Handbook of Biosurveillance (eBook)

Front cover 1
Title page 4
Copyright page 5
Table of contents 6
Preface 10
Acknowledgments 12
Contributors 14
Part I The Challenge of Biosurveillance 16
1 Introduction 18
INTRODUCTION 18
THE BIOSURVEILLANCE PROCESS 18
THE SCOPE OF BIOSURVEILLANCE 18
FUNDAMENTAL PROPERTIES OF THE BIOSURVEILLANCE PROCESS 19
BIOSURVEILLANCE SYSTEMS 24
SCIENTIFIC FOUNDATIONS OF BIOSURVEILLANCE 24
OPEN RESEARCH PROBLEMS IN BIOSURVEILLANCE 25
THE ROLE OF BIOSURVEILLANCE IN BIODEFENSE 25
ORGANIZATION OF THE BOOK 25
SUMMARY 26
ADDITIONAL RESOURCES 26
REFERENCES 26
2 Outbreaks and Investigations 28
INTRODUCTION 28
HISTORICAL OUTBREAKS 28
THE 1918 PANDEMIC OF INFLUENZA 28
RECENT OUTBREAKS 31
DEFINITIONS OF "OUTBREAK" AND "EPIDEMIC" 39
SUMMARY 39
ADDITIONAL RESOURCES 39
ACKNOWLEDGMENTS 40
REFERENCES 40
3 Case Detection, Outbreak Detection, and Outbreak Characterization 42
INTRODUCTION 42
CASE DETECTION 42
OUTBREAK DETECTION 48
OUTBREAK CHARACTERIZATION 51
LEGAL, ETHICAL, AND PUBLIC RELATIONS ISSUES 60
SUMMARY 61
ADDITIONAL RESOURCES 62
ACKNOWLEDGMENTS 62
REFERENCES 62
4 Functional Requirements for Biosurveillance 66
INTRODUCTION 66
FUNCTIONAL REQUIREMENTS AND SYSTEM SPECIFICATIONS 66
EXAMPLE: FUNCTIONAL REQUIREMENTS AND SPECIFICATIONS FOR ANTHRAX BIOSURVEILLANCE 67
THE COMPLEXITY OF BIOSURVEILLANCE SYSTEM DESIGN 68
REDUCING COMPLEXITY: THREAT PATTERNS 70
SPECIFYING BIOSURVEILLANCE DATA 77
SUMMARY 77
ADDITIONAL RESOURCES 77
ACKNOWLEDGMENTS 78
REFERENCES 78
Part II Organizations That Conduct Biosurveillance and the Data They Collect 80
5 Governmental Public Health 82
INTRODUCTION 82
HISTORY OF PUBLIC HEALTH SURVEILLANCE 82
LEGAL BASIS FOR PUBLIC HEALTH SURVEILLANCE 83
ORGANIZATIONAL STRUCTURE OF GOVERNMENTAL PUBLIC HEALTH 84
SURVEILLANCE DATA 86
GOVERNMENTAL PUBLIC HEALTH PROFESSIONALS 91
INFORMATION SYSTEMS 91
INTEROPERATING WITH OTHER ORGANIZATIONS 96
LIMITATIONS ON AND OF GOVERNMENTAL PUBLIC HEALTH 97
SUMMARY 99
ADDITIONAL RESOURCES 100
ACKNOWLEDGMENTS 100
REFERENCES 100
6 The Healthcare System 104
INTRODUCTION 104
ORGANIZATION OF THE U.S. HEALTHCARE SYSTEM 104
PERSONNEL 105
ROLE OF THE HEALTHCARE SYSTEM IN BIOSURVEILLANCE 105
DATA COLLECTED BY THE HEALTHCARE SYSTEM 105
INFORMATION SYSTEMS IN HEALTH CARE 106
BIOSURVEILLANCE OF THE HEALTHCARE SYSTEM 113
ASPS AND RHIOS 116
BARRIERS TO TIGHTER INTEGRATION BETWEEN HEALTH CARE AND GOVERNMENTAL PUBLIC HEALTH 119
SUMMARY 120
ADDITIONAL RESOURCES 121
ACKNOWLEDGMENTS 121
REFERENCES 121
7 Animal Health 126
INTRODUCTION 126
ANIMAL HEALTH ORGANIZATIONS 126
FARMING SYSTEMS 128
ANIMAL HEALTH PROFESSIONALS 130
ANIMAL HEALTH DATA 133
ANIMAL HEALTH INFORMATION SYSTEMS 138
ORGANIZATIONS THAT USE ANIMAL HEALTH DATA 139
