The future of public health surveillance

1
The future of public health surveillance

• Richard S. Hopkins, MD, MSPH
• USMI Dec 4, 2001

2
General principles old but durable

• Keep it simple
• Dont collect data you are not going to use
• Show reporters and community you are doing
  something useful with the data
• Dont depend on doctors
• Have clear objectives

3
Two kinds of surveillance

• Case-finding for intervention most prominent at
  local level
• Data collection for analysis, planning,
  evaluation most prominent at state and
  especially national levels

4
Why put a condition under surveillance?

• Follow-up required for every case (botulism)
• Detect clusters and outbreaks that need follow-up
  (salmonellosis)
• Learn more about a disease and its causes to
  allow design of interventions (AIDS)
• Monitor effectiveness of interventions (varicella)

5
Properties of a good surveillance system

• Timely
• Flexible
• Complete
• Accurate
• Sensitive
• High positive predictive value

• Ethical
• Legal
• Acceptable
• Inexpensive
• Effective feedback and dissemination
• Supports decision-making

6
Opportunities for enhanced surveillance

• Direct flow of data from clinical information
  systems into surveillance systems
• Claims and claims attachment standardization
  required by HIPAA
• Public and clinician concern about bioterrorism
• Technology to support two-way real-time
  transmission of data and information between
  clinicians and public health agencies clinical
  and PH decision support

7
Possible barriers to improvements in surveillance

• Lack of standards
• Decentralized public health system
• Changing local-state-federal relations
• Great diversity of clinical information systems
• Stovepipes old and new
• Lack of clarity about purposes of integration
• Lack of standards