Hospitals Need to Understand Syndromic Surveillance

Hospitals are looking at the Meaningful Use criteria and wonder “What is really going on with this syndromic surveillance thing.”  For those of use who are engaged in the field, “biosurveillance” and “syndromic surveillance” are common terms.  For a lot of people in healthcare, however, these terms are very unfamiliar.  So, hospitals have some solid, basic questions about meeting the syndromic surveillance optional criteria.  Here is one example:

I am currently completing a Meaningful Use document and one of the Public Reporting options is the ability to send syndromic surveillance data to public health agencies.  I was wondering if you have any white paper on who sees the data and how the data we provide in this interface is utilized.  I appreciate your help.



Herminio S. Navia Jr. (Bebet)

Thanks to Bebet for the question and letting me post it here.  To answer your question, I’ll provide a general overview of syndromic surveillance, discuss our system specifically, and provide links to resources that would be useful for you.  Hopefully this can benefit any hospitals attempting to answer similar questions.



Syndromic surveillance is a type of disease surveillance that typically uses pre-diagnostic data to understand health trends in a region.  A primary goal of syndromic surveillance systems is to provide early event detection.

A typical syndromic surveillance system collects chief complaints or diagnoses from hospital emergency departments.  These data are then classified into syndrome categories and timeseries analysis performed on those categories in an effort to characterize health conditions.

Most surveillance systems will operate on limited data sets that contain only de-identified information.  Since the purpose of these systems is to understand regional trends and not specific cases, individual information is not needed.  Public health departments are very sensitive to maintaining patient privacy and prefer not to collect identifiable information unnecessarily.


Health Monitoring Systems provides the EpiCenter service to public health departments.  The EpiCenter service is operated on a Software-as-a-Service basis.  No software is installed at either the hospital or the health department. While EpiCenter is capable of receiving data via most any standard format, we typically receive registration data via a HL7 data feed.

Regardless of the method chosen, we require that data be transmitted securely to the EpiCenter system.  Once transmitted, the data is stored in our database cluster, classified into ‘syndromic’ categories, spatially tagged, and analyzed hourly to provide regional health trends.

Two types of users can access the data in the EpiCenter system.  Public health officials with authority over the region can see the data, as well as users from the facility providing the data.  (Facility users are restricted to see only data from their own facility.)

What do public health users do with the data and analysis from EpiCenter?  Lots of things:  disease outbreak detection, long-term studies of health trends, monitoring heat-related illness, identification of emergency department usage patterns, supporting efforts to identify tainted drugs, flu tracking & reporting — the list goes on.

Most system users will look at the data for their region daily, attempting to spot events of interest.  When something statistically interesting happens, EpiCenter will send a notification to public health of the event so they may follow-up on it specifically.


As for white papers discussing syndromic surveillance systems, the International Society for Disease Surveillance maintains a resources page.  This contains links to a wealth of information.

Other frequently referenced papers on the topic include this paper which is an early overview of implementing syndromic systems.   This paper also provides an overview of how various syndromic surveillance systems operate.