Electronic Disease Surveillance

The Office of the Medical Examiner (OME) is a statewide system for investigation of sudden and unexpected death in Utah. OME, in the Utah Department of Health (UDOH), certified over 2000 of the 13,920 deaths in Utah in 2008.

Information from OME death investigations is currently stored in three separate UDOH data silos that have limited interoperability. These three electronic data systems include death certificates, medical examiner investigations, and laboratory results. Without interoperability, OME staff is required to enter the same data into multiple systems. In addition, the process of requesting laboratory analysis and receiving results is paper based, significantly slowing final cause of death determination in a majority of cases.

Epidemiological studies and surveillance activities are hindered by the lack of systems integration in UDOH and often require retrospective data linkage. As an example, in 2005, CDC and the UDOH reported that deaths in Utah caused by drug poisoning from non-illicit drugs had increased fivefold from 1991 to 2003.1 This significant finding relied on retrospective linkage of death certificates, medical examiner records, and toxicology results to describe the problem.

In 2008, funding from a bioterrorism grant from the US Department of Homeland Security was secured to support development of a unique, integrated system for medical examiner and death certificate data.

Objectives

The objectives of the Utah Medical Examiner Database (UMED) project are:

• To provide a single point of entry for medical examiner pathologists and staff to manage investigation information.
• To develop an operational system that links death certificate, medical examiner, and laboratory data in real time as a resource for epidemiology and public health surveillance.

Electronic disease surveillance systems can be extremely valuable tools; however, a critical step in system implementation is collection of data. Without accurate and complete data, statistical anomalies that are detected hold little meaning. Many people who have established successful surveillance systems acknowledge the initial data collection process to be one of the most challenging aspects of system implementation. These challenges manifest from varying degrees of economical, infrastructural, environmental, cultural, and political factors. Although some factors are not controllable, selecting a suitable collection framework can mitigate many of these obstacles. JHU/APL, with support from the Armed Forces Health Surveillance Center, has developed a suite of tools, Suite for Automated Global bioSurveillance, that is adaptable for a particular deployment’s environment and takes the above factors into account. These subsystems span communication systems such as telephone lines, mobile devices, internet applications, and desktop solutions - each has compelling advantages and disadvantages depending on the environment in which they are deployed. When these subsystems are appropriately configured and implemented, the data are collected with more accuracy and timeliness.

Objective

This paper describes the common challenges of data collection and presents a variety of adaptable frameworks that succeed in overcoming obstacles in applications of public health and electronic disease surveillance systems and/or processes, particularly in resource-limited settings.

Emerging and re-emerging infectious diseases are a serious threat to global public health. The World Health Organization (WHO) has identified more than 1100 epidemic events worldwide in the last 5 years alone. Recently, the emergence of the novel 2009 influenza A (H1N1) virus and the SARS coronavirus has demonstrated how rapidly pathogens can spread worldwide. This infectious disease threat, combined with a concern over man-made biological or chemical events, spurred WHO to update their International Health Regulations (IHR) in 2005. The new 2005 IHR, a legally binding instrument for all 194 WHO member countries, significantly expanded the scope of reportable conditions, and are intended to help prevent and respond to global public health threats. SAGES aims to improve local public health surveillance and IHR compliance, with particular emphasis on resource-limited settings.

Objective

This paper describes the development of the Suite for Automated Global bioSurveillance (SAGES), a collection of freely available software tools intended to enhance electronic disease surveillance in resource-limited settings around the world.