Challenges of Electronic Medical Surveillance Systems

In this paper, we discuss the technical challenges of electronic medical syndromic surveillance systems intended to provide early warning of bioterrorist attacks and naturally occurring epidemics. The discussion includes challenges associated with both civilian and military environments. In particular, we address the challenges in: (1) establishing an automated data collection infrastructure, (2) achieving timely access to quality data from disparate sources, (3) developing sensitive and specific outbreak detection algorithms, and (4) developing comprehensive and realistic simulation models for detection-algorithm development and validation. In addition, we identify unique attributes of military and North Atlantic Treaty Organization settings that may affect the development, deployment, and usage of medical surveillance systems. We conclude that considerable work and research are needed to overcome these challenges, that the information provided by these systems may lack the necessary specificity for follow-on mitigating actions, and that their cost-effectiveness and practical relevance, vis-à-vis the traditional reliance on health care providers to identify outbreaks, is still to be demonstrated.