such information to school absences and clinical information raises major privacy issues and has not been attempted as part of any biosurveillance program, to the committee’s knowledge.

Public health agencies do have legal authority to release personal medical data if such information is pertinent to public health. Frequency of false positives is a major concern with these systems, as the scenario in Box E.1 demonstrates. In large public health agencies where resources exist to maintain and staff syndromic surveillance systems appropriately and where digitized data streams are available, such systems may be cost-effective. A bioattack alarm may lead to revelations of the names and medical conditions of specific patients seen in emergency rooms associated with syndromic reporting. In such “emergencies” the violation of an individual’s privacy might be deemed acceptable given the public’s right to know what is going on. However, agencies should have procedures in place for dealing with consequences of false positives. They should also assess and identify the impact on individuals in non-alarm routine operations. The system itself should produce a tamper-resistant audit trail, and all personnel authorized to use the system and its outputs should receive training in appropriate use and the laws and policies applicable to its use. The agency should employ a privacy officer to ensure compliance with laws, policies, and procedures designed to protect individual privacy. These are but a few considerations toward assessing whether syndromic surveillance systems are consistent with U.S. laws and values.

tinely made available to public health authorities, they do exist with the data that drugstores routinely collect and could be made available under some circumstances. Various authors have analyzed these data bases to illustrate the potential of early detection of bioterrorist attacks—e.g., A. Goldenberg, G. Shmueli, R.A. Caruana, and S.E. Fienberg, “Early statistical detection of anthrax outbreaks by tracking over-the-counter medication sales,” Proceedings of the National Academy of Sciences 99(8):5237-5240, April 2002. Linking such information to school absences and clinical information raises major privacy issues and has not been attempted as part of any biosurveillance program to the committee’s knowledge.



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