ADDITIONAL RESOURCES 140
REFERENCES 141
8 Laboratories 144
INTRODUCTION 144
CLINICAL LABORATORIES 144
ENVIRONMENTAL LABORATORIES 146
COMMERCIAL LABORATORIES 147
GOVERNMENTAL LABORATORIES 147
SERVICES PROVIDED BY LABORATORIES 149
TESTING TECHNOLOGIES 150
LABORATORY INFORMATION MANAGEMENT SYSTEMS 151
NETWORKS OF LABORATORIES 152
SUMMARY 156
ADDITIONAL RESOURCES 156
REFERENCES 156
9 Water Suppliers 158
INTRODUCTION 158
WATER SURVEILLANCE 159
TESTING INFRASTRUCTURE 161
WATER MONITORING TESTS 161
SURVEILLANCE DATA 168
SYNDROMIC SURVEILLANCE CASE STUDIES 169
LABORATORY INFRASTRUCTURE 170
LABORATORY NETWORKS 171
SUMMARY 172
ACKNOWLEDGMENTS 172
REFERENCES 172
10 Food and Pharmaceutical Industries 176
THE FOOD INDUSTRY 176
FOOD PROCESSORS AND MANUFACTURERS 177
RESTAURANTS AND RETAILERS 179
GOVERNMENTAL AGENCIES 179
THE PHARMACEUTICAL INDUSTRY 182
SUMMARY 190
ACKNOWLEDGMENTS 190
REFERENCES 190
11 Coroners and Medical Examiners 194
INTRODUCTION 194
FUNCTION OF THE MEDICAL EXAMINER 194
ROLE OF MEDICAL EXAMINER IN BIOSURVEILLANCE 195
MEDICAL EXAMINERS' DATA: ACCESSIBILITY-USE OF ELECTRONIC RECORDS 195
TIMELINESS 195
RELIABILITY AND UTILITY 196
SUMMARY 196
REFERENCES 196
12 Other Organizations That Conduct Biosurveillance 198
INTRODUCTION 198
DEPARTMENT OF HOMELAND SECURITY 198
DEPARTMENT OF DEFENSE 200
U.S. POSTAL SERVICE (USPS) 202
PLANES, TRAINS, AND SHIPS 203
WORLD HEALTH ORGANIZATION 205
SUMMARY 207
ACKNOWLEDGMENTS 207
REFERENCES 209
Part III Data Analysis 212
13 Case Detection Algorithms 214
INTRODUCTION 214
PERFECTING CASE DETECTION 215
DIAGNOSTIC EXPERT SYSTEMS 215
EXAMPLES OF DIAGNOSTIC EXPERT SYSTEMS: BOSSS AND ILIAD 216
KNOWLEDGE REPRESENTATION AND INFERENCE IN DIAGNOSTIC EXPERT SYSTEMS 219
RULE-BASED EXPERT SYSTEMS 224
EMBEDDED EXPERT SYSTEMS 224
DIAGNOSTIC EXPERT SYSTEMS FOR BIOSURVEILLANCE 225
PERFECTING CASE AND OUTBREAK DETECTION 225
COMPUTER-INTERPRETABLE CASE DEFINITIONS 227
SUMMARY 228
ADDITIONAL RESOURCES 228
ACKNOWLEDGMENTS 228
REFERENCES 228
14 Classical Time-Series Methods for Biosurveillance 232
INTRODUCTION 232
SYNTHESIZING HEALTHCARE UTILIZATION DATA 234
CONTROL CHARTS 235
CHANGES FROM YESTERDAY 236
MOVING AVERAGE 239
CUSUM 241
COMPARING THE UNIVARIATE ALGORITHMS 241
EXPONENTIALLY WEIGHTED MOVING AVERAGE 242
REGRESSION 242
SICKNESS AVAILABILITY 246
FURTHER COMPARISON OF THE UNIVARIATE ALGORITHMS 247
ADDITIONAL METHODS 247
ADDITIONAL RESOURCES 248
ACKNOWLEDGMENTS 248
REFERENCES 248
15 Combining Multiple Signals for Biosurveillance 250
INTRODUCTION 250
THE IMPORTANCE OF MULTIPLE SOURCES OF DATA 250
COMBINING MULTIPLE TIME SERIES USING REGRESSION ANALYSIS 250
COMBINING MULTIPLE TIME SERIES USING THE HOTELLING STATISTIC 251
COMBINING MULTIPLE TIME SERIES USING PROBABILITY 252
