Disease Surveillance: A Public Health Informatics Approach

DISEASE SURVEILLANCE : A Public Health Informatics Approach......Page 1
Contents......Page 9
Contributors......Page 19
Preface......Page 21
Acknowledgments......Page 25
1.1 Introduction......Page 27
1.2 The Emerging Role of Informatics in Public Health Practice......Page 28
1.3.1 Early Use of Analytics, Visualization, and Communications......Page 31
1.3.2 Early Informatics Applications in Medicine & Public Health......Page 32
1.3.3 Public Health Records Archiving......Page 35
1.4 Guiding Principles for Development of Public Health Applications......Page 36
1 .5 Information Requirements for Automated Disease Surveillance......Page 38
1.6.1 Smallpox......Page 40
1.6.2 Plague......Page 41
1.6.3 Spanish Influenza, 1918......Page 42
1.6.4 Influenza Pandemics after 1918......Page 44
1.7 Disease as a Weapon......Page 46
1.7.1 Bioterrorism......Page 51
1.8.1 Components of an Early Recognition Disease Surveillance System......Page 52
1.8.2 Modern Surveillance Applications for Use by State and Local Health Departments......Page 56
1.8.3 National Disease Surveillance Initiatives......Page 58
References......Page 61
Part I: System Design and Implementation......Page 67
2 Understanding the Data: Health Indicators in Disease Surveillance......Page 69
2.1 Data Source Concepts......Page 70
2.2 Data from Pharmacy Chains......Page 75
2.3 Data from EMS and 911......Page 84
2.4 Data from Telephone Triage Hotlines......Page 86
2.5 Data from School Absenteeism and School Nurses......Page 89
2.6 Data from Hospital Visits......Page 91
2.7 Data from Physicians’ Office Visits......Page 92
2.8 Laboratories Role in pre-diagnostic Surveillance......Page 94
2.9.1 Environmental Data......Page 96
2.9.2 Animal Health Data......Page 98
2.10 Data Source Evaluation......Page 100
2.10.1 Approach and Methodology......Page 101
2.10.2 Example: Wildfires (October 2003)......Page 102
2.10.3 Example: Influenza Outbreak (December 2003)......Page 105
2.10.4 Example: Gastrointestinal Illness (January–February 2004)......Page 109
2.11 Study Questions......Page 111
References......Page 113
3.1 Introduction to Data Collection and Archiving......Page 117
3.1.1 The Internet: Universal Connectivity......Page 118
3.1.2 Databases: Flexible Data Storage......Page 121
3.1.3 Summary......Page 123
3.2.1 Sharing Health Indicator Data......Page 124
3.2.2 Data-Sharing Issues......Page 129
3.2.3 HIPAA and Disease Surveillance......Page 130
3.2.4 Summary of Data Sharing......Page 138
3.3 The Role of Standards in Data Exchange......Page 139
3.3.1 Types of Standards......Page 140
3.3.2 Standards Development......Page 141
3.3.3 Standards for Health Indicator Data in Biosurveillence......Page 143
3.4 Establishing the Data Feeds......Page 145
3.4.1 Information Systems of the Data Provider or Source......Page 146
3.4.2 Setting Up the Data Feed......Page 147
3.4.3 Data Characteristics......Page 149
3.4.4 Data Fields or Elements......Page 151
3.4.5 Data Transfer Format......Page 155
3.4.6 Data Transfer Protocol......Page 158
3.4.7 Security Considerations......Page 160
3.4.9 Data Cleaning......Page 161
3.4.10 Data Quality......Page 162
3.5 Study Questions......Page 163
References......Page 164
4.1 Statistical Alerting Algorithms......Page 169
4.2.1 Expected Data Behavior and the Denominator Problem......Page 173
4.2.2 Recognizing the Unexpected......Page 175
4.2.3 Use of Data Covariates......Page 176
4.2.4 Components of an Alerting Algorithm......Page 177
4.2.5 Steps in Algorithmic Processing......Page 179
4.3.1 Understanding the Noise Background......Page 180
4.3.2 Characterizing the Outbreak Signal......Page 181
4.4.1 Control Charts for Public Health Monitoring......Page 184
4.4.2 Data Forecasting for Public Health Monitoring.......Page 193
4.5.1 The Search for Hotspots and the Spatial Baseline......Page 202
4.5.2 Spatial Scan Statistics and Enhancements......Page 203
4.5.3 Global Clustering Methods and Adaptations......Page 208
4.6.1 Decision Making with Multiple Data Sources......Page 209
4.7 Study Questions......Page 214
References......Page 215
5.1 Introduction......Page 219
5.2.1 Stand-Alone System Application Design......Page 221
5.2.2 Thick Client vs. Thin Client......Page 222
5.2.3 Three-Tier and Multitier Architectures......Page 223
5.3.1 Database Design......Page 225
5.3.3 Database Server Hardware......Page 226
5.3.5 DBMS Vendor Overview......Page 228
5.4 Web Applications......Page 229
5.4.1 Web Servers......Page 231
5.4.2 Web Applications and Browsers......Page 232
5.4.3 Web Applications and Geographic Information Systems......Page 234
5.4.4 Web-Based Application Integration and Automation......Page 235
5.5.1 Fixed Vocabulary Data......Page 236
5.5.2 Free-Text Data......Page 238
5.6.1 When Will Detectors Be Used?......Page 242
5.6.2 Designing the Detector Interface......Page 243
5.7.1 Detection-Focused Visualizations......Page 244
5.7.2 Information System Interfaces......Page 252
