongly associated with morbidity and mortality. HTN is amenable to prevention and control through public and population health programs and policies. Therefore, public and population health programs require accurate, stable estimates of disease prevalence, and estimating HTN prevalence at the community-level is acutely important for timely detection, intervention, and effective evaluation. Current surveillance methods for HTN rely upon community-based surveys, such as the BRFSS. While BRFSS is the standard at the state- and national-level, they are expensive to collect, released once per year, and their confidence intervals are too wide for precise estimates at the local level. More timely, frequently updated, and locally precise prevalence estimates could greatly improve the timeliness and precision of public health interventions. The current study evaluated EHR data from a large, mature HIE as an alternative to community-based surveys for timely, accurate, and precise HTN prevalence estimation.

Objective:

To assess the equivalence of hypertension prevalence estimates between longitudinal electronic health record (EHR) data from a community-based health information exchange (HIE) and the Behavioral Risk Factor Surveillance System (BRFSS).