Disease Surveillance Public Health Informatics Discussion Response

Disease Surveillance Public Health Informatics Discussion Response

Disease Surveillance Public Health Informatics Discussion Response

4 days ago

William Payne

RE: Discussion – Week 6

In general terms, federalism is the mode of political organization in which separate entities (e.g., states, polities, etc.) agree to share amongst a collective certain powers and responsibilities while each retaining their own, individual sovereignty (The Editors of Encyclopaedia Britannica, 2019). In the United States, this most takes the form of a federal government sharing power with the fifty individual state governments (LII, n.d.). The doctrine amounts to a sort of compromise, born within the American historic experience of lessons the from the failures of centralism (i.e., in the American Revolution against Great Britain) and then of confederalism (i.e., with the replacement of the Articles of Confederation) (IHA, n.d.; Lumen Learning, n.d.). Although the United States Constitution never explicitly mentions the word federalism, it does, in effect, create a federalist system in the way it allocates power, and that system continues to this day (Monk, n.d.). Disease Surveillance Public Health Informatics Discussion Response

01. Identify the two levels of government and post an analysis of the challenges they face when implementing electronic disease surveillance systems.

This inherited federalist form of government has one major implication for public health surveillance: the federal government and the state governments maintain distinct surveillance systems with distinct roles, authorities, and challenges (NAoM, 2011; NAoM, 2002).

With regards to implementing an electronic public health surveillance system, at least three major differences between these levels of government come to mind.

First, states choose their own mandatory reporting of diseases and so can more easily balance surveillance load with the felt needs of their constituencies. This creates a challenge for the federal government, because the federal government may not share those preferences and so may have missing data for certain diseases in certain locations.

Second, in implementing a surveillance system, use of pre-existing data streams can help decrease reporting effort (Lombardo & Buckenridge, 2007). Different states may have different pre-existing data streams, and this, as well, can create compatibility issues for the federal government. This creates a challenge for the federal government, because the federal government often relies on voluntary reporting from the states (Danila et al., 2015).

Third, fiscally, the federal government and the state governments operate very differently, usually with the federal government having far more power. Even when controlling for % GDP, the federal government has a much larger portion of public health spending (CDC, 2013), and this gap has widened each decade since 1980 (Turnock, 2012, pp. 96-97). Beyond that, almost all state governments are required to balance their budget and cannot borrow money for operating purposes (Teitelbaum & Wilensky, 2013, p. 13). This means that state governments face steeper initial financial hurdles in implementing new surveillance systems and often may have to rely on the federal government to set up some shared, incentive-based plan for financing it.

02. Explain which challenges are common and which are unique to the two levels you selected.

To be sure, limited funding is a common, shared challenge at all levels of government. It is felt more acutely at the state and local levels, but it is a shared at all levels.

The problem of relying on lower forms of government is most acutely felt at the federal level. The federal government allows states to define their own mandatory reporting of conditions, allows them to decide on their own pre-existing data streams, and often allows them to choose their own software or hardware from vendors of their own choosing. This creates presents challenges to compatibility between data and to interoperability of systems most significant on the federal government’s side (Danila et al., 2015).

03. Consider the similarities and differences, and propose recommendations to mitigate the challenges.

At each level of government, officials are charged with promoting health of the population, and they must figure out how to best do so within their own scope of authority and own budgetary constraints. Between the federal and the state governments, the major difference lies in their authorities and tools for how they can do this.


Different constituencies may have differing preferences regarding choice of tradeoffs between such tensions as privacy vs. security, funding for health departments vs. funding for other institutions, timeliness of alarms vs. fewer false alarms, and more. Such tradeoffs admit of no single, obvious, best answer, and so it is right that the differing states be allowed to operate according to their own differing values, preferences, and circumstances. For this reason, different states have different mandatory-reporting requirements (Roush, Birkhead, & Koo, 1999; Danila et al., 2015). It is quite understandable and indeed quite sensible that, for instance, California and Missouri are faster to mandate reporting of the endemic encephalitis viruses (e.g., California Encephalitis, St. Louis Encephalitis, Western Equine Encephalitis, etc.) than is the more distant and discontiguous Hawaii (Roush, Birkhead, & Koo, 1999) or that the highly agrarian Texas mandates two forms of reporting of acute pesticide poisoning while the less agrarian Rhode Island requires none (Roush, Birkhead, & Koo, 1999; Cook, 2020).

