Situational Awareness and Disease Surveillance

There's broad overlap between Disease Surveillance efforts and Situational Awareness reporting.  If you look back to early March, former National Coordinator Farzad Mostashari illustrates on twitter the use of ILI reporting systems to support COVID-19 Situational Awareness.  Surveillance efforts abound: Biosurveillance, ELR, ECR, ILI, reportable/notifiable conditions, et cetera.

Surveillance efforts can be classified a couple of different ways, at the very least a) what you are looking for, and b) how you respond to that event.  You are either looking for a known signal (e.g., ILI, or a reportable/notifiable condition), or simply a deviation from a normal signal (e.g., biosurveillance, and to some degree ILI).  You can (especially true for known signals), trigger a predefined intervention or response , or "investigate", or simply communicate the information for decision making at various levels.  COVID-19 dashboards which show hospital / ventilator capacity are often used to support various kinds of decisions (e.g., support and supply), as well as to communicate risk levels to the public.

If you think about such efforts as reporting on bed capacity or medication usage related to COVID-19, you need to be able to a) check lab results and orders, b) evaluate collections of patient conditions (e.g., to detect suspected COVID-19 based on combinations of symptoms) and c) examine medication utilization patterns.  All of this can also be used to support various kinds of surveillance efforts.

Surveillance goes somewhat deeper than situational awareness.  The most common case is turning a positive signal for identifying a case into a case report for follow-up investigation, as in Electronic Case Reporting.  This goes beyond basic Situational Awareness reporting.  Case reporting can get rather involved, going deep into the patient record.  Where SA efforts are more aligned is when the initial data needed (e.g., as for an Initial Case Report) is fairly well defined.  For that, we have been defining mechanisms whereby the supplemental data reported in the measure can also be used to support those sorts of efforts.

The overlap between these efforts points to one thing, which is a general need to address the inefficiencies of multiple reporting efforts to public health.  The various reporting silos exist because of a fractured healthcare system, fractured funding, and the various legal and regulatory challenges for consolidating public health data.  There's NO quick fix for this, it will likely take years to get to a consolidation of methods, standards and policies across public health reporting initiatives, but it's something that's worth looking into.