Tag Archives: Public Health Surveillance

A Challenge to Public Health Surveillance Interoperability and Clinical Research

The obstacles that impact interoperability of the disease surveillance systems starts with the issue of balance between the public interest in the collection of information and the privacy rights. In theory, properly utilized, surveillance is a fundamental government activity, indispensable in nature (Gostin & Gostin, 2000). The legal complications brought about by the Fourth Amendment prohibition against unreasonable searches and seizures, triggered the social impetus behind HIPAA and the HHS Report. The Fourth Amendment is a constitutional protection against wrongful enforcement of the law on access to private medical records. These offers insight into the growth and development of non-Fourth Amendment protections for medical records privacy, and examines later actions that appear to restrict or undercut these potential medical record protections. The shared goals of both public health surveillance and the protection of health information privacy will encourage individuals to fully utilize health services and cooperate with health agencies. The key to protecting the well-being of the community is the optimum balance between public health activities and privacy protection. This balance is challenged by the enactment and enforcement of current legislation such as the Health Insurance Portability and Accountability Act’s Privacy (HIPAA). The way public health exception of HIPAA Rule was drafted resulted to confusion and put this balance in jeopardy, as well as recognized reluctance to provide information to state and local public health agencies. Wilson (2009) stated that the exception ambiguously defines the role of public health authorities in maintaining the privacy of personally identifiable health information. Incertitude about privacy can be equipoised by initiatives by state and federal policy makers such as the report “Confidentiality of Individually-Identifiable Health Information” issued by the Department of Health and Human Services (HHS).  This report reflected a legitimate interpretation and representation of the best aspects of constitutional and judicial protections of medical records privacy using current innovative technology in health information and communication.

State, local, and tribal public health authorities shares the privacy challenges that are inherent in data sharing. Wilson (2009) stated that, in the process of promulgating the Privacy Rule, HHS recognized the need to inscribe an exception for public health purposes in order to allow authorities at all levels of government to continue to collect, analyze, and use health information that would otherwise be unavailable without prior patient consent. State courts and policy makers have produced some protection for individuals’ medical histories which are characterized more by their diversity and conflicting standards than by the quality of protection. Unfortunately, state laws offer little additional support for medical records protection from law enforcement intrusion, thereby it is paramount for continued collaboration between public health professionals, health leaders and policy makers to focus on needed amendments to protect the interest of both the public, patients and researchers which will then bridge the divide on the interpretation of the law. It is critical to acknowledge that challenge of law- and policy-makers in finding common ground between individual privacy expectations and the communal health authorities’ needs for identifiable health data. The dissemination and use of identifiable health data for public health purposes are typically supported by the public, but it relies on how the government and other entities maintain appropriate privacy and security protections in acquiring the data. It is warranted for the continued improvement on the level of protection afforded to the public and patients by state laws governing medical records privacy. Moral justifications should be considered in establishing firm, consistent set of rules governing law enforcement’s use and exchange of private medical records and data needed in clinical research. The obstacles that forestall data-sharing practices should be assessed and remedied within each jurisdiction. Legal interpretations should be openly discussed to properly develop and implement model policy to strengthen disease surveillance, and increase the efficiency of data-sharing practices between researchers and public health authorities at all levels.


Aarestrup, F. M., Brown, E. W., Detter, C., Gerner-Smidt, P., Gilmour, M. W., Harmsen, D., … & Schlundt, J. (2012). Integrating genome-based informatics to modernize global disease monitoring, information sharing, and response. Emerging infectious diseases18(11), e1.

Act, A. (1996). Health insurance portability and accountability act of 1996.Public Law104, 191.

Bernstein, A. B., & Sweeney, M. H. (2012). Public health surveillance data: legal, policy, ethical, regulatory, and practical issues. MMWR Surveill Summ, 30-4.

Carroll, L. N., Au, A. P., Detwiler, L. T., Fu, T. C., Painter, I. S., & Abernethy, N. F. (2014). Visualization and analytics tools for infectious disease epidemiology: A systematic review. Journal of biomedical informatics.

Chan, M., Kazatchkine, M., Lob-Levyt, J., Obaid, T., Schweizer, J., Sidibe, M., … & Yamada, T. (2010). Meeting the demand for results and accountability: a call for action on health data from eight global health agencies. PLoS Med7(1), e1000223.

Chowdhary, S., & Srivastava, A. (2013). Cloud Computing: A Key to Effective & Efficient Disease Surveillance System. In Int. Conf. on Advances in Signal Processing and Communication. ACEEE (Lucknow).

El Emam, K., Hu, J., Mercer, J., Peyton, L., Kantarcioglu, M., Malin, B., … & Earle, C. (2011). A secure protocol for protecting the identity of providers when disclosing data for disease surveillance. Journal of the American Medical Informatics Association18(3), 212-217.

Gostin, L. O., & Gostin, L. O. (2000). Public health law: power, duty, restraint (Vol. 3). Univ of California Press.

Gostin, L. O., Hodge, J. G., & Marks, L. (2002). The Nationalization of Health Information Privacy Protections. Tort & Insurance Law Journal, 1113-1138.

Hodge Jr, J. G., Torrey Kaufman, J. D., & Jaques, C. (2012). Legal Issues Concerning Identifiable Health Data Sharing Between State/Local Public Health Authorities and Tribal Epidemiology Centers in Selected US Jurisdictions.

