J. E. Gunn

Developing syndrome definitions based on consensus and current use.

OBJECTIVE Standardized surveillance syndromes do not exist but would facilitate sharing data among surveillance systems and comparing the accuracy of existing systems. The objective of this study was to create reference syndrome definitions from a consensus of investigators who currently have or are building syndromic surveillance systems. DESIGN Clinical condition-syndrome pairs were catalogued for 10 surveillance systems across the United States and the representatives of these systems were brought together for a workshop to discuss consensus syndrome definitions. RESULTS Consensus syndrome definitions were generated for the four syndromes monitored by the majority of the 10 participating surveillance systems: Respiratory, gastrointestinal, constitutional, and influenza-like illness (ILI). An important element in coming to consensus quickly was the development of a sensitive and specific definition for respiratory and gastrointestinal syndromes. After the workshop, the definitions were refined and supplemented with keywords and regular expressions, the keywords were mapped to standard vocabularies, and a web ontology language (OWL) ontology was created. LIMITATIONS The consensus definitions have not yet been validated through implementation. CONCLUSION The consensus definitions provide an explicit description of the current state-of-the-art syndromes used in automated surveillance, which can subsequently be systematically evaluated against real data to improve the definitions. The method for creating consensus definitions could be applied to other domains that have diverse existing definitions.

Immunization registries: costs and savings.

OBJECTIVES The objectives of this study were to quantify the actual costs of developing, maintaining, and operating the Boston Immunization Information System (BIIS), an electronic registry and tracking system, and to compare the registrys costs with those of performing the same functions manually. METHODS Cost data were obtained from 23 BIIS health care sites, the city health department, and 13 control sites. Actual costs of developing and operating BIIS in 1998 and projected 1999 costs for a hypothetical expanded registry were measured. Total costs of registry-supported immunization activities were compared with the costs of similar types and volumes of manual activities. RESULTS The total annual cost of developing, maintaining, and operating BIIS in 1998 was

Direct cost associated with the development and implementation of a local syndromic surveillance system

345,556. Annual total cost per record was

Local collaborations: development and implementation of Boston's bioterrorism surveillance system.

5.45 for all children aged <23 years and

Cross-Disciplinary Consultancy to Enhance Predictions of Asthma Exacerbation Risk in Boston

10 when costs were distributed only among active users (children <8 years old). Operating BIIS saved

Big data and opportunities for injury surveillance

26,768 in 1998, compared with manual performance. The hypothetical projected total cost of an expanded BIIS in 1999 would have been

Cross-Disciplinary Consultancy to Bridge Public Health Technical Needs and Analytic Developers: Asyndromic Surveillance Use Case

577,919, with a projected savings of

Cross Disciplinary Consultancy to Bridge Public Health Technical Needs and Analytic Developers: Negation Detection Use Case

689,403 compared with manual costs. CONCLUSIONS Electronic immunization registries potentially offer an efficient tool for the delivery of immunization services. Registries can save substantial funds if their data are kept up-to-date, and if caregivers are willing and able to use the registries routinely.

Comparison of crowd-sourced, electronic health records based, and traditional health-care based influenza-tracking systems at multiple spatial resolutions in the United States of America

OBJECTIVE Enhancing public health surveillance to include electronic syndromic surveillance systems has received increased attention in recent years. Although cost continually serves as a critical factor in public health decision making, few studies have evaluated direct costs associated with syndromic surveillance systems. In this study, we calculated the direct costs associated with developing and implementing a syndromic surveillance system in Boston, Massachusetts, from the perspective of local, state, and federal governments. METHODS Between December 2003 and July 2005, the Boston Public Health Commission (BPHC), in collaboration with the Centers for Disease Control and Prevention (CDC), and the Massachusetts Department of Public Health developed a syndromic surveillance system in which limited demographic and chief complaint data are collected from all Boston acute care emergency departments every 24 hours. Costs were divided into three categories: development, operation, and upgrade. Within these categories, all fixed and variable costs incurred by both BPHC and CDC were assessed, including those associated with development of syndromic surveillance-related city regulations and system enhancements. RESULTS The total estimated direct cost of system development and implementation during the study period was

Using Syndromic Surveillance for All-Hazards Public Health Surveillance: Successes, Challenges, and the Future:

422,899 (