Follow-up, Reporting and Communications Protocols DIMACS Working Group on BioSurveillance Data Monitoring and Information Exchange Breakout group

Participants Steven Alles – Philadelphia Department of Health Steven Alles – Philadelphia Department of Health Ihsan Azzam – Nevada State Health Department Ihsan Azzam – Nevada State Health Department Dan Drociuk – South Carolina Department of Health and Environmental Control Dan Drociuk – South Carolina Department of Health and Environmental Control Jeff Johnson – San Diego County Human Services Agency Jeff Johnson – San Diego County Human Services Agency Fermin Leguen – Miami Dade County Health Department Fermin Leguen – Miami Dade County Health Department Matt Miller – IEM (BioSense) Matt Miller – IEM (BioSense) Jennifer Schneider – California Dept. of Health Services 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? Escalation could include a variety of situations not just BT 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. 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) Know own domain knowledge (may require a stable staff team with experience reviewing the data) Difficult to put that “domain process” into a process Difficult to put that “domain process” into a process Internal process vs external process Internal process vs external process Emphasis on an algorithm vs public health relationships with medical community Emphasis on an algorithm vs public health relationships with medical community Each data source has different requirements for follow-up Each data source has different requirements for follow-up

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

What info and what format should reports include? Depends upon the audience whom the report is intended. 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. 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. 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. 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. Begs us to ask “What is it we are looking for?” and are we capturing the data to reflect that.

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

Recommendations Inclusion of both “qualitative” and “quantitative” components when a flag is “thrown”. 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.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. Educate your partners regarding the “pros” and “cons” of syndromic surveillance data. Develop protocols, at each level, for response to signals. Develop protocols, at each level, for response to signals. Look towards sustainability of efforts and receptiveness of users. Look towards sustainability of efforts and receptiveness of users.