Re-Imagining Epidemiology: Meeting Increased Demands with Limited Resources

BACKGROUND:  Health departments of all sizes face many challenges in a climate of increasing demand for services and decreasing supply of resources to meet those demands.  One of these challenges is how to efficiently and effectively meet surveillance and epidemiology needs.  Federal and other sources of funding for infectious disease epidemiology have often been disease-specific.  In turn, the structure of many local and state health departments have also been built around diseases or disease categories, such as HIV, sexually transmitted infections, or vaccine-preventable diseases.  The Houston Health Department’s Bureau of Epidemiology is no different; however, leadership asked, “How can we do this better?” METHODS:  In March 2014, the Bureau of Epidemiology integrated surveillance, data/informatics, and research functions into three functional units, moving away from disease-specific units.  Prior to March 2014, the planning phase took many months, and training, organizational, and logistical needs were taken into account.  Following integration of functions, the bureau evaluated the progress made towards integration, accounting for and measuring progress during transitional periods in the process. RESULTS:  Integrating functionally allowed for many benefits to the business processes of the Bureau of Epidemiology.  Surveillance was conducted regionally, allowing employees to form relationships with facilities and communities.  Seasonal fluctuations seen in specific diseases were marginalized as teams had a broader focus.  And overall staff resource needs were decreased, allowing for redirecting efforts towards research, data management, and informatics.  However, functional integration was not without its downfalls.  Training, staff engagement, grant concerns, and logistic consideration posed significant hurdles to the process, which were eventually overcome.   CONCLUSIONS:  Health departments nationwide must start asking tough questions about how to better perform services in constrained environments.  Unlike other sectors, the public sector has little control over the services that it provides; therefore, reimagining service delivery is crucial to effectively meeting needs.  Why not start with how we think about epidemiology?