Follow-up, Reporting and
Communications Protocols
DIMACS Working Group on
BioSurveillance Data Monitoring and
Information Exchange
Breakout group
Participants
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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
When it is determined that an escalation of a
follow-up investigation is appropriate, what
are the protocols?
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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
What information is needed for
escalation of reports?
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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
What info and what format should
reports include?
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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.
Summary
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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.
Recommendations
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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.
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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.