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A Quest Diagnostics Incorporated – CDC collaboration in 2000  pioneered  exploration  of  test  ordering data to enhance infectious diseasessurveillance1. This  year’s  unexpected shortage of vaccine and reports of human illness caused by avian influenza  A  (H5N1)  in  Asia2  heightened concern about  influenza and focused attention on moving toward more complete, real time surveillance. We extended our previous collaboration to explore the use of  the Quest Diagnostics Corporate Informatics Data Warehouse (QIDW) as a tool for surveillance of influenza.

Objective

To explore the potential of a large commercial data warehouse for influenza surveillance.

Referenced File
Submitted by elamb on

For syndromic and related public health surveillance systems to be effective, state and local health departments and the Centers for Disease Control and Prevention (CDC) need access to a variety of types of health data. Since the development and implementation of syndromic surveillance systems in recent years, health departments have gained varied levels of access to personal health information for inclusion in these systems. A variety of federal, state, and local laws enable, restrict, and otherwise infl uence the sharing of health information between health care providers and public health agencies for surveillance, as well as research, purposes. Some health care providers have expressed reluctance or refused to provide identifi able data for syndromic surveillance to health departments (1), citing state privacy laws or the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule (2). Although the HIPAA Privacy Rule permits health care providers to disclose protected health information without patients’ consent to public health agencies for authorized purposes, it does not supersede state laws that provide greater protection of individual privacy (2,3). The use of individuals’ health information for syndromic surveillance poses challenging questions regarding the interpretation and future development of ethical and legal standards for public health practice and research. While the practice of syndromic surveillance extends the longstanding tradition of public health surveillance as an essential element of public health practice (4), it raises in a new light equally longstanding questions about governments’ authority to collect and use health information (5). As the practice of syndromic surveillance evolves, it is in the national interest to clarify the conditions under which health information can be shared, the ways that privacy and confi dentiality can be protected, and the ways that local, state, and federal public health agencies can legally, ethically, and effectively exercise their respective responsibilities to detect, monitor, and respond to public health threats.

 

Referenced File
Submitted by elamb on

The objectives of this consultation, supported by the International Society for Disease Surveillance (ISDS), were to develop expert, consensus-based recommendations to promote Canadian and U.S. collaboration in using syndromic surveillance (SS) to detect, assess, monitor, or respond to potential or actual public health threats. The consultation focused on the Great Lakes region of the Canadian-U.S. borderóa region where there is substantial flow of people and goods between the two nations, a potential for occurrence of public health emergencies that affect people in both countries. Despite prior advances achieved by participants in the Early Warning Infectious Disease Surveillance (EWIDS) program regarding cross-border collaboration in notifiable disease reporting and follow-up, the EWIDS deliberations had not substantially addressed the role and uses of syndromic surveillance as part of cross-border disease prevention and control efforts, particularly in the context of potential large-scale public health emergencies. Presentations addressed a mix of issues that define the context for cross- border collaboration, including updates on SS practice and development in jurisdictions in the region, shared methodological challenges, protocols for responding to SS alerts, health information privacy regulations, and policies concerning public health emergencies that may shape information sharing during a crisis. Potential legal barriers to information sharing centered on individual-level privacy concerns, as opposed to sharing of aggregate SS data or notices of statistical alerts based on SS data. The meeting provided an impetus and agenda for future, ongoing consideration of including syndromic surveillance as a key component within the broader context of the EWIDS process. Identified priorities included development of procedures to share information about SS alerts and alert response protocols within EWIDS, increased use of SS inputs in crossborder tabletop exercises for pandemic influenza, and further collaboration in development of mapping projects that use data inputs from both sides of the border. In addition, the participants recommended that annual ISDS conferences provide a forum to address challenges in cross-border collaboration in SS practice and research.

Referenced File
Submitted by elamb on

 Syndromic surveillance systems often classify patients into syndromic categories based on emergency department (ED) chief complaints. There exists no standard set of syndromes for syndromic surveillance, and the available syndromic case definitions demonstrate substantial heterogeneity of findings constituting the definition. The use of fever in the definition of syndromic categories is arbitrary and unsystematic. We determined whether chief complaints accurately represent whether a patient has any of five febrile syndromes: febrile respiratory, febrile gastrointestinal, febrile rash, febrile neurological, or febrile hemorrhagic.

