Issue 5 - December 2002: IS REAL TIME THE REAL THING FOR SYNDROMIC SURVEILLANCE?

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IS REAL TIME THE REAL THING FOR SYNDROMIC SURVEILLANCE?

With the advent of choices in syndromic surveillance (SS) software, one of the decisions many facilities and their health departments face is whether they should invest in:

1) An expensive real-time surveillance system with 24-hour capabilities for data retrieval and analysis, or

2) A less expensive system that imports data once a day for analysis at your convenience.

While there is not an easy or one-size-fits-all answer to this complex question, consider these issues before investing in any SS system.

Cost

Of course, the first question is “How much does the SS software cost – initially and on a monthly basis?” Who is going to support it? What is the cost of the technical support contract?

What about transmission of data? Continuous, on-line transfer of data is expensive to set up and maintain. Ask specific questions regarding initial cost to set up export interfaces (such as HL-7) and the expected costs to acquire, maintain and update these connections over time. If data is to be imported, ask what format is required. Even if the software itself is free, expect to spend thousands of dollars in these maintenance areas.

Data Entry (Is it Timely, Accurate and Complete?)

You might think that all real-time systems retrieve data from existing databases, and immediately begin analyzing it. However, some ‘real-time’ packages actually require MANUAL data entry on the web or on a secure server. This approach raises serious questions about how regularly or quickly personnel will enter data.

You might also assume that all real-time systems automatically translate symptoms into syndrome categories for analysis. However, some ‘real-time’ packages actually require the user to decide which syndrome is most likely. This approach raises concerns about how accurate or consistent the data will be.

The point is that a system can be ‘real-time’ but still fail to capture data that are accurate, complete or timely!

Data Storage

With real-time data, there is often a need for a server outside the hospital firewall where the data is held prior to its trip to the health department. Do you feel comfortable with this arrangement? Who else can look at your data? If the data repository is a research center, is this arrangement HIPAA-compliant? If the data is de-identified prior to transmission (HD), is the health department happy with anonymous data, or do they need a way to identify certain patients?

Thorough Analysis Requires People

Real-time data implies immediate analysis and review. What’s the point of spending thousands of dollars to capture real-time data when a qualified epidemiologist is only available to look at the data every few days? After the computer flags potential problems, the second stage of analysis typically involves a knowledgeable practitioner examining the data in more detail. This process takes time, and sometimes additional specialized software.

If the software claims to do ‘instant analysis’, ask what exactly that means. Most people don’t want a beeper going off at 2am to tell them their data needs a closer look.

Conclusion

While no one can argue that timely surveillance data is important, it is not a magic potion. Be sure you can justify the costs, staffing, analysis, and storage issues of a real-time syndromic surveillance system. Or consider spending less money for SS software that provides daily batch updates with easy-to-use interpretive analysis tools.

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