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ISDS Annual Conference Proceedings 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
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ISDS 2012 Conference Abstracts

Adapting Syndromic Surveillance Systems to Increase
Value to Local Health Departments
Erika Samoff*1, Mary T. Fangman1, Amy Ising2, Lana Deyneka3 and Anna E. Waller2

1NCPERRC, University of North Carolina, Chapel Hill, NC, USA; 2Carolina Center for Health Informatics, University of North Carolina
School of Medicine, Chapel Hill, NC, USA; 3North Carolina Division of Public Health, Chapel Hill, NC, USA

Objective
Our objective was to describe changes in use following syndromic

surveillance system modifications and assess the effectiveness of
these modifications.

Introduction
Syndromic surveillance systems offer richer understanding of pop-

ulation health. However, because of their complexity, they are less
used at small public health agencies, such as many local health de-
partments (LHDs). The evolution of these systems has included mod-
ifying user interfaces for more efficient and effective use at the local
level. The North Carolina Preparedness and Emergency Response
Research Center previously evaluated use of syndromic surveillance
information at LHDs in North Carolina. Since this time, both the NC
DETECT system and distribution of syndromic surveillance infor-
mation by the state public health agency have changed. This work
describes use following these changes.

Methods
Data from NC DETECT were used to assess the number of users

and usage time. Staff from 14 NC LHDs in 2009 and from 39 LHDs
in 2012 were surveyed (May-August of 2009 and June of 2012) to
gather information on the mode of access to syndromic surveillance
information and how this information was used. Data were analyzed
to assess the link between the mode of access and use of syndromic
surveillance data.

Results
System changes made between 2009 and 2012 included the cre-

ation of “dashboards” (Figure 1) which present users with LHD-spe-
cific charts and graphs upon login and increases in the distribution
of syndromic surveillance information by the state public health
agency. The number of LHD-based NC DETECT system users in-
creased from 99 in 2009 to 175 in 2012. Sixty-two of 72 respondents
completed the 2012 survey (86%). Syndromic surveillance informa-
tion was used in 28/40 LHDs (70%) for key public health tasks.
Among 20 NC EDSS leads reporting an outbreak in the past year,
25% reported using data from NC DETECT for outbreak response,
compared to 23% in 2009 (Figure 2). Among 30 responding NC
EDSS leads, 57% reported using data from NC DETECT to respond
to seasonal events such as heat-related illness or influenza, compared
to 46% in 2009. NC DETECT data were reported to have been used
for program management by 30% (compared to 25% in 2009), and to
have been used in reports by 33% (compared to 23% in 2009).

Conclusions
Changes in how syndromic surveillance information was distrib-

uted supported modest increases in use in LHDs. Because use of syn-
dromic surveillance data at smaller LHDs is rare, these modest
increases are important indicators of effective modification of the NC
syndromic surveillance system.

Keywords
evaluation; public health practice; syndromic surveillance; surveil-
lance; local health department

Acknowledgments

We thank Aaron Fleischauer, Anne Hakenewerth, and North Carolina
local health department staff members for their time and insights. This
research was carried out by the North Carolina Preparedness and Emer-
gency Response Research Center (NCPERRC) which is part of the UNC
Center for Public Health Preparedness at the University of North Car-
olina at Chapel Hill’s Gillings School of Global Public Health and was
supported by the Centers for Disease Control and Prevention (CDC) Grant
1PO1 TP 000296. The contents are solely the responsibility of the authors
and do not necessarily represent the official views of CDC. Additional
information can be found at http://cphp.sph.unc.edu/ncperrc/.

*Erika Samoff
E-mail: erika.samoff@unc.edu

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e83, 2013