Success Factors of European Syndromic Surveillance Systems: A Worked Example of Applying Qualitative Comparative Analysis

Introduction: Syndromic surveillance aims at augmenting traditional public health surveillance with timely information. To gain a head start, it mainly analyses existing data such as from web searches or patient records. Despite the setup of many syndromic surveillance systems, there is still much doubt about the benefit of the approach. There are diverse interactions between performance indicators such as timeliness and various system characteristics. This makes the performance assessment of syndromic surveillance systems a complex endeavour. We assessed if the comparison of several syndromic surveillance systems through Qualitative Comparative Analysis helps to evaluate performance and identify key success factors. Materials and Methods: We compiled case-based, mixed data on performance and characteristics of 19 syndromic surveillance systems in Europe from scientific and grey literature and from site visits. We identified success factors by applying crisp-set Qualitative Comparative Analysis. We focused on two main areas of syndromic surveillance application: seasonal influenza surveillance and situational awareness during different types of potentially health threatening events. Results: We found that syndromic surveillance systems might detect the onset or peak of seasonal influenza earlier if they analyse non-clinical data sources. Timely situational awareness during different types of events is supported by an automated syndromic surveillance system capable of analysing multiple syndromes. To our surprise, the analysis of multiple data sources was no key success factor for situational awareness. Conclusions: We suggest to consider these key success factors when designing or further developing syndromic surveillance systems. Qualitative Comparative Analysis helped interpreting complex, mixed data on small-N cases and resulted in concrete and practically relevant findings

Syndromic surveillance to assess the potential public health impact of the Icelandic volcanic ash plume across the United Kingdom, April 2010

The Eyjafjallajökull volcano in Iceland erupted on 14 April 2010 emitting a volcanic ash plume that spread across the United Kingdom and mainland Europe. The Health Protection Agency and Health Protection Scotland used existing syndromic surveillance systems to monitor community health during the incident: there were no particularly unusual increases in any of the monitored conditions. This incident has again demonstrated the use of syndromic surveillance systems for monitoring community health in real time

Preferred Workflows for Syndromic Surveillance Systems

Workflows are a sequence of information processing operations that people carry out to meet certain in-formational goals [1]. Using various user-centered design (UCD) techniques we uncovered the workflows that epidemiologists wished to follow when using syndromic surveillance (SS) systems

Use of outcomes to evaluate surveillance systems for bioterrorist attacks

<p>Abstract</p> <p>Background</p> <p>Syndromic surveillance systems can potentially be used to detect a bioterrorist attack earlier than traditional surveillance, by virtue of their near real-time analysis of relevant data. Receiver operator characteristic (ROC) curve analysis using the area under the curve (AUC) as a comparison metric has been recommended as a practical evaluation tool for syndromic surveillance systems, yet traditional ROC curves do not account for timeliness of detection or subsequent time-dependent health outcomes.</p> <p>Methods</p> <p>Using a decision-analytic approach, we predicted outcomes, measured in lives, quality adjusted life years (QALYs), and costs, for a series of simulated bioterrorist attacks. We then evaluated seven detection algorithms applied to syndromic surveillance data using outcomes-weighted ROC curves compared to simple ROC curves and timeliness-weighted ROC curves. We performed sensitivity analyses by varying the model inputs between best and worst case scenarios and by applying different methods of AUC calculation.</p> <p>Results</p> <p>The decision analytic model results indicate that if a surveillance system was successful in detecting an attack, and measures were immediately taken to deliver treatment to the population, the lives, QALYs and dollars lost could be reduced considerably. The ROC curve analysis shows that the incorporation of outcomes into the evaluation metric has an important effect on the apparent performance of the surveillance systems. The relative order of performance is also heavily dependent on the choice of AUC calculation method.</p> <p>Conclusions</p> <p>This study demonstrates the importance of accounting for mortality, morbidity and costs in the evaluation of syndromic surveillance systems. Incorporating these outcomes into the ROC curve analysis allows for more accurate identification of the optimal method for signaling a possible bioterrorist attack. In addition, the parameters used to construct an ROC curve should be given careful consideration.</p

Catching the flu: Syndromic surveillance, algorithmic governmentality and global health security

How do algorithms shape the imaginary and practice of security? Does their proliferation point to a shift in the political rationality of security? If so, what is the nature and extent of that shift? This article explores these questions in relation to global health security. Prompted by an epidemic of new infectious disease outbreaks – from HIV, SARS and pandemic flu, through to MERS and Ebola – many governments are making health security an integral part of their national security strategies. Algorithms are central to these developments because they underpin a number of nextgeneration syndromic surveillance systems now routinely used by governments and international organizations to rapidly detect new outbreaks globally. This article traces the origins, design and evolution of three such internet-based surveillance systems: 1) the Program for Monitoring Emerging Diseases, 2) the Global Public Health Intelligence Network, and 3) HealthMap. The article shows how the successive introduction of those three syndromic surveillance systems has propelled algorithmic technologies into the heart of global outbreak detection. This growing recourse to algorithms for the purposes of strengthening global health security, the article argues, signals a significant shift in the underlying problem, nature, and role of knowledge in contemporary security practices