Issue 2 - May 2002: SURVEILLANCE DECISIONS ARE BEING MADE NOW! MAKE SURE YOU ARE INCLUDED!

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In response to the events of last Fall, Congress appropriated $2.9 billion in bioterrorism funds. Of that amount, $1.1 billion is currently being allocated for states to strengthen their capacity to respond to infectious disease outbreaks, bioterrorism, and other public health emergencies. The money will allow them to begin planning and building the public health systems necessary to respond effectively.(1) Specifically, states can apply to the CDC through the "Cooperative Agreement Award" for funds to develop "new active or sentinel surveillance activities" including "emergency department visits". (2)

"Syndromic surveillance" is the new term for this type of health monitoring. Syndromic surveillance is the ongoing analysis of medical data to search for unusual combinations of signs and symptoms in a population. Emergency Departments (EDs) are the best source of patient-level symptom data, because most severely ill patients present to a hospital ED before being admitted. Therefore, the most efficient method to perform syndromic surveillance is for the EDs to collect this data and forward it to their local health department.

But roadblocks do exist. Hospitals have many different software programs already in use. EDs are busy places, where cost-saving and timesaving measures have priority over data collection. Personnel are stretched, with few extra staff available to enter additional surveillance data.

To help insure that syndromic software decisions are made with compatibility, ease of use, report generation capability, and price in mind, we recommend the following:

1) Coordination between public health departments and local emergency departments is essential. Look for solutions that benefit both parties.

a. Hospital EDs need syndromic software that can easily be installed and used. Manual data entry should be avoided in favor of data mining of previously entered ED symptom data. Waiting for ICD-9 coding is not timely; reports must be available quickly and offer maximum flexibility. Export capabilities to the public health department should monitor reportable diseases as well syndromic surveillance.

b. Public Health Districts need robust software that is compatible with data sent by their hospitals. When transmitted to the health department, data must be encrypted. At the health department, it should be easily merged into a common database. The data stream provided to the public health department will be valuable beyond bioterrorism. It can be used to gauge the health of the entire community. What other trends or outbreaks of infectious disease might be occurring? Alerts, when syndromes exceed the preset threshold, should be automatic. Geographic mapping can provide easy identification of clusters and problem areas.

2) Hospitals should identify individuals who are stakeholders in syndromic surveillance to help make software decisions. Should the CEO, Emergency Department Director, Infection Control and/or Hospital Epidemiologist be involved?

3) Hospitals should contact their public health authority ASAP to inquire about their plans for syndromic surveillance. Of particular concern is software that is easy to use and requires minimum time commitment by hospital personnel. Consider what additional resources each specific software package under consideration will require. Of primary importance is that the hospital and health departments use the same software tool.

4) Both hospitals and health departments should focus on "the bare essentials" - critical software features needed to identify an outbreak. Morgan Stanley recently estimated that U.S. companies squandered $130 billion just in the past two years on unneeded software. (3) While glitzy features may look great, they typically make the software more difficult to use and more expensive than necessary to maintain. Decide what is needed to do the job right.

The U.S. public health sector is poised to make a huge investment in resources. Decisions are being made that will change the way surveillance data is obtained, transmitted and analyzed. Syndromic surveillance is considered to be the future of public health. Whether this will be a smooth or difficult transition will partly depend on wise decisions by all players in this move to make the U.S. safe from terrorists.

(1) http://www.os.dhhs.gov/news/press/2002pres/20020131b.html

(2) http://www.bt.cdc.gov/Planning/CoopAgreementAward/CDC4BTATTACHMENT-B-MASTER-2-14-2002-442pm.asp

(3) USA Today. Hopkins, Jim and Kessler, Michelle. "Companies squander billions on tech; In the go-go days of the 1990s, firms spend wildly on software they really didn't need". May 20, 2002.

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