States can mitigate budgetary issues by acquiring federal grants or in joining into shared payment programs for surveillance systems that help to install and maintain surveillance systems, especially if states can present the argument that the system would benefit the federal government as well (as by, for instance, feeding into CDC’s BioSense) (Lombardo & Buckenridge, 2007).


The federal government’s larger budget and ability to borrow and/or operate at a budgetary deficit makes it most strongly positioned to finance the implementation of electronic surveillance systems. Its reliance on the states for reporting and its deference to state surveillance decisions regarding local matters means that it sometimes struggles with compatibility. To promote interoperability, the federal government can and should foster standardization in data-coding practices and in helping the states to fund the implementation of compatible systems (Richards et al., 2017).


Cook, R. (2020, December 25). Ranking of states with the most farms. Beef2Live. https://beef2live.com/story-states-farms-ranking-1-50-154-113143.

Cornell Law School’s Legal Informatics Institute [LII]. (n.d.) Federalism. Legal Information Institute. https://www.law.cornell.edu/wex/federalism.

Danila, R. N., Laine, E. S., Livingston, F., Como-Sabetti, K., Lamers, L., Johnson, K., & Barry, A. M. (2015). Legal authority for infectious disease reporting in the United States: Case study of the 2009 H1N1 influenza pandemic. American Journal of Public Health, 105(1), 13–18. 

Editors of Encyclopaedia Britannica, The. (2019, August). Unitary state. Encyclopædia Britannica. https://www.britannica.com/topic/unitary-state.

Independence Hall Association, The [IHA]. (n.d.) Federalism. USHistory.org. https://www.ushistory.org/gov/3.asp.

Lombardo, J. S., & Buckeridge, D. L. (2007). Disease Surveillance: A Public Health Informatics Approach. Hoboken, NJ: John Wiley & Sons.

2 days ago

Dominique Morgan

RE: Discussion – Week 6

Identify the two levels of government and post an analysis of the challenges they face when implementing electronic disease surveillance systems

At every level of government, public health professionals are charged with ensuring the health of the population, and a part of that includes carrying out surveillance activities. As with any system, there will be challenges that arise, especially during the implementation phase. For the local government level, one of the challenges of implementing an electronic disease surveillance system is cost. The initial costs can be higher, as it covers starting, maintaining, and monitoring the systems. Buying the hardware, software, paying staff, accessing the data from various streams, and more are included in start-up costs (Lombardo & Buckeridge, 2007). Another challenge in implementation at the local is ensuring the quality of the data. With electronic systems, the quality of the system relies heavily on the quality of the data (Aliabadi et al., 2020). Data quality depends on human input and can sometimes lead to errors if there is no continuous quality review. Disease Surveillance Public Health Informatics Discussion Response

The challenges of implementing an electronic disease surveillance system at the regional level are more complex for severa l reasons. One challenge with regional level surveillance is that it requires additional communication levels between the jurisdictions individually and the entire region as a whole. Communication can be challenging when ensuring the regional data is accurately captured, analyzed, disseminated, and maintained with the appropriate people while ensuring everyone is on the same page (Lombardo & Buckeridge, 2007). Another challenge in implementation at the regional level is maintaining the system can be more complicated. Each jurisdiction retains its own systems and funnels the information into the regional hub (Lombardo & Buckeridge, 2007). Maintenance can be challenging as each jurisdiction has different ways of collecting and analyzing data, different data streams, and more, causing it to be more challenging to piece all the information together to represent the region as a whole.

