¶ … Management Project in the Health Care Organization Setting This study describes the implementation of a syndromic surveillance system. The syndromic surveillance system collects and analyzes prediagnostic and nonclinical disease indicators, drawing on preexisting electronic data that can be found in systems such as electronic health records, school absenteeism records and pharmacy systems. The systems are utilized to identify specific symptoms within a population that may indicate a public health event or emergency such as signaling an outbreak of an infectious disease. school absenteeism records and pharmacy systems. The systems are utilized to identify specific symptoms within a population that may indicate a public health event or emergency such as signaling an outbreak of an infectious disease.

Informatics Management Project In The Health Care Organization Setting

Part One - Introduction

The objective of this study is to describe the implementation of a syndromic surveillance system. Syndromic surveillance systems collect and analyze prediagnostic and nonclinical disease indicators, drawing on preexisting electronic data that can be found in systems such as electronic health records, school absenteeism records and pharmacy systems. The systems are utilized to identify specific symptoms within a population that may indicate a public health event or emergency such as signaling an outbreak of an infectious disease.

The implementation of this system will also enable collaboration among the health care agency, health care provider, information technology vendors, researchers, and the business community. There are several primary challenges faced by the health care agency in that the data must first be collected from hospitals and specifically emergency rooms and development and support of the required interfaces to the applications in a large number of hospitals presents a daunting task since the hospitals have different software and there is a diversity of data standards. As well, there is a hesitation in diverting IT staff and budgeting to the implementation of the necessary interfaces. In order to address this challenge, a commercial package will be required or the software to ease the integration must be built that will enable each hospital to assess its own mix of patients and their presenting problems.

The health care agency is contemplating the development of regulations that would require hospitals to report the needed information. The second challenge is that the system must be designed to ensure protection of patient privacy. The third challenge is funding which will be acquired through federal grants. Strategies are required for the agency to ensure the financial sustainability of the application and the related analysis capabilities should federal funding on this project end. Finally, the agency must ensure that the project has the staff and tools necessary to appropriate analyze the data once it has been collected.

Questions that must be addressed in this initiative include those asking: (1) How would the head of the agency's epidemiology section address these stated challenges? (2) Which of the challenges is the most important to address and why? (3) If the hospital CEO were asked to redirect IT resources on this project what would the CEO want in return from the agency to ensure that the system provided value to the organization and clinicians? And (4) A strong privacy group has expressed alarm about potential problems that the system could create, how would those concerns be responded to?

Research Questions

The head of the agency's epidemiology section address these stated challenges through first considering the necessary regulations and guidelines that must be adhered to by the organization in the implementation of the system. Secondly, the epidemiology section would assess the system for its diagnoses categories and gain an understanding of what triggers are built into the system chosen for identification of disease outbreak. According to one report the majority of the syndromic surveillance systems "employ multiple data streams…the increased sensitivity provided by multiple data sources requires users to review and summarize an unprecedented amount of data daily.

Clear guidelines for using these systems are needed to help epidemiologists (1) quickly identify and disregard statistically significant but epidemiologically unimportant events; (2) distinguish true disease clusters from groups of unrelated cases; (3) determine which true disease clusters warrant further evaluation or public health response; and (4) perform these tasks quickly and cost effectively. (CDC, 2005, p.1) It is additionally reported that a protocol is followed for the detection and analysis of anomalies in the data. (CDC, 2005, paraphrased) Required is the establishment of a framework "for evaluation and response to syndromic surveillance data" that will serve to facilitate the implementation of the syndromic surveillance systems and for standardization of procedures to validate the findings...

As a result, once these syndromic reports exceed a predefined threshold of detection (defined differently for each specific syndrome) disease control and response efforts can be initiated without need for definitive laboratory confirmation. Furthermore, early recognition of and responses to outbreaks can help get them under control earlier and prevent subsequent illness." (Arkansas Department of Health, 2013, p.1)
Many laboratory studies can take two or even three weeks for completion and report to the provider. In addition, diagnosis of vaccine preventable diseases and tick-borne diseases can take up to a month following the initial tests. Meaningful use has three primary components: (1) the use of certified EHR in a meaningful manner, such as e-prescribing; (2) The use of a certified EHR technology for electronic exchange of health information to improve quality of health care; and (3) the use of certified EHR technology to submit clinical quality and other measures. (Arkansas Department of Public Health, 2013, p.1) These requirements must be met in order for the health care organization to receive federal funding.

Privacy concerns of patients in relation to syndromic surveillance is addressed by the Centers for Disease Control and Prevention which states primary points for consideration in the use of the syndromic surveillance system. The first stated consideration is the determination of authority to collect syndromic surveillance data. It is stated by a mandate by state law would alleviate the problem and that several states have already modified their statutes in order to effectively implement syndromic surveillance and others have used education and support provided by the Joint Commission on the Accreditation of Health Resources and Services Administration (HRSA).

Stated secondly by the CDC is the necessity to understand the rights of public health authorities to use syndromic surveillance and that states have recognized as a primary priority ensuring security in using the syndromic surveillance system. Finally, the CDC states the consideration of whether it is important to note the difference between collection of identifiable information since when no identifiable information is used there are no implications related to HIPAA. (Association of State and Territorial Health Officials, 2004, p.3)

Part Two - Background Analysis

This section of this study intends to report on the syndromic system state-of-the-art and to summarize the project and identify key points and common themes in the research. The strengths and weaknesses of what is known and what is unknown about use of syndromic surveillance systems will be examined and an evaluation of how authoritative the sources utilized are. It is reported in the work of Sloane, et al. (2006) the results of an evaluation of the feasibility of conducting syndromic surveillance in a primary care office using billing data. The one-year study reports results that the most frequently recorded syndromes were "respiratory illness, gastrointestinal illness, and fever." (p.351) The preliminary study is stated to have demonstrated "the feasibility of implementing syndromic surveillance in an office setting at a low coast and with minimal staff effort." (Sloane, et al., 2006, p.351) A Study reported in the work of Buckeridge et al. (2005) reports a study that desired to describe a model for stimulation of cases that might result from exposure to inhalational anthrax and then make use of the model for the evaluation of the ability of syndromic surveillance to detect an outbreak of inhalational anthrax after an aerosol release. The study concluded "syndromic surveillance of a respiratory syndrome using a temporal detection algorithm tended to detect an anthrax attack within 3-4 days after exposure if less than 10,000 person were infected." (Buckeridge, et al., 2005, p.1) As the number of individuals infected decreased the performance of surveillance in terms of timeliness and sensitivity was noted to worsen.

State-Of-The-Art Syndromic Systems

Some of the syndromic systems presently being used include those stated and described as follows:

(1) BioSense

The work of Chen, Zen, Ping and Ping (2010) report that thirteen nationwide syndromic surveillance systems and two open source global public health status monitoring system are noted as being presently in use. CDC's BioSense system is a national initiative that supports detection of early outbreak through provision of technologies for acquisition of timely data, near real-time reporting, outbreak identification that is automated and related analytics. BioSense collects ambulatory care data, emergency room diagnostic and procedural information from military and veteran medical facilities and clinical laboratory test orders and results from LabCorp. Also monitored by BioSense are over-the-counter drug…