Public Health Surveillance

Paula Yoon, ScD, MPH Division of Health Informatics and Surveillance

Center for Surveillance, Epidemiology and Laboratory Services Centers for Disease Control and Prevention

June 16, 2016

Center for Surveillance, Epidemiology, and Laboratory Services Division of Health Informatics and Surveillance

Definition of Public Health Surveillance

The ongoing, systematic collection, analysis, and interpretation of health-related data with the a priori purpose of preventing or controlling disease or injury, or identifying unusual events of public health importance, followed by the dissemination for public health action Data for Action Cornerstone of public health practice

Health-Related Data

Demographic & geographic Laboratory tests and results Vaccine history Disease and diagnosis Signs and symptoms Risk factors and behaviors, environment, travel history Social determinants of health Cause of death, life expectancy, functional status Genetics Health care services

Uses of Public Health Surveillance Data

Identify individual cases Track and manage cases Identify outbreaks and clusters Investigate causes Implement measures to prevent or control diseases Monitor trends, distribution, spread Study etiology, natural history, and risk factors Target resources Evaluate prevention and control efforts Assess healthcare utilization and quality of care Set research agendas

Local

National

Types of Surveillance

Case reporting Registries (e.g., cancer, exposures, vaccine) Vital registration (deaths, births) Syndromic surveillance BioSurveillance Risk factor and disease prevalence surveys Environmental monitoring (air pollution, weather) Secondary data uses

Data sources – individuals, health care providers, health records and documentation, claims data, environmental sensors, non-health records and professionals, social media, etc.

Considerations Legal

• State and federal laws and regulations • Privacy Act, HIPAA • Common Rule, OMB PRA

Partnership, Ethics, and Trust • Trust between health authorities and the public • Data sharing and ownership • Data aggregation and suppression

Standards • Harmonization • Interoperability • Meaningful Use

Case Reporting National Not ifiable Diseases Surveillance System (NNDSS)

Surveillance and Occupational History Data

CSTE Position Statements • 12-OH-01 - NIOSH to implement recommendations from IOM 2011

report “Incorporating Occupational Info in EHRs” (Stage III MU) • 14-OH-01 - Bureau of Labor Statistics make case-level work-related

injury fatalities available to state public health • 14-OH-02 - CDC to include standardized occupation and industry

data elements in CDC surveillance systems

Harmonization of occupational exposure in NNDSS: 41/90

conditions; 44 data elements. Examples: • Provide the subject's occupation (demographic question) • Did the case work as a rancher? (Q fever) • Does patient have DIRECT patient care responsibilities? (SARS) • Exposure: Construction/repairs (Vibriosis)

Many Case Based Surveillance Systems

National Healthcare Safety Network National TB Surveillance System (NTSS) ArboNET Childhood Blood-Lead Poisoning Surveillance System (CBLS) enhanced HIV/AIDS Reporting System (eHARS) Registries:

• National Program of Cancer Registries (NPCR) • Immunization • Paul Coverdell National Acute Stroke Registry

Vital Registration: • Births • Deaths

Syndromic Surveillance

ED data - chief complaints, demographics, vital signs, diagnosis

Other data sources – ambulatory care, pharmacy, laboratory, poison control

Categorize data into syndromes; apply statistical algorithms to identify aberrations in activity

More often used for ad-hoc queries of near real-time chief complaint data to detect and respond to events of public health significance

Also provides notifications of increased disease activity in an area, awareness of cyclical and temporal trends, and an historic baseline for future assessment

Statewide Heat-Related ED Visits and NOAA Maximum

Daily Temperature Averages (April 1 – August 31, 2013)

Seasonal (May 15 - August 31) Daily Heat-Related ED

Visits, 2010 – 2013

Michigan Syndromic Surveillance System Heat Illness Surveillance

Currently 54% of ED visits

Risk Factor Surveillance

National Center for Health Statistics surveys • National Health and Nutrition Examination Surveys (NHANES) • National Health Care Surveys • National Health Interview Surveys (NHIS) • National Vital Statistics System (NVSS) • National Immunization Surveys

Behavioral Risk Factor Surveillance System • State-based telephone surveys that collect data about U.S. residents

regarding their health-related behaviors, chronic health conditions, and use of preventive services

• Completes more than 400,000 adult interviews each year. • Core modules (fixed and rotating), Optional modules and state-

added questions

BRFSS Occupational Data • What kind of work do you do? • What kind of business or industry do you work in?

CDC’s 2014 Surveillance Strategy

Comprehensive approach to transform surveillance systems to better address the needs of the public health community for data to inform decisions. Goals:

• Improve data timeliness, availability and quality • Advance the use of EHR, mobile technology and cloud

computing • Identify and amend or retire outdated or redundant

CDC surveillance systems • Maximize the effectiveness of available agency

resources devoted to surveillance.

Initiatives to Improve Case Reporting

NNDSS Modernization Initiative (NMI) • One data exchange standard instead of 3 (HL7)

Electronic Laboratory Reporting (ELR) Initiative • Lab test results reported to health departments electronically

Electronic Death Reporting Initiative • Faster reporting for near real-time mortality surveillance

Electronic Case Reporting (eCR) • Electronic initiation and report of data on potential cases

Healthcare Provider

Certified EHR Technology

Public Health

electronic Case/Condition Reporting (eCR)

Record encounter

in EHR

Generate initial case

message

Reportable?

Receive Notice of

Reportability

Send Notice of Report-

ability “No/Yes/Maybe”

Jurisdiction Receives

Initial Case Message

No

Yes/Maybe

Surveillance System

URL Gather URL and pre-populated

data

Trigger Codes

Route initial case message

Determine Reportability Rules

Reportable Condition Knowledge Management Service (RCKMS)

Route to Reporter

(Local Copy)

Trigger Codes

Match?Yes

Intermediary Platform(e.g., Public Health Community Platform)

Investigation and case

classification

Case Notification

to CDC

Data Access and Visualization

Analysis and Visualizat ion • Sortable Stats • Health Indicators

Warehouse • HealthData.gov • MMWR Surv Summaries • BRFSS Prevalence and

Trends Tool • Environmental Public

Health Tracking Program • NIOSH Surveillance Data

& Statistics • EpiQuery (NYC) • HealthStats for NC

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Center for Surveillance, Epidemiology, and Laboratory Services Division of Health Informatics and Surveillance