COMBINING FIELDS IN EVENT DATA: THE "WHAT'S STRANGE ABOUT RECENT EVENTS" APPROACH 253
FURTHER MULTIVARIATE APPROACHES 257
ADDITIONAL RESOURCES 257
REFERENCES 257
16 Methods for Detecting Spatial and Spatio-Temporal Clusters 258
INTRODUCTION 258
OVERVIEW OF SPATIAL CLUSTER DETECTION 258
THE SPATIAL SCAN STATISTIC 260
RELATED METHODS 267
SUMMARY 268
ADDITIONAL RESOURCES 268
REFERENCES 268
17 Natural Language Processing for Biosurveillance 270
INTRODUCTION 270
THE ROLE OF NLP IN BIOSURVEILLANCE 270
EXAMPLE USE OF NLP 270
HOW HARD IS NLP? 270
LINGUISTIC CHARACTERISTICS OF CLINICAL TEXT-WHAT MAKES NLP HARD? 271
TECHNOLOGIES FOR NATURAL LANGUAGE PROCESSING 274
EVALUATION METHODS FOR NLP IN BIOSURVEILLANCE 279
SUMMARY 282
ADDITIONAL RESOURCES 283
ACKNOWLEDGMENTS 283
REFERENCES 284
18 Bayesian Methods for Diagnosing Outbreaks 288
INTRODUCTION 288
BACKGROUND 288
BIOSURVEILLANCE USING BAYESIAN NETWORKS 290
EMPIRICAL EVALUATION 293
SUMMARY 302
EXTENSIONS 302
ADDITIONAL RESOURCES 302
ACKNOWLEDGMENTS 302
REFERENCES 302
19 Atmospheric Dispersion Modeling in Biosurveillance 304
INTRODUCTION 304
EXAMPLE OF USING AN ATMOSPHERIC DISPERSION MODEL TO PROVE WIND AS ROUTE OF OUTBREAK TRANSMISSION 304
ATMOSPHERIC DISPERSION MODELS 306
ATMOSPHERIC DISPERSION MODELS AND THE ANALYSIS OF BIOSURVEILLANCE DATA 310
OTHER USES OF DISPERSION MODELS IN BIOSURVEILLANCE 311
WEATHER DATA 312
SUMMARY 313
ADDITIONAL RESOURCES 313
ACKNOWLEDGMENTS 313
REFERENCES 313
20 Methods for Algorithm Evaluation 316
INTRODUCTION 316
GOALS OF ALGORITHM EVALUATION 316
EVALUATING ALGORITHMS FOR CASE DETECTION 316
EVALUATING ALGORITHMS FOR OUTBREAK DETECTION 319
EVALUATING ALGORITHMS FOR OUTBREAK CHARACTERIZATION 323
DETERMINING WHETHER BAYESIAN ALGORITHMS ARE WELL CALIBRATED 323
EVALUATING THE COMBINATION OF ALGORITHM AND DATA 324
DIAGNOSTIC PRECISION AND THE QUESTION OF "HOW GOOD IS GOOD ENOUGH?" 324
SUMMARY 324
ADDITIONAL RESOURCES 325
REFERENCES 325
Part IV Newer Types of Surveillance Data 326
21 Methods for Evaluating Surveillance Data 328
INTRODUCTION 328
ATTRIBUTES OF SURVEILLANCE DATA RELEVANT TO ACQUISITION DECISIONS 328
METHODS FOR ESTIMATING INFORMATIONAL VALUE OF SURVEILLANCE DATA FOR CASE DETECTION 329
METHODS FOR ESTIMATING INFORMATIONAL VALUE OF SURVEILLANCE DATA FOR OUTBREAK DETECTION/CHARACTERIZATION 329
VALUE OF INFORMATION 332
GOLD STANDARDS FOR EVALUATION OF SURVEILLANCE DATA 332
SUMMARY 333
ADDITIONAL RESOURCES 333
ACKNOWLEDGMENTS 334
REFERENCES 334
22 Sales of Over-the-Counter Healthcare Products 336
INTRODUCTION 336
DESCRIPTION OF OTC DATA 336
AVAILABILITY OF OVER-THE-COUNTER SALES DATA 336
THE INFORMATIONAL VALUE OF OTC SALES DATA 337
ANALYTICAL ISSUES IN MONITORING SALES OF OTC PRODUCTS 342