Explain which challenges are common and which are unique to the two levels you selected

The challenges common for both local and regional levels of government electronic surveillance systems are cost and timeliness of receiving and reporting data. Regardless of government level, the costs associated with implementing a biosurveillance system is the main factor that everyone considers. It will be difficult for an agency to electronically carry out their surveillance activities if the funds are not accounted for before choosing the system and implementing it. Also, every level of government has their own budget and may or may not have a say in what gets allocated where. The timeliness of receiving and reporting data is also common among all levels of government. Timeliness can differ depending on the disease or condition being reported, how the data will be used, and the government level of the agency (Jajosky & Groseclose, 2004). Regional surveillance systems present unique challenges, such as combining the data from many localities into one and having to over-communicate with all involved to ensure clarity at every step. Some local surveillance systems present unique challenges of only providing episodic surveillance or when something occurs versus monitoring disease, conditions, or events overall consistently (Thomas et al., 2018).

Consider the similarities and differences and propose recommendations to mitigate the challenges

Both the local and regional levels factor in costs for set up and maintenance of the system and factor in the need for staff, training them on the system, and their availability to monitor the system (Lombardo & Buckeridge, 2007). The main difference is that regional systems are multi-jurisdictional and can comprise many public health departments/agencies into one (Lombardo & Buckeridge, 2007). The recommendations to mitigate the challenges that local and regional government systems face include focusing on training staff, developing effective communication strategies, and increasing funding for surveillance activities. These actions will help identify the needs of communities and ultimately lead to improved design and delivery of policies, programs, and interventions (Chan et al., 2020).


Aliabadi, A., Sheikhtaheri, A., & Ansari, H. (2020). Electronic health record-based disease surveillance systems: A systematic literature review on challenges and solutions. Journal of the American Medical Informatics Association, 27(12), 1977–1986. 

Chan, P. Y., Perlman, S. E., Lee, D. C., Smolen, J. R., & Lim, S. (2020). Neighborhood-Level chronic disease surveillance: Utility of primary care electronic health records and emergency department claims data. Journal of Public Health Management and Practice. 

Jajosky, R. A., & Groseclose, S. L. (2004). Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. BMC Public Health, 4, 29–9. 

Lombardo, J.S. & Buckeridge, D.L. (2007). Disease surveillance: A public health informatics approach. John Wiley & Sons, Inc Publications.

Thomas, M. J., Yoon, P. W., Collins, J. M., Davidson, A. J., & Mac Kenzie, W. R. (2018). Evaluation of syndromic surveillance systems in 6 US state and local health departments. Journal of Public Health Management and Practice, 3, 235. 

Nyoka Rogers

RE: Discussion – Week 6

Select two levels of government (e.g., local, state, regional, or national) and consider the challenges faced by the two levels in electronically monitoring conditions/diseases.

The two levels of government that I would like to discuss when discussing disease surveillance are state and federal. According to the Center for Disease Control and Prevention, in September 2000, states began receiving federal funding to plan and implement integrated electron systems for disease surveillance. Electronic disease surveillance is needed to improve the usefulness of public health surveillance and the timeliness of response to outbreaks of disease. According to the Center for Disease Control and Prevention, state health departments received most case-report forms by mail and then entered the data into computer systems, sometimes weeks after the cases of notifiable disease had occurred, including cases that warranted immediate public health investigation. The challenges faced with electronic disease surveillance at the state level are “issues with personnel and stakeholders, issues with resources in a developing setting, issues with processes involved in the collection of data and operation of the system, and issues with organization at the central hub” (Araujo et. al., 2008). Another challenge to states using electronic disease surveillance is being able to obtain data from patients/clients, health professionals, and health departments. In a national (federal) system, a user could select a section of the country at login instead of trying to work with the entire country (Lombardo & Buckeridge, 2007). Challenges faces by a federal system could also be not being able to determine what data to use, being that this particular governmental system should have access to local and state data. Disease Surveillance Public Health Informatics Discussion Response

Then explain which challenges are common and which are unique to the two levels you selected.

