Exploring the Impacts of Public Health Laws on Syndromic Disease Surveillance Practices in the United States

Public health surveillance prevents morbidity and mortality by monitoring notifiable diseases. The widespread adoption of electronic health information technology has catalyzed the practice of syndromic disease surveillance (SyS)—the highly automated analysis of clinical data to monitor trends in clusters of symptoms (i.e., syndromes), which can identify outbreaks more rapidly than notifiable disease surveillance. The federal government invested in SyS infrastructure after the anthrax attacks of 2001, and all 50 states have a SyS program today. The rapid development of SyS practices, however, may have outpaced the evolution of public health laws that authorize notifiable disease surveillance. As a result, the potential of SyS to protect public health may be constrained.

The purpose of this study is to explore the impact of laws on SyS practices in the United States. We are investigating these questions through a multi-site, qualitative case study research design. We have purposively selected 5 jurisdictions as case study sites and are conducting semi-structured, in-depth interviews with 7-10 SyS stakeholders (e.g., state/local health officials, legal counsel, hospital personnel) in each. All interviews are being audio-recorded, transcribed, and analyzed by 2 coders using thematic content analysis. We have also identified and analyzed relevant legal documents. The impact of federal/state health information privacy statutes, the legal terms of data use agreements, and Meaningful Use Regulations have emerged as areas of research focus.

This study is funded by the Robert Wood Johnson Foundation and data collection will be complete by the time of the presentation and preliminary findings will be available.