A "DATA UTILITY" MODEL: NRDM 344
SUMMARY 344
ADDITIONAL RESOURCES 345
ACKNOWLEDGMENTS 345
REFERENCES 345
23 Chief Complaints and ICD Codes 348
INTRODUCTION 348
CHIEF COMPLAINTS 348
ICD CODES 360
USING CHIEF COMPLAINTS AND ICD-CODED DIAGNOSES IN BIOSURVEILLANCE 370
SUMMARY 370
ADDITIONAL RESOURCES 371
ACKNOWLEDGMENTS 371
REFERENCES 371
24 Absenteeism 376
INTRODUCTION 376
PUBLIC/PRIVATE SCHOOLS 376
EMPLOYER AND MILITARY ATTENDANCE REPORTING 381
LIMITATIONS TO ABSENTEEISM DATA 382
SUMMARY 382
REFERENCES 382
25 Emergency Call Centers 384
INTRODUCTION 384
911 CALL CENTER/DISPATCH COMPUTER SYSTEMS 384
MILITARY CALL CENTER/DISPATCH 386
COMMERCIAL ASSISTANCE CALL CENTERS 387
POISON INFORMATION CENTERS 387
USE OF CALL CENTERS IN BIOSURVEILLANCE 388
SUMMARY 389
REFERENCES 389
26 The Internet as Sentinel 390
INTRODUCTION 390
INTERNET AS SENTINEL I: PROMED-MAIL 391
INTERNET PRIMER 392
INTERNET AS SENTINEL III: MONITORING USAGE OF HEALTH WEBSITES AND HEALTH-RELATED QUERIES TO SEARCH ENGINES 396
INTERNET AS SENTINEL IV: SELF-REPORTING 398
SUMMARY 399
ADDITIONAL RESOURCES 399
ACKNOWLEDGMENTS 399
REFERENCES 399
27 Physiologic and Space-Based Sensors 402
INTRODUCTION 402
SENSORS FOR MONITORING THE HEALTH STATUS OF PEOPLE OR ANIMALS 402
IMAGE ANALYSIS 404
SATELLITES 404
MONITORING WEATHER AND ENVIRONMENTAL CONDITIONS 406
SUMMARY 407
ACKNOWLEDGMENTS 407
REFERENCES 407
28 Data NOS (Not Otherwise Specified) 408
INTRODUCTION 408
CLINICAL DATA 408
PRECLINICAL DATA 413
PRESYMPTOMATIC DATA 414
PERMISSIVE ENVIRONMENT 414
SUMMARY 415
ADDITIONAL RESOURCES 415
ACKNOWLEDGMENTS 415
REFERENCES 415
Part V Decision Making 418
29 Decision Analysis 420
INTRODUCTION 420
THE DECISION TO ISSUE A BOIL-WATER ADVISORY (GLASGOW, 2002) 420
THE SCIENCE OF DECISION MAKING 422
DECISION ANALYSIS: ISSUE A BOIL-WATER ADVISORY OR WAIT FOR RESULTS OF DEFINITIVE TESTING 423
COMPUTATIONAL DECISION ANALYSIS 429
SUMMARY 429
ADDITIONAL RESOURCES 429
ACKNOWLEDGMENTS 430
REFERENCES 430
30 Probabilistic Interpretation of Surveillance Data 432
INTRODUCTION 432
CURRENT METHODS FOR INTERPRETING BIOSURVEILLANCE DATA 432
BAYESIAN WRAPPER METHOD 434
PROBABILITIES AND COSTS 436
GENERALIZATION OF THE BAYESIAN WRAPPER METHOD 437
SUMMARY 437
ADDITIONAL RESOURCES 437
ACKNOWLEDGMENTS 437
REFERENCES 437
31 Economic Studies in Biosurveillance 438
INTRODUCTION 438
DEFINITIONS AND BASIC CONCEPTS 438
TYPES OF ECONOMIC ANALYSES 441
SENSITIVITY ANALYSES 442
EXAMPLES OF ECONOMIC ANALYSES IN BIOSURVEILLANCE 443
CURRENT LIMITATIONS AND FUTURE DIRECTIONS 447
SUMMARY 448
ADDITIONAL RESOURCES 449
ACKNOWLEDGMENTS 449
REFERENCES 449
Part VI Building and Field Testing Biosurveillance Systems 452
32 Information Technology Standards in Biosurveillance 454