Kulynych, J., & Korn, D. (2003). The New HIPAA (Health Insurance Portability and Accountability Act of 1996) Medical Privacy Rule Help or Hindrance for Clinical Research? Circulation108(8), 912-914.

Labilles, U. (2014). Obstacles of Disease Surveillance Interoperability: A Challenge to Public Health. (Unpublished, PUBH-8270-2. Health Informatics and Surveillance. 2014 Spring Qtr. WK11Disc) Walden University, Minneapolis.

Lenert, L., & Sundwall, D. N. (2012). Public health surveillance and meaningful use regulations: a crisis of opportunity. American journal of public health, 102(3), e1-e7.

Office for Civil Rights, H. H. S. (2002). Standards for privacy of individually identifiable health information. Final rule. Federal Register67(157), 53181.

Van Der Goes Jr, P. H. (1999). Opportunity Lost: Why and How to Improve the HHS-Proposed Legislation Governing Law Enforcement Access to Medical Records. University of Pennsylvania law review, 1009-1067.


Bridging the Technology Gap and Geographic Divide

This morning, I attended a webinar on the transitioning to ICD-10 CM and its impact on Public Health Surveillance presented by Peter Hicks of Centers for Disease Control and Prevention (CDC). While its benefits and challenges were discussed, the question to ask is the cost implications of the transition. Another question to ask is its compatibility to existing health information technology. I believe at this point, we need to embrace its advantages, and explore the merging of this initiative on its potential for higher quality and patient-centered care. Setting this topic aside for future dialogue, let me follow-up last week’s discussion on the true, meaningful use of personal health records (PHR), and health information exchange (HIE). In this milieu, let me discuss the promise of telehealth on higher quality and patient-centered care. The geographic separation between regional multi-site healthcare system in which one site is 32 miles or even 51.4 miles away is no longer a logistic problem using telehealth. The quality of care of the traditional model, where health care takes place when the patient and the provider are together at the same time and place can be amplified by current modern system of healthcare. It is important to acknowledge the importance of modern telecommunications and information technologies in providing management flexibility to providers, administrators and managers. It bridges the geographic separation between the patient-provider and management-staff, and allow us to challenge the notion of location and time. Video conferencing can be used to communicate with the provider, where the patient is located one part of the state and the physician is located at another part, or to show new Mohs technicians to perform cryotomy or frozen section immunohistochemistry. In this model, we can remotely monitor patient’s physical condition. Telehealth in concert with disease-specific surveillance data can assess the need for community outreach to educate and inform about the significance of the intervention.

The ability to capture and transmit images using the internet, teleconsultation can be used as an additional approach to teaching new surgical techniques, unbiased by doctrine or surgeon’s experience, enabling accurate quantitative criteria to evaluate the effectiveness of surgical cuts. In the context of cutaneous surgery, whereby contemporary research tools may become one of the criteria in the designing and performing of operations—telemedicine could be an innovative teaching platform presenting systematic pursuit of accurate, optimal cutting patterns and new surgical techniques. This capacity, when used in combination with digital pathology, could offer an alternative method to comply with Clinical Laboratory Improvement Amendments (CLIA) proficiency testing compliance on sharing Mohs slide images with another laboratory to confirm the quality of test of patient frozen section samples. In a multidisciplinary approach, it could bridge the consultation with dermatopathologist on the critical success of a high-quality Mohs surgery program. The dermatopathologist can play a role in quality assurance by reviewing Mohs slides at regular intervals to satisfy the requirement for proficiency testing. Teleconsultation and digital pathology can help assess margins in rare and difficult tumors. Moreover, consultation with dermatopathologist helps in ruling out residual disease or for further immunohistochemistry studies, as well as consultation to assess perineural involvement and uncertain frozen section diagnosis of unusual proliferative lesions. High ground such as remote monitoring of the progress of surgical repairs; we need to acknowledge the challenge in which many of these technologies can impact privacy and security. Telemedicine network structure may have an advantage over competitive hospital- or university-based networks, but the challenge will always be funding and organizational support.


Edwards, M. A., & Patel, A. C. (2003). Telemedicine in the state of Maine: A model for growth driven by rural needs. Telemedicine Journal and e-Health9(1), 25-39.

Labilles, U. (2014). Telehealth: Bridging the Geographic Challenge. (Unpublished, PUBH-8270-2. Health Informatics and Surveillance. 2014 Spring Qtr. WK8Disc) Walden University, Minneapolis.

Laureate Education, Inc. (Executive Producer). (2011). Introduction to health informatics and surveillance: Telehealth. Baltimore, MD: Johnson, K. & Speedie S.

Sanders, T. B., Bowens, F. M., Pierce, W., Stasher-Booker, B., Thompson, E. Q., & Jones, W. A. (2012). The Road to ICD-10-CM/PCS Implementation: Forecasting the Transition for Providers, Payers, and Other Healthcare Organizations. Perspectives in health information management/AHIMA, American Health Information Management Association9(winter).

Terry, N. P. (2012). Anticipating Stage Two: Assessing the Development of Meaningful Use and EMR Deployment. Annals Health L.21, 103.

Tilleman, T. R. Optimization of Incisions in Cutaneous Surgery including Mohs’ Micrographic Surgery.