Automated, High-throughput Surveillance Systems for Public Health

Abstract

Modern public health is a relatively recent innovation, a mid-nineteenth century response to explosive epidemics of infectious diseases, including plague, influenza, and cholera, that periodically ravaged human settlements. Public health practice is distinguished from most other medical services by a focus on the prevention of illness at the level of whole communities or populations, motivated by the fact that timely and effective preventive or curative intervention, directed at susceptible individuals, can be an extremely cost-efficient way of improving health at the level of a population. Routine childhood vaccination against polio and diphtheria and targeted interventions to minimize the spread of tuberculosis are well-known examples. Ideally, public health service delivery is informed, evaluated, and improved using objective criteria and data provided by a variety of population-based routine surveillance systems. These collect and summarize information needed for intervention and evaluation, ranging from identifiable, clinical case details to aggregate summaries of new cases by time and location, for illnesses of potential public health importance. Statutory health care practitioner initiated reporting is the basis for most of these collections and often requires paper forms to be completed, submitted, and processed manually, with associated delay, missing data, and poor reliability. More recently, automated, high-throughput surveillance methods adding value to large collections of electronic health records (EHR) have been shown to improve the timeliness, completeness, and reliability of surveillance data, and are the main focus of this chapter. Some of the associated issues of privacy protection, governance, validation, and evaluation, together with practical technical options for constructing secure, automated, portable, and high-throughput systems, adding value to existing EHR or personally controlled health records, are reviewed. The importance of establishing external validity and public health utility is emphasized, because these measures are fundamental to evaluating, improving, and justifying ongoing investment in information systems, competing in a modern, resource-constrained public health service delivery environment.