INTRODUCTION 454
THE GOOD, THE BAD, AND THE UGLY 454
TYPES OF INFORMATION TECHNOLOGY STANDARDS 455
LANGUAGE STANDARDS 456
STANDARDS WITH WHICH YOU NEED PASSING FAMILIARITY 464
ADOPTION OF STANDARDS 465
SUMMARY 466
ADDITIONAL RESOURCES 466
REFERENCES 466
33 Architecture 468
INTRODUCTION 468
DEFINITIONS 468
ENTERPRISE AND PAN-ENTERPRISE ARCHITECTURES 469
AN ENTERPRISE ARCHITECTURE FOR BIOSURVEILLANCE SYSTEMS 469
A PAN-ENTERPRISE ARCHITECTURE FOR BIOSURVEILLANCE 472
SUMMARY 477
ADDITIONAL RESOURCES 478
ACKNOWLEDGMENTS 478
REFERENCES 478
34 Advancing Organizational Integration: Negotiation, Data Use Agreements, Law and Ethics 480
INTRODUCTION 480
AGREEMENTS TO PROVIDE OR EXCHANGE DATA 480
LEGAL AND ETHICAL CHALLENGES 491
SERVICE AGREEMENTS 494
SUMMARY 494
ADDITIONAL RESOURCES 495
ACKNOWLEDGMENTS 495
REFERENCES 495
35 Other Design and Implementation Issues 496
INTRODUCTION 496
HOSTING FACILITY 496
SOFTWARE 499
SUPPORTING THE BIOSURVEILLANCE PROCESSES 501
MAKING USE OF DATA UTILITIES 505
SUMMARY 506
REFERENCES 506
36 Project Management 508
CBBS AND CBBS PROJECTS 508
PROJECT MANAGEMENT 509
PROJECT LIFE CYCLES 511
UNIQUE CBBS PROJECT MANAGEMENT CONSIDERATIONS 515
APPLYING PROJECT MANAGEMENT PRINCIPLES IN THE REAL WORLD 516
SUMMARY 520
ACKNOWLEDGMENTS 520
REFERENCES 520
37 Methods for Field Testing of Biosurveillance Systems 522
INTRODUCTION 522
QUESTIONS NOT ADDRESSED BY BENCH TESTING OF DATA AND ALGORITHMS 522
GOALS OF FIELD TESTING 522
ATTRIBUTES OF SYSTEMS AND COMPONENTS 523
AN EXAMPLE EVALUATION: FIELD TESTING OF THE DATA LAYER 529
SUMMARY 529
ADDITIONAL RESOURCES 529
ACKNOWLEDGMENTS 529
REFERENCES 530
Epilogue: The Future of Biosurveillance 532
INTRODUCTION 532
MEGATRENDS 532
THE FUTURE OF BIOSURVEILLANCE RESEARCH 536
EDUCATION, ORGANIZATION, AND LEADERSHIP 537
REFERENCES 538
Appendices 540
Appendix A CDCTM Severe Acute Respiratory Syndrome 542
SUPPLEMENT B: SARS SURVEILLANCE 542
Appendix B Sample Questionnaire/Survey 546
Appendix C Surveillance Data Tables 550
Appendix D Derivation of Bayes’ Rule 568
BAYES' RULE 568
MINI-BOSSS EXAMPLE, REVISITED 568
Appendix E Predictive Value Positive and Negative 570
Appendix F Data Communication to RODS: Technical Specifications 572
HL-7 ADMISSION-DISCHARGE-TRANSFER (ADT) DATA TYPE 572
NON-HL7-FORMATTED ADT DATA 572
NETWORK CONNECTION 573
PRODUCTION SYSTEM MAINTENANCE AND CONTACT INFORMATION 573
FAQ 574
Appendix G Data Use Agreement 576
Appendix H Department of Health Authorized Use Agreement for Clinical Data 580
Appendix I National Retail Data Monitor/RODS Account Access Agreement 584
Appendix J Data Security Agreement—-Personnel 586
Appendix K Data Use Agreement with Commercial Data Provider 588
Glossary 590
Index 606