BACKGROUND: Individuals exposed to infectious diseases like Ebola virus disease (EVD), highly pathogenic avian influenza (HPAI), measles, and tuberculosis require close monitoring and swift intervention to protect the health of the public. Using Tennessee Department of Health’s (TDH) response system for HPAI as a case study, we describe the development of a monitoring system with real-time, data visualization to support timely decision-making during an emergency response.
METHODS: Before developing the HPAI-specific system, we evaluated TDH’s protocols and tools used for monitoring individuals exposed to EVD to identify lessons applicable to HPAI. We considered end-user needs, in particular, the critical questions that would need timely answers for decision-making during an emergency response. TDH used resources from the United States Department of Agriculture, Food and Drug Administration, Centers for Disease Control and Prevention, and Minnesota Department of Health to develop two data collection tools. One tool included elements about the response site and the other, about incident responders. Both were created in REDCap, a web-based application for secure data collection. We used iDashboards, a web-based data visualization software, to develop two interactive dashboards. Our “overview” dashboard promoted situational awareness among decision-makers by providing aggregate data, displaying a timeline of exposure and monitoring of all responders. The second, our “Red Flag” dashboard, highlighted individual responders whose status required further action from the health department either because they became symptomatic or missed a scheduled monitoring check.
RESULTS: The monitoring system that resulted from this initiative is now ready-to-deploy for various emergency response scenarios. Because the instruments are web-based, they can be used by multiple users simultaneously across the state. This system can be quickly adapted for other diseases or conditions by altering risk assessment questions and adjusting the monitoring frequency and duration. Lastly, we identified the following steps for developing similar systems in the future: 1) evaluate past responses and apply lessons learned, 2) understand the needs of the end-user, 3) plan a data collection process conducive to emergency response, and 4) learn from your partners and predecessors.
CONCLUSIONS: An effective health monitoring system must present data in an actionable manner. In order to rapidly develop a monitoring system for emergency responses, it is important to approach the process in a systematic manner. The most critical step in this process is a careful examination of end-user needs prior to instrument development to ensure a final product which supports evidence-based public health decision-making and action.