Rethinking Public Health Surveillance for the Future

Perry F. Smith CSTE Annual Conference

Pittsburgh, PAJune 13, 2011

Outline• Some History• What’s happening with the CSTE surveillance

review?• The 1994 NPHSS Concept• What happened to the NPHSS and Why?• Where to go from here

– Results of the CSTE review to date

Some History

State-based legal authority to mandate reporting of personal health information to public authorities was left to the states by the 10th Amendment of the US Constitution:

…powers not delegated to the federal government, nor prohibited by it to the States, are reserved to the States…

CSTE’s Birth

In 1951, CDC asked the Association of State and Territorial Health Officers to charge the state epidemiologists with deciding which diseases should be reported nationally. CSTE was formed and generated the first list of notifiable diseases for the country.

Why Discuss Surveillance Now?Because the surveillance landscape has changed.

Three Major Influences

• Heightened need for public health preparedness

• New technologies

• Healthcare reform

CSTE Approach to Rethinking Surveillance Strategy

• Meeting of 40 public health leaders in Denver, Feb. 2011– CSTE Exec. Bd., local/state epidemiologists,

academicians, CDC, ASTHO, NACCHO, PHII– Purpose: Update strategic vision for public health

surveillance, identify new areas of surveillance activity, and define surveillance activities for CSTE

– Presentations, facilitated discussions and breakout groups

– Special report available

CSTE Approach to Rethinking Surveillance Strategy (Cont’d)

• Ongoing discussions– CSTE surveillance committee calls– Position statement preparation

• Sunday’s Pre-conference Workshop– About 100 participants

• Goal: a white paper describing updated guiding principles and recommendations for surveillance

“The Blueprint”

The NPHSS: Cornerstone of the 1995 Blueprint

• System fragmentation, limited resources, changing medical care system, and new IT systems require a new, coordinated, flexible approach for public health surveillance (National Public Health Surveillance System) that matches data collection techniques and funding levels to the goals of assessment at each level of the PH system

Highlights of the Blueprint (Cont’d)

• The NPHSS– The NPHSS and its constituent surveillance

systems should be constructed in a rational manner, based on sound epidemiologic and public health principles

– Recommended methods and data elements should be specified for each outcome at each level of the public health system, based on what is most appropriate for each level and the goals

Highlights of the Blueprint (Cont’d)

• The NPHSS– …an integrated information system linking

relevant surveillance data in states and multiple federal agencies in a virtual system that appears as one to users

– …maintained by CDC– An interdisciplinary group of epidemiologists

should reach consensus about what should be under surveillance in each discipline and the most appropriate methodology and information system for each.

Implementation of the NPHSS• 1994: CSTE passed NPHSS Position Statement• 1995-2000: CSTE added upwards towards 100

conditions to the NPHSS • 1997: CSTE passed Position Statement to ask

CDC to develop website with information on major national surveillance data systems and activities, and to have CDC’s Surveillance Coordination Group (SCG) serve as a forum for PH to coordinate all surveillance activities

Why the NPHSS Concept Lost SteamA Few Speculations

• Loss of leadership and focus• Redundancy• Purpose• Resources

Issues Discussed at Pre-Conference Workshop

• The NPHSS• Process for making surveillance policy

decisions• Incorporating various surveillance domains

and strategies into the NPHSS concept• Data issues

NPHSS Questions

• Is some version of the NPHSS worth keeping? • What is the value of saying that certain

conditions are or should be under surveillance throughout the US?

• What are or should be the criteria and methods

for adding conditions to the NPHSS?

Where Are We Now in Our Surveillance Strategy Review?

Elements of a New Strategy Paper

• The Basis of Public Health Surveillance: History and Principles, Goals and Methods (Tables of surveillance goals and methods)

• Current Influences Affecting the Changing Landscape of Public Health Surveillance

• Public Health’s Response to the Changing Surveillance Landscape• A New Conceptual Framework for Thinking about Surveillance• Updated Guiding Principles for Public Health Surveillance• Recommendations

Emphasis on Some Previous Guidelines• Attention to core principles of surveillance is critical,

including: – establish surveillance priorities using sound measures, such as

disease severity and availability of preventive measures;– identify the goals of each surveillance system;– use surveillance data, especially at the local level;– demonstrate the value of surveillance data by educating the

suppliers of data through good visualization/reporting tools;– apply the measures of good surveillance systems;– incorporate bi-directional communication that enables medical

providers to take appropriate actions on the basis of public health information;

– ensure data security, especially in the IT era;– prioritize effort and use resources wisely.

Draft Guidelines—New Emphasis• One of public health’s main roles in surveillance is

data evaluation, analysis, interpretation, and use for disease prevention.

• Data quality needs to be only as good as its purpose.

• New data sources should not replace old proven data sources until they have been assessed and deemed an improvement over the old sources.

Draft Guidelines—New Emphasis• In this age of national standards, states and

localities will continue to need local flexibility (e.g., free text fields in electronic forms).

• But, states and localities must be prepared to yield to national standardization of surveillance methods and technology when state-to-state variation is unnecessary.

Questionsand

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