Syndromic Surveillance System for Korea–US Joint Biosurveillance Portal: Design and Lessons Learned

Abstract

Driven by the growing importance of situational awareness of bioterrorism threats, the Republic of Korea (ROK) and the United States have constructed a joint military capability, called the Biosurveillance Portal (BSP), to enhance biosecurity. As one component of the BSP, we developed the Military Active Real-time Syndromic Surveillance (MARSS) system to detect and track natural and deliberate disease outbreaks. This article describes the ROK military health data infrastructure and explains how syndromic data are derived and made available to epidemiologists. Queries corresponding to 8 syndromes, based on published clinical effects of weaponized pathogens, were used to classify military hospital patient records to form aggregated daily syndromic counts. A set of ICD-10 codes for each syndrome was defined through literature review and expert panel discussion. A study set of time series of national daily counts for each syndrome was extracted from the Defense Medical Statistical Information System between January 1, 2011, and May 31, 2014. A stratified, adjusted cumulative summation algorithm was implemented for each syndrome group to signal alerts prompting investigation. The algorithm was developed by calculating sensitivity to sets of 1,000 artificial outbreak signals randomly injected in the dataset, with each signal injected in a separate trial. Queries and visualizations were adapted from the Suite for Automated Global bioSurveillance. Findings indicated that early warning of outbreaks affecting fewer than 50 patients will require analysis at subnational levels, especially for common syndrome groups. Developing MARSS to improve sensitivity will require modification of underlying syndromic diagnosis codes, engineering to coordinate alerts among subdivisions, and enhanced algorithms. The bioterrorist threat in the Korean peninsula mandates these efforts.

Complementing conventional infectious disease surveillance with national health insurance claims data in the Republic of Korea

“…For example, if a test result or drug use record is reported together, the accuracy of the monitoring system can be improved by preventing up-coding 12 . A system using medical records with available syndromic surveillance can also be established to supplement low timeliness, which is a disadvantage of claim-based surveillance 30 . The surveillance system should also be designed to identify the source of infections, whether it was acquired from abroad or domestic, through separate diagnosis codes.…”

Urologic Diseases in Korean Military Population: a 6-year Epidemiological Review of Medical Records

“…DMSIS is a system, which is operated by the Armed Forces Medical Command (AFMC), to provide epidemiological information to increase its capability of situational awareness against natural and deliberate disease outbreaks (19). This system offers archiving, querying, and generating functions for the epidemiological data from a database of electronic medical records of nineteen military hospitals across Korea.…”

Epidemic Alert System: A Web-based Grassroots Model

“…The need for web-based disease surveillance is also being explored and implemented by the armed forces as seen in the joint bio-surveillance portal championed by the Republic of Korea and the United States of America [17].…”