Follow-up, Reporting and Communications Protocols

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

2. Participants • 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

3. 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 • 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

4. What information is needed for escalation of reports? • 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

5. What info and what format should reports include? • 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.

6. Summary • 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.

7. Recommendations • 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. • 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.