Follow-up, Reporting and Communications Protocols

1
Follow-up, Reporting and Communications Protocols

• DIMACS Working Group on BioSurveillance Data
  Monitoring and Information Exchange
• Breakout group

2
Participants

• Steven Alles Philadelphia Department of Health
• Ihsan Azzam Nevada State Health Department
• Dan Drociuk South Carolina Department of Health
  and Environmental Control
• Jeff Johnson San Diego County Human Services
  Agency
• Fermin Leguen Miami Dade County Health
  Department
• Matt Miller IEM (BioSense)
• Jennifer Schneider California Dept. of Health
  Services

3
When it is determined that an escalation of a
follow-up investigation is appropriate, what are
the protocols?

• Escalation could include a variety of situations
  not just BT
• Variations based upon jurisdiction (e.g. local,
  state, national). Protocols may differ based upon
  jurisdictions.
• Know own domain knowledge (may require a stable
  staff team with experience reviewing the data)
• Difficult to put that domain process into a
  process
• Internal process vs external process
• Emphasis on an algorithm vs public health
  relationships with medical community
• Each data source has different requirements for
  follow-up

4
What information is needed for escalation of
reports?

• Situational reports providing minimal information
  may be useful
• Some jurisdictions (i.e. target population) may
  require differing information.
• Concern about misinterpretation.
• A work load burden may result as a follow-up.
  Need to be sensitive to this issue at all levels.
• Assuming prior confirmation of aberration.
• Follow-up with local providers who generated the
  data.
• Interview of cases.
• Clustering by demographics

5
What info and what format should reports include?

• Depends upon the audience whom the report is
  intended.
• Depends if PH is asking for active case finding
  or recommended lab tests to be conducted.
• Subtle vague reports may encourage reporting to
  be on the lookout for certain diseases of
  concern.
• The fact that there is no report to give or no
  signals may suggest the lack of a large scale
  biological event.
• Begs us to ask What is it we are looking for?
  and are we capturing the data to reflect that.

6
Summary

• General consensus that no jurisdictions have
  issued an alert based upon something found in
  syndromic data.
• Rather, general updates and bulletins (e.g. flu
  season updates) include SS data for supporting
  documentation.
• Confirmation calls to local jurisdictions.
• Protocols in place for a local command process
  that identifies current process.
• A comment made that the public should be
  notified, and if so, when?
• Make sure a consistent message is going out
  regarding the event.
• A shift in how Epi is conducted with the
  inclusion of syndromic surveillance data sources.
• Several locations have dedicated staff for
  follow-up.
• Review process for reports will follow-up routine
  protocols.

7
Recommendations

• Inclusion of both qualitative and
  quantitative components when a flag is
  thrown.
• Be cautious when notifying and sensitive to the
  expectations of those being notified.
• Educate your partners regarding the pros and
  cons of syndromic surveillance data.
• Develop protocols, at each level, for response to
  signals.
• Look towards sustainability of efforts and
  receptiveness of users.