New York City Syndromic Surveillance Systems
The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has conducted prospective surveillance of nonspecific health indicators (syndromes) since 1995 (Heffernan et al., 2004a). The DOHMH syndromic surveillance system consists of (ED)-visi
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The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has conducted prospective surveillance of syndromes since 1995 (Heffernan et al., 2004a). The DOHMH syndromic surveillance system consists of Emergency Department (ED)-visits-based surveillance system and a few other complementary surveillance systems for Emergency Medical Services (EMS) ambulance dispatch calls, retail pharmacy sales, and work absenteeism data. These systems started operating separately, and different analytical methods are being employed by each of them. A “drop-in” syndromic surveillance system that deployed CDC field-staff to conduct 24 hours surveillance for bioterrorism related illness was implemented following the September 11th 2001 attack (Das et al., 2003; CDC, 2002). We use Table 11-1 to summarize these systems that comprise the syndromic surveillance activities in New York City. However, in the following text, the case study will focus around the ED visits based syndromic surveillance system in NYC.
H. Chen et al., Infectious Disease Informatics: Syndromic Surveillance for Public Health 157 and BioDefense, Integrated Series in Information Systems 21, DOI 10.1007/978-1-4419-1278-7_11, © Springer Science + Business Media, LLC 2010
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Chapter 11
Table 11-1. The syndromic surveillance systems in New York City.
Syndromic system Emergency Medical Services (EMS) Ambulance Dispatch Calls (Greenko et al., 2003) Emergency Department Visits (Heffernan et al., 2004b) Retail Pharmacy Sales (cough and influenza medications, and antidiarrheal medicines)
Analytical approaches
Analysis frequency An adaptation of the excess Daily influenza mortality cyclical (linear) regression model
Data transmission Calls
Prospective temporal and spatial scan statistics
Daily
FTP or Email attachments
Daily (weekdays only)
FTP
A linear regression model similar to that used in the EMS system, controlling for season, holidays, day of the week, promotional sales, positive influenza tests, and temperature Worker absenteeism CUSUM method with a 14day baseline A “drop-in” syndromic Same techniques that had surveillance system been developed for the EMS following the 9/11 ambulance dispatch system attack (CDC, 2002)
1.
Daily Daily
CDC fieldstaff collected the data at 15 NYC hospital ERs
NYC ED SYNDROMIC SURVEILLANCE SYSTEM DATA COLLECTION
By November 2003, 44 of NYC’s 67 EDs participated in this system, thereby capturing 80% of all NYC ED patient visits (Heffernan et al., 2004a). Data files are transmitted to DOHMH daily, either as email attachments or through FTP. Half of the participating hospitals have already automated the transmission process. Files can be in several formats, most commonly as fixed-column or delimited ASCII text. “Data are read and translated into a standard format, concatenated into a single SAS dataset, verified for completeness and accuracy, and appended to a master archive.” (Heffernan et al., 2004a, 2004b).
11. New York City Syndromic Surveillance Systems
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The chief complaints captured by the ED visit
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