Public Health Biosurveillance Systems Position Statement

As biosurveillance systems are established for public health, they should be developed with established protocols including consequence management, system integrity, timeliness of information sharing, and appropriate safeguards as priorities, and with participation from all levels of governmental public health and other users from the outset.

Background

The desire to quickly identify and monitor health threats that result from natural and manmade causes has led to the development of biosurveillance systems. The benefits incorporating newly emerging information technology in this way are just beginning to be seen. Biosurveillance is often referred to as syndromic surveillance; however the ability to detect events early requires a broader set of information than that of syndromes. While there is no single agreed upon definition, there is agreement that such “biosurveillance” systems need to take advantage of integrated data from multiple sources including public health information as well as electronic health information not traditionally monitored by public health. Biosurveillance systems must leverage two major surveillance methods:

• Well established public health surveillance methods and sources used for the tracking, monitoring, and reporting of health-related information, such as epidemiologic investigations of infectious disease outbreaks or environmental conditions, are needed to ensure a broad coverage of data sources, to use as baselines comparisons, and to support the accuracy and reliability of the biosurveillance findings.
• Early event detection and situational awareness, the use of an automated system to evaluate case and suspect case reporting along with statistical surveillance and data visualization of pre-diagnostic and diagnostic data to support the earliest possible detection of events that may signal a public health emergency, is an essential component for near real-time detection of natural or man-made health events.

State health agencies (SHAs) are in varying stages of implementing biosurveillance programs and substantial efforts are underway to coordinate with local and federal public health agencies, hospitals, and emergency responders to ensure that a reliable resource exists for the early detection and proper management of health events. The Centers for Disease Control and Prevention is working with SHAs and local health agencies to coordinate these efforts through the Public Health Information Network. The Department of Health and Human Services, declared biosurveillance a breakthrough area and charged a workgroup with developing a plan to allow specific health information data to be transmitted from health care providers to public health systems. Additionally, the development of a Nationwide Health Information Network has begun that will link healthcare information systems together to achieve an interoperable health information exchange across the country. The Council of State and Territorial Epidemiologists and other partners are working to ensure that this newly emerging scientific field is implemented in a way that adds value to ongoing public health activities.

Position

I. Established Protocols. From the outset, the appropriate protocols and expectations must be developed, understood, and accepted by all involved. Protocols need to be in place to facilitate the sharing of valuable health information in a timely, secure, and accurate manner to allow for the coordination of appropriate response measures at the local, state, and national levels. Protocols must take into consideration the unique role and legal authority that each partner has in surveillance of population health data, response to health events, and access to their data once integrated into a nationwide system. There should also be protocols for consequence management as to how the public health community is going to react with its responders and with the clinical responders. Coordination of communication and public health education should be a priority, as explanation to the community regarding any false or true alarms is complicated and sensitive.

II. System Integrity (Science Based). Biosurveillance programs must be based on strong science that incorporates sound research findings and has been shown to effectively and accurately detect health events. To the extent possible, systems must be developed based on demonstrated evidence of public health value. Biosurveillance programs should compare early event detection signals to traditional long term surveillance trends to verify the plausibility and reduce the possibility of false positives. Every effort must be made to ensure that the best available algorithms, matrices, detection and investigational tools, and human decision-making are used to ensure maximum benefit with minimal burden. Biosurveillance programs should include the capacity to monitor, share, and respond to the information collected in a timely manner. More evaluation of systems needs to be conducted and built in as they are deployed.

III. Timeliness of Information Sharing. All partners must collaborate to share and disseminate vital health information quickly. The capability of communicating emergency and time sensitive health data must be coordinated among federal, state, and local public health agencies, essential private sector partners, and responders. The alignment of programs in the public and private sector would also allow for better use of resources and infrastructure, to avoid replication of activities, and ensure interoperability between systems.

IV. Appropriate Safeguards. Programs need to safeguard patient privacy and security, while addressing the need for public health access to identifiable health data in order to protect the public’s health. Biosurveillance represents an opportunity for an advanced understanding of the status of adverse health scenarios. While these efforts should be pursued aggressively, protections need to exist to assure the confidentiality of patient data and the appropriate use of information.

Approval History:

ASTHO Position Statements relate to specific issues that are time sensitive, narrowly defined, or are a further development or interpretation of ASTHO policy. Statements are developed and reviewed by appropriate Policy Committees and approved by the ASTHO Executive Committee. Position Statements are not voted on by the full ASTHO membership.

Public Health Informatics Policy Committee Review and Approval on February 27, 2006. 
Preparedness Policy Committee Review and Approval on February 28, 2006. 
Executive Committee Review and Approval on March 17, 2006. 
Policy Expires on March 17, 2007.

For further information about this Position Statement, please contact ASTHO Public Health Informatics Policy staff at afix@astho.org.

Other ASTHO Publications:

ASTHO BioSense Issue Brief