Referenced File
Submitted by elamb on

Homeland Security Presidential Directive – 21 (HSPD-21) requires the Department of Health and Human Services to establish a national biosurveillance capability that provides early warning and situation awareness for urgent public health events.  Early concepts of biosurveillance focused primarily on syndromic surveillance methodologies; while recent descriptions call for a more comprehensive and integrated approach to determine a nationwide biosurveillance capability (1, 2).

Objective:

Develop consensus for the definition, scope and assessment of current nationwide capability for biosurveillance based on diverse stakeholder input.

Referenced File
Submitted by elamb on

We describe the development and implementation of a protocol for identifying syndromic signals and for assessing their value to public health departments for routine (non-bioterrorism) purposes. The specific objectives of the evaluation are to determine the predictive value positive, sensitivity, and timeliness of the surveillance system, as well as its costs and benefits to public health.

Referenced File
Submitted by elamb on

The Triple-S project (Syndromic Surveillance Systems in Europe, www.syndromicsurveillance.eu), co-financed by the European Commission and involving twenty four organizations from fourteen countries was launched in September 2010 with the following objectives 1) performing an inventory of existing or planned SyS systems in Europe both in animal and public health, 2) building a network of experts involved in SyS 3) producing guidelines to implement SyS systems, 4) developing synergies between human and animal health SyS systems. The project is based on a cooperation between human and animal health experts, as supported by the One Health initiative [1].

Objective: 

The objective of this study, based on the Triple-S project outputs, was to present the existing synergies between human and animal health syndromic surveillance (SyS) systems in Europe and a proposal to enhance this kind of collaboration.

 

Submitted by Magou on

Hospital emergency departments in Cook and surrounding counties currently send data to the Cook County Department of Public Health (CCDPH) instance of ESSENCE on CCDPH servers. The cloud instance of ESSENCE has been enhanced to receive and export all meaningful use data elements in the meaningful use format. The NATO summit provided the opportunity for a demonstration project to assess the ability of an Amazon GovCloud instance of ESSENCE to ingest and process meaningful use data, and to export meaningful use surveillance data to the Cook County Locker in BioSense 2.0.

Objective

In May 2012, thousands of protesters, descended on Chicago during the NATO Summit to voice their concern about social and economic inequality. Given the increased numbers of international and domestic visitors to the Windy City and the tension surrounding protesting during the summit, increased monitoring for health events within the city and Chicago metropolitan region was advised. This project represents the first use of cloud technology to support monitoring for a high profile event.

Submitted by uysz on

Monitoring laboratory test reports could aid disease surveillance by adding diagnostic specificity to early warning signals and thus improving the efficiency of public health investigation of detected signals. Laboratory data could also be employed to direct and evaluate interventions and countermeasures, while monitoring outbreak trends and progress; this would ultimately result in better outbreak response and management, and enhanced situation awareness. Since Electronic Laboratory Reporting (ELR) has the potential to be more accurate, timely, and cost-effective than reporting by other means of communication (e.g., mail, fax, etc.), ELR adoption has been systematically promoted as a public health priority.  However, the continuing use of non-standard, local codes or text to represent laboratory test type and results complicates the use of ELR data in public health practice. Use of structured, unique, and widely available coding system(s) to support the concepts represented by locally assigned laboratory test order and result information improves the computational characteristics of ELR data. Out of several coding strategies available, the Office of the U.S. National Coordinator for Health Information Technology has recently suggested incorporating Logical Observation Identifiers Names and Codes (LOINC) for laboratory orders and Systemized Nomenclature of Medicine- Clinical Terms (SNOMED CT) codes for laboratory results to standardize ELR.



Objective:

To examine the use of LOINC and SNOMED CT codes for coding laboratory orders and results in laboratory reports sent from 63 non-federal hospitals to the BioSense Program in calendar year 2011.

 

Submitted by Magou on
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