The challenges that are common between state and federal government when using electronic disease surveillance is receiving, managing, and analyzing data. I also think that sharing data amongst different departments, public health entities, and levels of governments are also a challenge amongst state and federal government. One unique aspect of the state system is that it has it has control of certain aspects of disease surveillance. According to Lombardo and Buckeridge, state and local jurisdictions may have their own monitoring and response protocols. The unique aspect of the federal government is that data can be compiled from all fifty states when surveilling a particular disease.

Consider the similarities and differences, and propose recommendations to mitigate the challenges.

One recommendation to mitigate the challenges faced between state and federal levels when discussing disease surveillance would be to make sure that all databases are made accessible to all levels of government. Also, a proposed recommendation would be to create a health survey that is used at local health levels that can be transferred directly to a state and federal database. Accessibility, in my opinion is key to mitigating the challenges faced between state and federal government when exploring disease surveillance. Lastly, I think the similarities amongst state and federal governing bodies is that all data should be consistent and share common variables. Commonality needs to exist not only at the data communications level, but also at the receiving, processing, and monitoring levels (Lombardo & Buckeridge, 2007).


Araujo-Castillo, R. V., Blazes, D. L., Fernandez, M., Leturia, C., Mundaca, C. C., Neyra, J., & Soto, G. (2008). Challenges in the implementation of an electronic surveillance system in a resource-limited setting: Alerta, in Peru. BMC Proceedings, 2, 4th ser., 1-7.

Lombardo, J. S., & Buckeridge, D. L. (2007). Disease surveillance: A public health informatics

approach. Hoboken, NJ: Wiley-Interscience

Progress in Improving State and Local Disease Surveillance —United States, 2000–2005. (n.d.). Retrieved January 07, 2021, from 

2 days ago

James Green

RE: Discussion – Week 6

The two levels of government that I will explore this week are Local and National Government. These two levels are interesting in that they are distinctly different systems but rely on each other for accurate and complete disease surveillance.

Local Government

Local government is where disease surveillance begins. Local governments are initially responsible for mandated reporting of notifiable diseases and generally receive reports from clinics, hospitals and laboratories in their jurisdictions before funneling that data, manually or automatically, up to regional, state, and national systems (Lewis et al., 2011). In this way, local governments and national governments have similar challenges in that they need systems to transmit and receive this data from multiple sources. Unique to local government, however, are the challenges with organizing data from stakeholders that may have different systems or methods of data recording and transmission and requires data managers to understand and translate that data into something that can be condensed and evaluated (Lewis et al., 2011).

National Government

The data surveillance challenges at the national level are similar to those at the local level in that data is coming from many local, regional, and state level jurisdictions and the data is not always generated in a standardized way (Lewis et al., 2011). Unique to national surveillance is that the data transfer is not only one way, and reports need to be generated and provided back down the chain to allow local, regional, and state jurisdictions to make sense of the aggregate data and make sound decisions.


From this week’s reading, the most valuable recommendation I could make to ease the transfer and organization of disparate data is to standardize the systems that create it. Lewis et al. (2011) describe the efforsts of BioSense and ESSENCE developers in conforming their systems to respond the same way to the same data, but this should be done broadly. There should be a national health record system that can be implemented into every local clinic, pharmacy, hospital and communicate directly with local, regional, state, and national systems. There are enormous issues with that recommendation from privacy concerns to cost, among others, but for the purpose of creating a fluid bio surveillance system it would be the most straightforward approach.


Lewis, S.H., Hurt-Mullen, K., Martin, C., Ma, H., Tokars, J.I., Lombardo, J.S., & Babin, S. (2011). Modern disease surveillance systems in public health practice. In J.S. Lombardo & D. Buckeridge (Eds.), Disease surveillance: A public health informatics approach. [MBS Direct]. Retrieved from 


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