5.7.3 Visualizing Data and Information......Page 253
5.8 Communication Among Surveillance Users......Page 266
5.8.2 Embedding User Comments into System Components......Page 267
5.9 Security......Page 268
5.9.1 Design and Implementation of a Secure System......Page 271
5.9.2 User Authentication......Page 274
5.9.3 Access Privilege Management Overview......Page 276
5.9.4 User Responsibilities......Page 277
5.10 System Administration......Page 278
5.10.1 Physical Administration......Page 279
5.10.3 User Management......Page 280
5.12 Study Questions......Page 281
References......Page 282
Part II: Case Studies......Page 289
6.1 Public Health Surveillance Requirements......Page 291
6.1.1 Disease Reporting Requirements......Page 292
6.1.2 Existing Automated Disease Surveillance Systems......Page 295
6.2.1 Monitoring Surveillance System Outputs......Page 299
6.2.2 Characterization of Anomalies......Page 300
6.2.3 Case Studies......Page 304
6.2.4 Summary of Anomaly Characterization......Page 310
6.3 Utility of Disease Surveillance Systems at the Local Level......Page 311
6.3.2 Local Perspective on Implementation......Page 312
6.3.3 Regional Perspective......Page 314
6.4.1 BioSense System Description......Page 317
6.4.2 Monitoring of BioSense Application for National Surveillance......Page 321
6.4.3 Movement Toward Surveillance System Standardization......Page 323
6.6 Study Questions......Page 324
References......Page 325
7.1.1 Understanding the True Public Health Needs......Page 329
7.1.2 Developing and Harnessing the Right Technology......Page 330
7.2.2 Working with Stakeholders to Improve Disease-Specific Surveillance Through the Implementation of Technology......Page 333
7.2.3 Lessons Learned Through Disease-Specific Surveillance Application Development......Page 340
7.3 Real-Time Syndromic Surveillance......Page 341
7.3.1 Canadian Early Warning System......Page 342
7.3.2 Unique Solution for a Unique Problem: FARMS......Page 346
7.4.1 Importance of Communication and Collaboration......Page 354
7.4.2 Integrating Surveillance into a Comprehensive Public Health Information Management Framework......Page 355
7.4.3 Future Opportunities in Public Health Surveillance......Page 356
7.5 Study Questions......Page 357
References......Page 359
8.1 Introduction......Page 361
8.1.2 The UK Experience: NHS Direct......Page 362
8.1.3 Using Telephone Triage Data for Syndromic Surveillance......Page 364
8.2.2 System Design......Page 366
8.2.3 Investigating Exceedances......Page 368
8.3.1 Stages 1 to 3......Page 371
8.3.2 What Have the Data Detected?......Page 372
8.3.3 Weekly Reporting......Page 377
8.4.1 Linking Syndromic Data with Traditional Laboratory Sources......Page 378
8.4.2 A Statistical Model: Types of Infections That Cause People to Phone Telephone Triage Systems......Page 380
8.5.1 Main Benefits of the System......Page 382
8.5.3 Cautionary Note for Future Work......Page 384
8.5.5 Recommendations......Page 385
8.6 Study Questions......Page 387
References......Page 388
9 Surveillance for Emerging Infection Epidemics in Developing Countries: EWORS and Alerta DISAMAR......Page 393
9.1 Improving Surveillance in Resource-Poor Settings......Page 394
9.2 U.S. Military Overseas Public Health Capacity Building......Page 395
9.3.1 System Development, Configuration, and Operation......Page 397
9.3.2 Outbreak Detection and Response......Page 399
9.3.3 System Flexibility......Page 404
9.3.4 Summary......Page 405
9.4.1 System Development, Configuration, and Operation......Page 406
9.4.2 Outbreak Detection and Response......Page 410
9.4.3 System Flexibility......Page 413
9.5 Conclusions......Page 416
9.6 Study Questions......Page 417
References......Page 418
Part III: Evaluation, Education, and the Future......Page 423
10.1.1 Why? — The Need to Evaluate......Page 425
10.1.2 What? — The Focus of Evaluation......Page 426
10.2.1 Question and Scope......Page 427
10.2.4 Evaluation Plan......Page 428
10.3.1 Data for Evaluation......Page 429
10.3.3 Simulated Outbreaks......Page 431
10.3.4 Simulated Background......Page 435
10.4.3 Applying Response Protocols......Page 436
10.5 Measuring Performance......Page 437
10.5.1 Outbreak Detection......Page 438
10.6 Summary......Page 446
References......Page 447
11.1 Competencies for Disease Surveillance......Page 451
11.3 Training Opportunities in Public Health Education......Page 458
11.4 Informatics Training......Page 459
11.4.1 Training Opportunities in Public Health Informatics......Page 461
11.6 Study Questions......Page 462
References......Page 463
12.1 Introduction......Page 469
12.2 Integration of Disease Surveillance Systems......Page 470
12.2.1 Data Privacy and Public Health Networks......Page 471
12.2.2 Standards for Information Sharing......Page 472
12.2.3 Regional and National Networks......Page 473
12.3.1 Better Health Indicators......Page 474
12.3.2 Biostatistics......Page 476
12.3.3 Information Technology......Page 477
12.4 Study Questions......Page 478
References......Page 479
Index......Page 481