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Summer Olympics May Test Disease Surveillance Capability

July 23, 2012
by David Raths
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Syndromic Surveillance Improving in UK and USA

The London 2012 Summer Olympics brings together people from around the world, which makes it a potential epicenter for an infectious disease outbreak.

To better prepare to respond, Britain’s Health Protection Agency has made several enhancements to its syndromic surveillance systems, including a new emergency department syndromic surveillance system, which is providing real-time monitoring of attendance data from a network of emergency departments and a newly developed GP out-of-hours/unscheduled care syndromic surveillance system, which is now providing daily reports of patients presenting to unscheduled services and walk-in centers.

These HPA notes that these new surveillance schemes may be an important legacy of the Olympic Games by providing England and Wales with one of the most comprehensive public health-based syndromic surveillance systems in the world.

Progress is being made in the United States as well, including through the meaningful use framework. Under meaningful use Stage 1 rules, sending test electronic syndromic surveillance (ESS) data to public health agencies is an optional incentive measure that is not fully defined, according to the International Society for Disease Surveillance (ISDS) in Brighton, Mass. A data content standard is missing for the ESS Stage 1 measure. The CDC’s Public Health Information Network (PHIN) Messaging Guide for Syndromic Surveillance is proposed as the content standard for Stage 2 attestation and 2014 EHR certification. Adopting this messaging guide should better align meaningful use rules with state and local public health priorities and resources, as well as better define the Stage 2 incentive measure, according to ISDS, which has been refining the recommended Stage 3 meaningful use standards for syndromic surveillance.

What are some ways that U.S. syndromic surveillance systems are evolving and getting better? I had the chance to interview several public health leaders about this topic for Emergency Management magazine earlier this year.

One good example of a statewide syndromic surveillance system that has grown more valuable over time is the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) in North Carolina.  It started in 1999 with a statewide mandate that hospital EDs electronically report chief complaint data. Amy Ising, the NC DETECT program director in the Carolina Center for Health Informatics in the University of North Carolina Department of Emergency Medicine, talked to me about how the system has evolved. “We are constantly adding features to handle a variety of scenarios,” she said. “User feedback from local public health officials drives what we work on.”

NC DETECT now provides near-real-time statewide surveillance capacity to local, regional and state-level users across North Carolina with twice-daily data feeds from 117 emergency departments, hourly updates from the statewide poison center and daily feeds from statewide EMS runs and select urgent care centers. The Web application allows public health officials to access aggregate data as well as information customized to their jurisdictions.

Syndromic surveillance has evolved as state and local public health emergency response efforts support epidemiologists in their work and start pulling data from multiple sources and they are getting better at sharing data, said Charles Ishikawa, associate director of Public Health Programs for the ISDS. “The more evolved the system is, the more sophisticated the number and type of data sources they are able to draw on, ranging from ED visits to 911 call centers, poison control to school absenteeism.”

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