Informatics in Disease Prevention and Epidemiology
This chapter provides a description of the components of disease prevention and control programs, and then focuses on information systems designed to support public health surveillance, epidemiologic investigation of cases and outbreaks, and case management. For each such system, we describe sources used to acquire necessary data for use by public health agencies, and the technology used to clean, manage, organize, and display the information. We discuss challenges and successes in sharing information among these various systems, and opportunities presented by emerging technologies.
Systems to support public health surveillance may support traditional passive case-reporting, as enhanced by electronic laboratory reporting and (emerging) direct reporting from electronic health records, and also a wide variety of different surveillance systems. We address syndromic surveillance and other novel approaches including registries for reporting and follow-up of cases of cancer, birth defects, lead poisoning, hepatitis B, etc., and population-based surveys (such as BRFSS or PRAMS).
Systems to support epidemiologic investigation of outbreaks and clusters include generic tools such as Excel, SAS, SPSS, and R, and specialized tool-kits for epidemiologic analysis such as Epi-Info. In addition to supporting outbreak investigation, agencies also need systems to collect and manage summary information about outbreaks, investigations, and responses.
Systems to support case management, contact tracing, and case-based disease control interventions are often integrated to some degree with surveillance systems. We focus on opportunities and choices in the design and implementation of these systems.
KeywordsCase reports Shared services Unified systems Positive predictive value Syndrome Incidence Outbreak Cluster Reportable Notifiable Registry Surveillance system
- 1.Kite-Powell A, Hamilton J, Wojcik R, Loschen W, Hopkins R. Florida’s ESSENCE system: from syndromic surveillance to routine epidemiologic analysis across syndromic and non-syndromic data sources (Abstract). Emerg Health Threats J. 2011;4(Suppl):44–5.Google Scholar
- 2.Thacker SB, Berkelman RL. History of public health surveillance. In: Halperin W, Baker EL, editors. Public health surveillance. New York: Van Nostrand Reinhold; 1992.Google Scholar
- 4.CDC. Status of state electronic disease surveillance systems – United States, 2007. MMWR Morb Mortal Wkly Rep. 2009;58(29):804–7. Accessed at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5829a3.htm on 31 Mar 2013.Google Scholar
- 5.Hopkins RS, Eisenstein L. Prioritizing investigations of reported cases of selected enteric infections. Paper presented at Council of State and Territorial Epidemiologists, Omaha, 6 June 2012.Google Scholar
- 6.CDC. Nationally notifiable disease surveillance system case definitions. Accessed at http://wwwn.cdc.gov/nndss/script/casedefDefault.aspx on 31 Mar 2013.
- 7.Association of State and Territorial Health Officers. Biosense 2.0 governance. Accessed at https://sites.google.com/site/biosenseredesign/governance on 31 Mar 2013.
- 8.CDC Guidelines Working Group. Updated guidelines for evaluating public health surveillance systems, recommendations from the Guidelines Working Group. MMWR Morb Mortal Wkly Rep. 2001;50(RR13):1–35.Google Scholar
- 10.Sosin DM, Hopkins RS. Surveillance. In: Guest C, Ricciardi W, Kawachi I, Lang I, editors. Oxford handbook of public health practice. 3rd ed. Oxford: Oxford University Press; 2013.Google Scholar
- 11.CDC. Behavioral risk factor surveillance system. http://www.cdc.gov/brfss/about/about_brfss.htm. Accessed 30 Mar 2013.
- 12.CDC. Overview of influenza surveillance in the United States. http://www.cdc.gov/flu/weekly/overview.htm. Accessed on 30 Mar 2013.
- 13.International Society for Disease Surveillance Meaningful Use Workgroup. Final recommendation: core processes and EHR requirements for public health syndromic surveillance. Boston, 2011. Accessed at http://www.syndromic.org/storage/ISDSRecommendation_FINAL.pdf on 30 Mar 2013.
- 14.International Society for Disease Surveillance Meaningful Use Workgroup. Electronic syndromic surveillance using hospital in patient and ambulatory clinical care electronic health record data. Boston, 2012. Accessed at http://www.syndromic.org/storage/ISDS_2012-MUse-Recommendations.pdf on 30 Mar 2012.
- 15.CDC. National Program of Cancer Registries. http://www.cdc.gov/cancer/npcr/. Accessed on 30 Mar 2013.
- 16.CDC. Paul Coverdell National Acute Stroke Registry Surveillance – four states, 2005—2007. MMWR Morb Mortal Wkly Rep. 2009;58(SS07):1–23.Google Scholar
- 17.CDC. Metropolitan Atlanta Congenital Defects Program (MACDP). Accessed at http://www.cdc.gov/ncbddd/birthdefects/macdp.html on 30 Mar 2013.
- 18.North American Association of Central Cancer Registries, Inc. (NAACCR). Implementation guidelines and recommendations. 2012. Accessed at http://www.naaccr.org/LinkClick.aspx?fileticket=WlmSkHUgKrI%3D&tabid=126&mid=466 on 30 Mar 2013.
- 19.Florida Department of Health. Report on birth defects in Florida 1998–2007. Accessed at http://www.fbdr.org/pdf/FBDR_report_May2011.pdf on 30 Mar 2013.
- 21.Florida Department of Health. Online food and waterborne illness complaint form. Accessed at http://www.doh.state.fl.us/environment/medicine/foodsurveillance/Online_Foodborne_Complaint_Form.html on 13 Mar 2013.
- 22.CDC. National Biosurveillance plan for human health, version 2.0. Atlanta, 2010. p. 40–4. Accessed at http://www.cdc.gov/osels/pdf/NBSHH_v2.pdf on 30 Mar 2013.
- 23.CDC. Introducing EpiInfo 7. Accessed at http://wwwn.cdc.gov/epiinfo/ on 30 Mar 2013.
- 24.CDC. National Notifiable Diseases Surveillance System (NNDSS), CDC. Accessed at http://wwwn.cdc.gov/nndss/ on 30 Mar 2013.
- 25.National ELR Workgroup. ELR survey summary reports. Available from www.coast2coastinformatics.com. Cited 9 Mar 2013.
- 26.National ELR Workgroup. 2011 National Electronic Laboratory Reporting (ELR) Snapshot Survey. Available from www.coast2coastinformatics.com. Cited 9 Mar 2013.
- 29.CDC. Potential effects of electronic laboratory reporting on improving timeliness of infectious disease notification – Florida, 2002—2006. MMWR Morb Mortal Wkly Rep. 2008;57(49):1325–8.Google Scholar
- 30.Health Level Seven (HL7®) homepage. Available at http://www.hl7.org/. Cited 9 Mar 2013.
- 31.Logical Observation Identifiers Names and Codes (LOINC®). Available at http://www.regenstrief.org/medinformatics/loinc/. Cited 9 Mar 2013.
- 32.Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT®). Available at http://www.ihtsdo.org/snomed-ct/. Cited 9 Mar 2013.
- 33.See for example section 64D-3.031(5) of the Florida Administrative Code: notification by laboratories. https://www.flrules.org/.
- 34.CDC. Public health emergency preparedness cooperative agreement, budget period 1, performance measures specification and implementation guidance, at-a-glance summary. p. 22–4. Accessed at http://www.cdc.gov/phpr/documents/PHEP+BP1+PM+At-a-Glance_v1_1.pdf on 30 Mar 2013.
- 35.Public Health Informatics Institute. Redesigning public health surveillance in an eHealth world. Decatur, 2012. Accessed at http://www.phii.org/resources/view/1186/RedesigningPublicHealthSurveillanceinaneHealthWorld on 31 Mar 2013.