Implementation of a syndromic surveillance system in health care

¶ … Management Project in the Health Care Organization Setting

This study describes the implementation of a syndromic surveillance system. The syndromic surveillance system collects and analyzes prediagnostic and nonclinical disease indicators, drawing on preexisting electronic data that can be found in systems such as electronic health records, school absenteeism records and pharmacy systems. The systems are utilized to identify specific symptoms within a population that may indicate a public health event or emergency such as signaling an outbreak of an infectious disease. school absenteeism records and pharmacy systems. The systems are utilized to identify specific symptoms within a population that may indicate a public health event or emergency such as signaling an outbreak of an infectious disease.

Informatics Management Project In The Health Care Organization Setting

Part One - Introduction

The objective of this study is to describe the implementation of a syndromic surveillance system. Syndromic surveillance systems collect and analyze prediagnostic and nonclinical disease indicators, drawing on preexisting electronic data that can be found in systems such as electronic health records, school absenteeism records and pharmacy systems. The systems are utilized to identify specific symptoms within a population that may indicate a public health event or emergency such as signaling an outbreak of an infectious disease.

The implementation of this system will also enable collaboration among the health care agency, health care provider, information technology vendors, researchers, and the business community. There are several primary challenges faced by the health care agency in that the data must first be collected from hospitals and specifically emergency rooms and development and support of the required interfaces to the applications in a large number of hospitals presents a daunting task since the hospitals have different software and there is a diversity of data standards. As well, there is a hesitation in diverting IT staff and budgeting to the implementation of the necessary interfaces. In order to address this challenge, a commercial package will be required or the software to ease the integration must be built that will enable each hospital to assess its own mix of patients and their presenting problems.

The health care agency is contemplating the development of regulations that would require hospitals to report the needed information. The second challenge is that the system must be designed to ensure protection of patient privacy. The third challenge is funding which will be acquired through federal grants. Strategies are required for the agency to ensure the financial sustainability of the application and the related analysis capabilities should federal funding on this project end. Finally, the agency must ensure that the project has the staff and tools necessary to appropriate analyze the data once it has been collected.

Questions that must be addressed in this initiative include those asking: (1) How would the head of the agency's epidemiology section address these stated challenges? (2) Which of the challenges is the most important to address and why? (3) If the hospital CEO were asked to redirect IT resources on this project what would the CEO want in return from the agency to ensure that the system provided value to the organization and clinicians? And (4) A strong privacy group has expressed alarm about potential problems that the system could create, how would those concerns be responded to?

Part Two - Background Analysis

This section of this study intends to report on the syndromic system state-of-the-art and to summarize the project and identify key points and common themes in the research. The strengths and weaknesses of what is known and what is unknown about use of syndromic surveillance systems will be examined and an evaluation of how authoritative the sources utilized are. It is reported in the work of Sloane, et al. (2006) the results of an evaluation of the feasibility of conducting syndromic surveillance in a primary care office using billing data. The one-year study reports results that the most frequently recorded syndromes were "respiratory illness, gastrointestinal illness, and fever." (p.351) The preliminary study is stated to have demonstrated "the feasibility of implementing syndromic surveillance in an office setting at a low coast and with minimal staff effort." (Sloane, et al., 2006, p.351) A Study reported in the work of Buckeridge et al. (2005) reports a study that desired to describe a model for stimulation of cases that might result from exposure to inhalational anthrax and then make use of the model for the evaluation of the ability of syndromic surveillance to detect an outbreak of inhalational anthrax after an aerosol release. The study concluded "syndromic surveillance of a respiratory syndrome using a temporal detection algorithm tended to detect an anthrax attack within 3-4 days after exposure if less than 10,000 person were infected." (Buckeridge, et al., 2005, p.1) As the number of individuals infected decreased the performance of surveillance in terms of timeliness and sensitivity was noted to worsen.

State-Of-The-Art Syndromic Systems

Some of the syndromic systems presently being used include those stated and described as follows:

(1) BioSense

The work of Chen, Zen, Ping and Ping (2010) report that thirteen nationwide syndromic surveillance systems and two open source global public health status monitoring system are noted as being presently in use. CDC's BioSense system is a national initiative that supports detection of early outbreak through provision of technologies for acquisition of timely data, near real-time reporting, outbreak identification that is automated and related analytics. BioSense collects ambulatory care data, emergency room diagnostic and procedural information from military and veteran medical facilities and clinical laboratory test orders and results from LabCorp. Also monitored by BioSense are over-the-counter drug sales and lab test results for environmental samples collected through the BioWatch effort. BioSense aims to "monitor 11 syndrome categories including fever, respiratory, gastrointestinal illness, hemorrhagic illness, localized cuteanous lesion, symphadenitis, neurologic, rash, severe illness and death, specific infection and botulism-like/botulism." (Chen, Zen, Ping, and Ping, 2010, p.10)

