Costs to develop and maintain a state biosurveillance system: The New York example
The New York State Department of Health developed a case study describing costs and experience with building a single surveillance system for clinical laboratories to meet their public health reporting requirements.
In the early 2000s, the New York State Department of Health (NYSDOH) built 4 biosurveillance systems to monitor laboratory reports, syndromic surveillance, and communicable disease incidence. The platforms operate within the NYSDOH Health Commerce System (HCS), which provides a large, Web-based infrastructure for secure information exchange between the public health agency and external partners. The HCS currently supports approximately 40,000 organizations and more than 100,000 users.
The following case study describes NYSDOH's efforts to evaluate the costs of developing several biosurveillance system components within a state's existing technology infrastructure, with the hope that it can be useful for other jurisdictions trying to plan similar surveillance systems.
- Difficulty in estimating costs. Costs in building a surveillance system can be hard to estimate, because they often depend on specific design features of the system and the needs and capacity of the jurisdiction in which surveillance is conducted.
- Compatibility of existing technology. Most surveillance system components are designed and built to be compatible with a health agency's existing information technology (IT). Because IT environments vary widely between jurisdictions, it is difficult to generalize a surveillance system estimate across departments or geographies.
- Variability in jurisdictions' surveillance processes. Each jurisdiction will require different designs and processes from its surveillance system due to desired workflow, legal authority, technology capabilities, and how it wishes the surveillance system to develop and be maintained over time.
The New York State Department of Health developed a case study describing costs and experience with building a single surveillance system for clinical laboratories to meet their public health reporting requirements.
Between 2000 and 2005, NYSDOH developed the following 4 essential systems to support biosurveillance across the state:
- The Electronic Clinical Laboratory Reporting System (ECLRS) transmits lab results to NYSDOH.
- The Communicable Disease Electronic Surveillance System (CDESS) collects, integrates, analyzes, and reports data from various sources for infectious disease surveillance. CDESS was designed to integrate with ECLRS so that lab reports of communicable diseases can trigger public health case investigations, and it can provide tracking, case management, and some contact tracing.
- The Electronic Syndromic Surveillance System (ESSS) monitors near-real-time, health-related data to indicate potential outbreaks and monitor health events. The ESSS also monitors general community health trends, recognizes outbreaks before diagnoses and lab reports are available, and characterizes geographic and temporal spread of communicable disease. The system also monitors Medicaid over-the-counter and prescription medication purchases and data from emergency department records from 135 hospitals outside of New York City. The ESSS provides objective evidence that an outbreak may or may not be occurring.
- The Wadsworth Public Health Laboratory's Clinical Laboratory Information Management System (CLIMS) tracks public lab results and transmits the data to ECLRS.
Staff involved in developing the systems and ensuring they acted as a unified infrastructure included approximately 11 developers, 3 business analysts, and 1 project manager. The combined 5-year development costs for electronic lab reporting, syndromic surveillance, and case reporting were $6.8 million US dollars (USD), and the estimated cost for public health lab reporting was $1.95 million USD.
Maintenance of the systems between 2006 and 2013 required approximately 6 developers, 2 business analysts, and 1 project manager. Work on ECLRS, CDESS, and ESSS cost $1.8 million USD over 8 years, while maintaining CLIMS cost an estimated $487,000 USD per year.
As the systems were developed and maintained over more than a decade, expenses are only approximate and may not reflect costs in today's dollars.
- Funding. Considerable costs and a long-term financial commitment were involved in developing these state surveillance systems, and funding came from both state sources and CDC PHEP grants.
- A unified surveillance infrastructure. Developing and maintaining the 4 systems meant NYSDOH could provide a single system for clinical labs to meet their public health reporting requirements by securely and rapidly transmitting results to NYSDOH, New York's 57 local health departments, and the New York City Department of Health and Mental Hygiene. Thanks to this feature, NYSDOH was also able to track communicable disease trends and launch public health case investigations in near-real time.
- Adaptable systems and technology. Through a thorough evaluation of its system's costs, NYSDOH was able to identify lessons learned about the development of large biosurveillance systems. Lessons included prioritizing a jurisdiction's specific needs at all points in the project's development, anticipating future needs that can be accommodated by the technology, and building on existing system capabilities.
