Future of Surveillance
Public health agencies, ministries of finance, and international donors and organizations need to transform surveillance from dusty archives of laboriously collected after-the-fact statistics to meaningful measures that provide accountability for local health status or that deliver real-time early warnings for devastating outbreaks. This future depends in part on developing consensus on critical surveillance content and developing commitment on the part of countries, funding partners, and multilateral organizations to invest in surveillance system infrastructure and to use surveillance data as the basis for decision making. This vision of the future assumes a coherent, integrated approach to surveillance systems that is based on matching the surveillance objective with the right data source and modality and on paying attention to country-specific circumstances while maintaining global attention to data content needs.
Information technology and informatics can help in attaining this vision. Specifically, technology can facilitate the collection, analysis, and use of surveillance data, if data standards are developed and compatible systems are established. Data collection for surveillance would be an automatic by-product of any electronic systems used to support clinical care. Under this scenario, an automatic electronic message would be sent to the responsible public health jurisdiction with information about a health event (for example, death, disease, or injury), including all relevant information from the electronic health record about the patient, provider's name, patient's home address, risk factors, previous immunizations, and treatments. Even before this ideal capacity becomes widespread, technology such as cell phone-based systems could accelerate collection of key data (for example, occurrence of a viral hemorrhagic fever outbreak). The rapid penetration of cell phones in developing countries might obviate the need for prohibitively expensive landline-based systems. An accelerated system of wireless Internet access might also transform the capacities to which a local health post or a district health official might have access. These systems should also be considered as means for collecting information beyond traditional data. For example, telemedicine access can permit views of a rash illness to be shared with national or international medical specialists.
Analysis of surveillance data can also be transformed by using available technology. Software that is Web-enabled, together with the advances in geographic information system software and global positioning devices, means that anyone with Internet access can potentially apply the latest version of software running on a distant server in the national capital to local data to generate up-to-date maps and graphs describing health status in that jurisdiction.
Use of surveillance data can also be transformed. Sophisticated algorithms can be applied to data as it is collected to determine when (and how) an alert should be sent to local, national, or even international health officials to indicate a need for immediate investigation. Increasingly sophisticated visual display techniques and creation of custom channels with data of particular relevance to groups of data users are just some of the tools already being used to put public health content on the desktop of anyone with broadband, secure Internet access.
Realization of this future vision does not require technology beyond what is already feasible, but the following factors are needed:
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the organizational and political will to develop and coordinate the needed systems and standards that will enable those systems
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appropriate attention to individual privacy and system security
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removal of the financial and logistical barriers to broadband Internet access
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a strategic multisectoral approach to accelerating national infrastructure among the poorest developing nations.