(2) ESSENCE

ESSENCE is reported to have been used in monitoring the health status of military healthcare beneficiaries worldwide, relying on outpatient ICD-9 diagnostic codes for outbreak detection." (Chen, Zen, Ping and Ping, 2010, p. 10) The Rapid Syndrome Validation Project (RSVP) is reported as an "Internet-based population health surveillance tool designed to facilitate rapid communications between epidemiologist and healthcare providers." (Chen, Zen, Ping, and Ping, 2010, p.10) Patients with syndrome categories are labeled and the judgment of clinician's regarding illness severity reported in order to "facilitate timely geographic and temporal analysis." (Chen, Zen, Ping, and Ping, 2010, p.11)

(3) The Early Aberration Reporting System (EARS)

The Early Aberration Reporting System (EARS) is used to monitor bioterrorism activities during events large in scale. The system monitors "emergency department visits, 911 calls, physician office data, school and work absenteeism and OTC drug sales for 42 syndrome categories." (Chen, Zen, Ping, and Ping, 2010, p.12)

(4) The National Bioterrorism Syndromic Surveillance Demonstration Program

The National Bioterrorism Syndromic Surveillance Demonstration Program monitors in excess of 20 million people and analyzes disease cases for "neurologic, upper/lower GI, upper/lower respiratory, dermatologic, sepsis/fever, bioterrorism category A agents and influenza-like illness" all derived from electronic patient-encounter records from health care organizations that are participating. (Chen, Zen, Ping, and Ping, 2010, p.12)

(5) BioAlirt

The Bio-Event Advanced Leading Indicator Recognition Technology (BioAlirt) program conduct examination of the use of spatial and other covariate information from disparate sources to improve the timeliness of outbreak detection in reaction to possible bioterrorism attacks…" as well as monitoring "military and civilians outpatient visit records with ICD-9 codes, and military prescription records for unusual ILI and GI occurrences." (Chen, Zen, Ping, and Ping, 2010, p.12)

(6) BioStorm

Biological Spatio-Temporal Outbreak Reasoning Module (BioStorm) aims at the integration of disparate data sources and deploys various analytic problem solvers focused on supporting surveillance of public health. It is reported that BioStorm is ontology-based and is comprised by "a data broker, a data mapper, a control structure, and a library of statistical and spatial problem solvers." (Chen, Zen, Ping, and Ping, 2010, p.13) BioStorm monitors such as 911 emergency calls and implements a library of statistical methods analyzing data as a single or multiple time series and knowledge-based methods that relate detected anomalies to knowledge about reportable diseases." (Chen, Zen, Ping, and Ping, 2010, p.13)

(7) BioPortal

Another biosurveillance system is that of BioPortal which makes provision of "a flexible and scalable infectious disease information sharing, alerting, analysis, and visualization platform." (Chen, Zen, Ping, and Ping, 2010, p.13)

(8) B-SAFER

Bio-Surveillance Analysis, Feedback, Evaluation, and Response (B-SAFER) is a reported web-based infectious disease monitoring system that is part of the open source OpenEMed project for use in emergency care settings that collects chief complaints, discharge diagnoses, and disposition data for detection analysis concerning a group of syndromes including respiratory, GI undifferentiated infection, lymphatic, skin, neurological, and other. This system analyzes daily on a daily basis by a first-order model that utilizes regression for fitting trends, seasonal effects, and day-of-week effects. (Chen, Zen, Ping, and Ping, 2010, p.13)

(9) INFERNO

Integrated Forecasts and EaRly eNteric Outbreak (INFERNO) incorporates infection disease epidemiology into adaptive forecasting utilizing the concept of an outbreak signature as a composite of disease epidemic curves." (Chen, Zen, Ping, and Ping, 2010, p.13)

(10) DiSTRIBuTE

The DiSTRIBuTE project is a proof-of-concept, distributed influenza surveillance system that utilizes "aggregate influenza-like illness, emergency department data from existing syndromic surveillance systems developed by state and local public health departments." (Chen, Zen, Ping, and Ping, 2010, p.18)

(11) Others

Two other global scale real-time disease even detection and tracking systems are reported as taking a differentiated approach from the systems already mentioned and those two are the Argus and HealthMap projects which monitor online media from global resources rather than disease cases reported by hospitals, clinics and other health facilities.

Summary

This study has explained the various state-of-the-art syndromic surveillance systems presently being utilized by various agencies and health care providers. The effectiveness of the use of these systems are being documented and the contribution that these systems are making to surveillance of disease and epidemic outbreaks among the population.