Current Trends in Surveillance

1
Current Trends in Surveillance
University of Toronto/alPHa 14 March, 2003
Dr. David Mowat Director General Centre for
Surveillance Coordination
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Overview

• The nature of surveillance
• History
• Surveillance and decision-making
• Surveillance and surveillance infostructure
• The Network for Health Surveillance in Canada
• ICTs and surveillance possibilities progress

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What is surveillance?

• Health surveillance is the ongoing, systematic
  use of routinely collected health data to guide
  public health
• Surveillance processes include data collection,
  collation, analysis, interpretation and
  dissemination followed by action

action
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Surveillance is not

• research
• evaluation

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Information on "health events"

• morbidity
• mortality
• risk factors
• threats to health
• laboratory diagnosis
• adverse events
• etc.

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Information uses

• identifying emerging re-emerging diseases
• monitoring trends
• identifying outbreaks
• identifying unusual patterns
• forecasting
• generating hypotheses

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Information ultimately used for decisions

• policies
• programs
• practice
• public

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(No Transcript)
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John Snow
10
Natural and Political OBSERVATIONS Mentioned in a
following Index, and made upon the Bills of
Mortality.
By John Graunt
with reference to the Government, Religion,
Trade, Growth, Ayre, Diseases, and the several
Changes of the said CITY.
-- Non, me ut miretur Turba, laboro. Contentus
paucis Lectoribus
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New Challenges

• new threats e.g. bioterrorism
• new concerns e.g. biotechnology
• new technologies e.g. genomics

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ICTs in Health Sector

• Banks, insurance companies typically investing
  10 -12 of budget in ICTs
• Health is an intensive information-based business
  However
• Invested only 1 - 2 in ICTs during 1990s
• Investments uncoordinated
• Health needs larger ICT investments, and an
  integrated approach

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Evidence-Based Decision-Making

• information on events
• information on interventions
• information on context

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Surveillance Surveillance Infostructure

• The infrastructure approach provides

• efficiency
• power of integration
• flexibility responsiveness

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Design Considerations

• Start with the business
• Make the business explicit
• Document the purpose(s)
• Choose desired characteristics

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Developing Data Sources

• re-use
• "by-product"
• "transactional"
• preclinical/syndromic

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Bio-Surveillance Detection Timeline
T 0 Time of attack (Fixed) T SMC Time
to seek medical care (Mean) T Diag Time of
typical diagnosis (Mean) T Death Time of death
(Mean) W 1 Window to detect
(Non-Traditional) W 2 Window to detect
(Non-Trad. Medical) W 3 Window to detect
(Trad. Medical) IDW Improved Detection
Window

• Detection Analysis Timeline
• Non-clinical and behavioral data
• Pre-diagnostic clinical data
• Diagnostic data

Ease of Detecting Bioagent Effects Over Timeline
W3
TONSET
T0
TSMC
T Death
T Diagnosis.
Bio-Agent Impact Timeline
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Developing Data Sources

• re-use
• "by-product"
• "transactional"
• preclinical/syndromic
• intelligence

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Data Integration

• data warehouses
• data marts

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Analysis

• power
• business intelligence tools

OLAP SOLAP presentation tools spatial tools
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Extracting Meaning

• monitoring
• alerts

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Access

• connectivity
• language
• discovery
• manipulation
• permission

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Discovery

• The "virtual library"

• store
• classify
• search/navigate/browse

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Inventories

• Health Canada
• Injury
• Environmental
• CHAIN

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The Infospace Vision

• tools business intelligence
• Geographic Information System
• automated alert function
• discovery functions
• inventories
• metadata
• search/navigation
• continuing education
• discussion environments
• conference, job postings, etc.

• databases
• summary reports
• daily updates/news
• bulletins
• systematic reviews
• position papers
• practice guidelines
• regulatory notices
• dictionaries, references

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Schneider's lunchmate outbreak
Canada, 1998
Schneiders recall 1

Number of Cases
(March 31)
40
Lunchmate (386)
( lt 386 )
35

No Lunchmate (127)
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Outbreak recognized
(March 25)
25
20
Schneiders recall 2
(April 9)
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Cheese recall
(April 15)
10
5
0
05-Apr
12-Apr
19-Apr
01-Mar
08-Mar
15-Mar
22-Mar
29-Mar
Date of Onset Of Illness
N513
N lt 513
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CIPHS

• National Reportable Disease Database
• Communicable diseases, immunization, VAAE
• Data as a by-product of doing regular work
• Provides tools to local public health (PHIS) to
  microbiology labs (LDMS)
• Connects in near-real-time
• Part of end-to-end strategy of HSWG

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Supporting end-to-end surveillanceenteric disease
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Supporting end-to-end surveillance(vaccine-preven
table disease)
Immunizationregistry
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Architecture
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Standards

• The advantages of a uniform statistical
  nomenclature, however imperfect, are so obvious
  that it is surprising that no attention has been
  paid to its enforcement in bills of mortalityThe
  nomenclature is of as much importance in this
  department of inquiry as weights and measures in
  the physical sciences, and should be settled
  without delay. - William Farr, 19th Century

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G. I. S.
Geographic data
GIS
Disease data
Denominator data
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G. I. S.

• access to data
• tools to download
• service
• consultation training

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Skills Enhancement for Health Surveillance

• Develop an Internet-based training program in
  both official languages.
• For front-line public health professionals across
  Canada
• To increase skills in the following areas
• Epidemiology
• Surveillance
• Information management

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Skills Enhancement's Role

• A continuing education training program
• NOT to replace existing training programs
• Support other educational programs
• To help fill the gap for accessible, flexible
  applied continuing education training for
  front-line public health practitioners

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Modules Currently Available

• Orientation to Online Learning
• Module 1 Basic Epidemiological Concepts
• Module 2 Measurement of Health Status
• Module 3 Descriptive Epidemiological Methods

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Key Information

• Each module ranges from 10-20 hours in length.
• Students must complete a module within 6-8 weeks.
• Registrants can take a module at no charge, but
  are responsible for Internet costs for
  hardware/software.

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Formats Offered

• Facilitated
• Students have access to an online facilitator
  whose
• role is to answer content-related questions
  encourage
• discussion provide feedback on exercises and
  guide
• students through the material.
• Unfacilitated
• Students progress through the course
  independently.

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Examples of Future Modules

• Introduction to Surveillance
• Introduction to Information Management
• Basic Biostatistics
• Survey Methods
• Communicating Data Effectively
• Moving Data to Action Evidence-based planning
• Applied Epidemiology 1 eg Outbreak Management
  and Control
• Applied Epidemiology 2 eg Injury
• Applied Epidemiology 3 eg Chronic Diseases