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Appendix C: Summary of Research into the Costs of Enhanced Public Health Surveillance Systems
Pages 199-216

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From page 199...
... . The committee consists of experts in areas that include biological threat assessments, evaluation of biological detection systems, environmental monitoring technologies, biological assays, microbiology, virology, epidemiology, syndromic surveillance, health information technology, the U.S.
From page 200...
... Note that this memorandum is not intended to provide information about the merits of the current or "enhanced" public health system or provide a snapshot of current public health surveillance capabilities nationwide. Furthermore, for the reasons detailed below, IEc and the committee have concluded that the available data do not support a comprehensive cost analysis of either current or enhanced public health activities related to biosurveillance and outbreak response.
From page 201...
... Given the tight time frame of the committee's analysis, and not wishing to preempt current efforts in this area, the committee opted to instead highlight opportunities for enhancement of surveillance through the public health and health care systems in broad categories of legally mandated reporting, automation of health care information systems and public health linkages, laboratory and diagnostic testing capacity, and information integration. We have used these categories to guide our cost research.
From page 202...
... IEc also spoke with committee member James Buehler, who provided cost information about health departments in Georgia. At the local level, IEc interviewed a representative of the Tarrant County, Texas, health department, and we obtained data for the New York City health department from committee member Marci Layton.
From page 203...
... For example, to implement ELR in North Carolina, the health department needed to develop a National Electronic Disease Surveillance System (NEDSS) function in order to receive ELR information.
From page 204...
... to the Washington State HIE, which is being developed under a $5 million CDC grant. The Tarrant County effort, described as a "rudimentary" HIE that covers 50 to 60 hospitals, illustrates a less highly tailored approach, using open-source syndromic surveillance systems (RODS and ESSENCE)
From page 205...
... Massachusetts Dina Caloggero Michigan James Collins Minnesota Richard Danila NACCHO Jack Herrmann, William Stephens (Tarrant County (TX) Public Health, December 18, 2008)
From page 206...
... 0 BIOWATCH ANd PuBlIC HEAlTH SuRVEIllANCE TABLE C-2 Public Health Cost Matrix: Examples of Surveillance Program Costs Category Example Programs Environmental Monitoring Programs Enhance animal, wildlife, vector Canada's National Wildlife Disease Strategy testing Legally Mandated Reporting and Surveillance Systems: Notifiable Diseases, Outbreak Reporting, Vital Event Registration Enhance electronic laboratory 1. APHL/ANSER/CDC estimate for developing a reporting systems national ELR system 2.
From page 207...
... Paper identified by committee member Seth Foldy suggests $4–5 million over 3 years to design and implement global animal surveillance system for zoonotic pathogens 1. Development: $650 million 1.
From page 208...
... Automation of Healthcare Information Systems and Public Health Linkages Enhance use clinical decision eTriage support tools for diagnosis, VisualDx reporting, & management (e.g., triage, isolation, treatment)
From page 209...
... thousands of dollars per year "though staff varies with (upper bound, NYC) size of department, e.g., percentage of several For Internet-based systems, MDs' time employed there is a startup cost plus in outreach in NYC" 1 IT FTE to maintain it (Marci Layton, personal (~$48,000/yr)
From page 210...
... Also local HIE efforts to increase integration with EHRs, beyond typical syndromic surveillance features -- more public health user control over data reporting, reachback features (e.g., WA state, Indiana, NY?
From page 211...
... HIE with EMR extraction for syndromic surveillance Development: $5 million in CDC grant over 3 years No cost data yet on ESP ESP developed through a collaboration between CDC, the CDC-funded Center of Excellence in Public Health Informatics based at Harvard, Harvard Vanguard Medical Associates, and the Massachusetts Department of Public Health continued
From page 212...
... Enhance public health capacity to electronically alert healthcare sector of important public health events (e.g., inform evaluation, triage, isolation, treatment) Laboratory and Diagnostic Testing Capacity Expand access to rapid diagnostic Luminex tests, "point of care" tests Extend capacities to characterize pathogens and coalesce reports to identify emergence or spread of related cases of infectious disease (e.g., PulseNet model)
From page 213...
... Rich Tsui, University million ($500,000 over 2 of Pittsburgh, RODS years) ; O&M: similar to laboratory, personal maintenance costs in current communication public health system NYC: Several million in Marci Layton, personal startup costs plus 3–4 communication FTEs to operate/maintain (~$200,000/yr)
From page 214...
... NOTES: APHL, Association of Public Health Laboratories; BWIC, Biological Warning and Incident Characterization; CDC, Centers for Disease Control and Prevention; DHS, Department of Homeland Security; ED, emergency department; EHR, electronic health record; ELR, electronic laboratory reporting; EMR, electronic medical record; ESP, Electronic Support for Public Health; ESSENCE, Electronic Surveillance System for the Early Notification of Community-based Epidemics; FTE, full-time equivalent; FY, fiscal year; HIE, health information
From page 215...
... WATrac Development: 2. Margaret Hansen, WATrac: bed tracking and $160,000; O&M: $45,000 WADOH, personal ED status in 82% of WA communication hospitals; resource and pharmaceutical tracking anticipated to be implemented in 2009 statewide exchange; IT, information technology; LIMS, laboratory information management system; NEDSS, National Electronic Disease Surveillance System; NBIC, National Biosurveillance Information Center; NBIS, National Biosurveillance Information System; O&M, operation and maintenance; PHRED, Public Health Reporting of Electronic Data; RHIO, regional health information organization; RODS, Real-time Outbreak and Disease Surveillance; WADOH, Washington State Department of Health.
From page 216...
... Journal of Public Health management Practice 13(2)


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