Assessment of Syndromic Surveillance Practice Among U.S. State Health Departments: Results and Recommendations

BACKGROUND:  In response to advances in information technology, the improved availability of electronic health data, and the growing demand for prompt population health monitoring, syndromic surveillance (SyS) is increasingly a component of public health surveillance at the state and local levels. Knowing the status of SyS systems across state health departments (SHDs) is key to identifying gaps and best practices that can be translated to capacity-building activities (CBA) for improving SyS practice and application. Comparison with previous assessments of SyS practice enables measurements of longitudinal progress in SyS implementation.

METHODS: An electronic survey was sent to the primary SHD contact for SyS, or knowledgeable staff. The survey questions regarded details of SyS practice, including type of system, perceived utility of SyS data sources; use of the BioSense application; business processes for data quality assurance; access to Health Information Exchanges (HIEs), data sharing; and legal issues and Meaningful Use as barriers or enablers to SyS. Input from the biosurveillance community was then used to match the survey insights with recommendations for effective CBA that could be provided by CDC, ASTHO, ISDS, CSTE, and other partners.

RESULTS: Responses from 50 states and the District of Columbia found that 80% (41/51) of state health departments use SyS methods and collect electronic health record (EHR) data from emergency departments. Ten jurisdictions reported using BioSense as their only tool for managing and reviewing data. Six of the ten states not currently conducting SyS plan to add this capacity. Key SyS functions were trend analysis and situational awareness during a public health event, with 95%of SHDs indicating they find SyS somewhat or highly useful for influenza surveillance. Jurisdictions were more open to sharing aggregate level data than de-identified visit-level data with other jurisdictions or with CDC. Community review of the survey results is helping to shape recommendations for improving SyS practice through information exchange, training, peer learning, and technical assistance.

CONCLUSIONS:  Syndromic surveillance provides SHDs with population-level health information for decision-making. Despite considerable variability in SyS practice across states, there are areas where both standardization and tailored assistance would improve SyS practice, use of BioSense, and workforce skills. The results of this assessment will enable effective CBA directed to the actual systems SHDs are using for data acquisition and analysis; to assist selected states with implementing new priority activities; and to develop skills and tools to address identified data management and quality issues.