Stakeholder Engagement

In 2004, the Indiana State Department of Health (ISDH) partnered with the Regenstrief Institute to begin collecting syndromic data from 14 ED’s to monitor bioterrorism-related events and other public health emergencies. Today, Indiana’s public health emergency surveillance system (PHESS) receives approximately 5,000 daily ED visits as real-time HL7 formatted surveillance data from 55 hospitals. The ISDH analyzes these data using ESSENCE and initiates field investigations when human review deems necessary.1 The Marion County Health Department, located in the state’s capitol and most populous county, is the first local health department in Indiana using ESSENCE.

Objective

This paper describes how local and state stakeholders interact with Indiana’s operational PHESS, including resources allocated to syndromic surveillance activities and methods for managing surveillance data flow. We also describe early successes of the system.

Efforts have been made to standardize and prioritize the description and evaluation of syndromic surveillance systems. Systematic information on the performance of existing systems can be used to assess and compare the value of these systems, and inform decisions regarding their use. 

The Michigan’s Emergency Department Syndromic Surveillance System (MSSS) is an implementation of an early version of the Real-time Outbreak and Disease Surveillance system developed by the University of Pittsburgh, which collects patient chief complaint data from emergent care facilities in real time. At the Michigan Department of Community Health the system has been in use since 2003. Alterations to the system and recruitment of data contributors have been ongoing. The primary stated purpose of the MSSS is earlier detection of outbreaks of severe illness, enabling a more rapid public health response and intervention to reduce the impact of public health threats.

Objective

This work describes key characteristics of MSSS and reports on its evaluation.

Regional disease surveillance systems allow users the ability to view large amounts of population health information and examine automated alerts that suggest increased disease activity. These systems require users to view and interpret which of these alerts or data streams are epidemiologically important. This interpretation is valuable information that may benefit other users. In addition to the daily interpretation of data done by users, the ability to communicate local concerns and findings during a public health event to neighboring jurisdictions is of great public health importance. Public health officials also need constant situational awareness and a venue to share their concerns about increases in disease activity before a health emergency is declared. The Event Communications Component (ECC) was created to provide this venue. The ECC was developed for the National Capital Region (NCR) public health surveillance network to facilitate the need for users to communicate. The NCR system is an operational multi-jurisdictional biosurveillance system employed in the District of Columbia and in surrounding Maryland and Virginia counties. NCR users include epidemiologists and public health officials from different levels of government. The ECC has been in operation for a year in the NCR system. ECC 2.0 is being developed to improve on the original version’s capabilities and solve its shortcomings.

 

Objective

Identify areas of improvement and establish design goals of ECC 2.0. These design goals include: the incorporation of comment centric design versus event centric, automatic notification of new events/comments, the use of action oriented concern levels and user interface improvements. Focus design goals by utilizing prototyping and user group reviews. Develop ECC 2.0 and integrate it into the NCR system.

A syndromic surveillance system has been implemented at Kingston, Frontenac and Lennox & Addington Public Health in Kingston Ontario as part of a pilot project funded by the Ontario Ministry of Health and Long-Term Care – Public Health Division. The information captured by the Real-time Outbreak and Disease Surveillance-based syndromic surveillance system includes Febrile Respiratory Illness screening results (implemented since SARS) for Emergency Department (ED) visits and information detailing hospital admissions.

Objective

To use an electronic real-time ED monitoring tool to involve public health, acute care and laboratory stakeholders in an integrated alerting and response process for community-wide influenza.

The purpose of this study is to depict a local county health departmentís analysis and dissemination algorithm of surveillance system (SS) aberration (alarm) to designated stakeholders within the community.

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.