Governmental public health has primary responsibility for protecting the public's health. It plays a major role in biosurveillance along with water companies, hospitals, veterinarians, and other entities described in the following chapters. It has primary responsibility for investigation of outbreaks.

States and their local jurisdictions are responsible for the health of their populations, whereas the federal government is tasked with establishing goals and standards. The federal government has also been involved in setting goals and standards for information systems used by different state and local health departments.

Information system development focuses on four types of systems, which are being created in accordance with specifications that will ultimately allow them to interoperate or merge.

Despite the development of new biosurveillance systems based on the federal government's recommendations, public health still lacks a fully automated and integrated biosurveillance system. At present, the effort is focused on four types of systems: NEDSS, syndromic surveillance systems, ELR, and a laboratory network. These systems do not cover all of the functionality required, and they are also not well integrated. Each system requires its own password, database, data collection tool, user interface, and support system, making it cumbersome for the user and the information technologists in the health department who must maintain multiple systems.

The traditional role of health departments in biosurveillance has expanded beyond analysis and response to disease reporting since 2000. The use of information technology in health departments is also evolving rapidly. Recent reports and recommendations have reiterated the need for information to flow rapidly and seamlessly across sectors of the public health system (National Committee on Vital and Health Statistics, 2002). Moreover, a trend toward more effective use of information technology that began before the 2001 anthrax attack has greatly accelerated as a result of federal funding, resulting in re-engineering of biosurveillance systems. An integrated system, which is easily accessible and can be used and maintained by health departments at the federal, state, and local levels, would significantly enhance biosurveillance capability. This system should include established standards for consistent data collection and transmission practices and assurance of privacy protections. In addition, the system should afford the capacity for transmission of urgent health alerts across all levels of the public health system and implementation of data systems that facilitate reporting, analysis, and dissemination.

In addition to information systems, resources for a wide range of individuals, as in Table 1.1, are also required to develop the required functionality. Although a health department often has sufficient resources to develop needed biosurveillance capacities (and there are roughly 60 entities at the level, including territorial and tribal divisions), some of the 3,000 local health departments do not have the capacity. This observation suggests the need for regional cooperative efforts, perhaps centered around large population centers or, in less densely populated areas, at the state or even regional levels.

Such an integrated system, which includes the proper information systems and workforce infrastructure, may aid in the identification of a bioterrorist event by having the capacity to identify patterns and trends rapidly. In addition, rapid communication provided by the network will aid in information sharing and educating individuals and the community at large about critical issues.

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