Real-time Surveillance

Adoption of electronic medical records is on the rise, due to the Health Information Technology for Economic and Clinical Health Act and meaningful use incentives. Simultaneously, numerous HIE initiatives provide data sharing flexibility to streamline clinical care. Due to the consolidated data availability in centralized HIE models, conducting syndromic surveillance using locally developed systems, such as GUARDIAN, is becoming feasible. During the past year, Chicago has embarked on a city-wide HIE deployment campaign. Perhaps the most unique aspect of this endeavor is that the data warehouse for the HIE is intricately tied to the GUARDIAN syndromic surveillance system.

Objective

The objective is to describe the technical process, challenges, and lessons learned in scaling up from a local to regional syndromic surveillance system using the MetroChicago Health Information Exchange (HIE) and Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification (GUARDIAN) collaborative initiative.

It is admitted that real time surveillance system permits to reduce delay of outbreak detection, and preventive measures implementation. It is usually based on pre diagnostic numeric data collection and transmission. ASTER (Alerte et surveillance en temps reel) is a real time surveillance system for French Armed Forces deployed in French Guiana and Djibouti, constituted by 2 kinds of networks : several declaration networks and one analysis network. On June 2011, an outbreak occurred among a French Army Regiment in Djibouti, which has permitted to evaluate ASTER in real conditions.

Objective

To discuss advantages of real time surveillance system within Armed Forces, using a real outbreak case.

Detection of biological threat agents (BTAs) is critical to the rapid initiation of treatment, infection control measures, and public health emergency response plans. Due to the rarity of BTAs, standard methodology for developing syndrome definitions and measuring their validity is lacking.

Objective

The objective of this study is to outline and demonstrate the robust methodology used by Geographic Utilization of Artificial Intelligence in Real-Time for Disease Identification and Alert Notification surveillance system to generate and validate BTA profiles.

Late in September 2012, the Tennessee Department of Health (TDH) identified a cluster of fungal infections following epidural injection of methylprednisolone acetate (MPA) from a single compounding pharmacy. This presented a public health imperative to contact, educate and monitor approximately 1,100 Tennessee residents who received injections from contaminated MPA lots that were shipped to three clinics in Tennessee. There was no precedent to accomplish this rapidly and efficiently. To accomplish this goal a secure, web-based application designed by TDH for emergency patient management was deployed. 

Objective

The purpose was to facilitate real-time information sharing and data visualization for incident management during the Fungal Infections Outbreak in Tennessee.

Recent health events in France, such as the dramatic excess of mortality occurred during the 2003 heat wave showed the need for a better provision of information to health authorities. A new syndromic surveillance system based on the recording of general practitioner’s visits by SOS Médecins has been developed by the Aquitaine Regional Epidemiology unit (Cire).

Objective

To describe the surveillance system based on SOS Medecins data, the first GP emergency and healthcare network in France and to show the utility and validity of this data source as a real-time syndromic surveillance system.

The syndromic surveillance system “2SE FAG” has been installed within the French Armed Forces in French Guiana (3000 people) in October 2004 [1-2]. During the conception and the deployment of such a system, ergonomic issues were highlighted and training of stakeholders as well [3]. Daily exchanges with users have already permitted to enhance the system. An standardized and quantified evaluation among the users had to be done after 18 months of functioning. The objectives of this work were to evaluate the knowledge, the attitude and the practice of the stakeholders of the system.

Objective

This paper describes an evaluation survey made within the users of a real time surveillance system in French Guiana.

The Houston Department of Health Department of Health and Human Services (HDHHS) monitors emergency departments (ED) chief complaints across the Houston metropolitan area, Harris County, and the surrounding jurisdictions by Real-time Outbreak Disease Surveillance (RODS). The influenza-like illnesses (ILI) data is collected by sentinel surveillance provider network of 12 physicians and RODS, an electronic syndromic surveillance database consisting of about 30 EDs in metropolitan Houston. Previous research indicates that there is a relationship between new HIV diagnoses and neighborhood poverty. However, there is limited research on health disparity to investigate the association between influenza-like illnesses (ILI) and social determinants of health (SDH), such as poverty.

Objective

To investigate the association between social determinants of health and influenza-like illnesses in Houston/Harris County and to identify neighborhoods for targeted surveillance or interventions.

In February of 2007, the Bureau of Epidemiology (BOE) received a request from Houston Department of Public Works to investigate a possible rise in gastrointestinal (GI) illness associated with complaints about poor water quality in a Northeastern Houston neighborhood. To investigate this complaint, BOE combined case report data with syndromic data from our Real-Time Outbreak Disease Surveillance (RODS). The Houston RODS collects and synthesizes real-time chief complaint data from 34 area hospitals and health facilities, representing approximately 70% coverage of licensed ER beds in Harris County. The system uses a Naïve Bayes Classifier to categorize ER chief complaints into 7 different syndromes, including GI illness.

Objective

To investigate public concern over a possible increase in GI illness associated with water quality complaints in Northeast Houston.

In Connecticut (CT), several syndromic surveillance systems have been established by the Department of Public Health (DPH) to detect and monitor potential public health threats. The emergency department syndromic surveillance (EDSS) routinely categorizes chief complaint data into pre-defined syndrome categories, and also has the flexibility to define syndromes in real-time. Thus, DPH can use this system for situational awareness during public health events. Several recent events provided an opportunity to evaluate EDSS for this purpose: 1) two cases of cutaneous anthrax in CT in September 2007; 2) national and local media attention surrounding MRSA infections and published research in October 2007 and 3) the introduction of rotavirus vaccine through the Vaccines for Children Program in July 2006 following its licensing in February 2006.

Objective

To evaluate the performance of the CT EDSS system for situational awareness during specific public health events.