“It was maybe a first step in that direction for a particular location, for a particular disease, at a particular point in time,” he said.

“There are, or should be, a lot of qualifications. We need more study, more broadly, for which we do things like look at different definitions of things like influenza-like illness to try to understand which ones have the most signal in them.”

The availability of more granular data for more research may also help better overall design of biosurveillance systems, Fricker said.

“It seems like these systems have often been put together in a sort of ad hoc fashion,” he said, “not from the point of view of, ‘What are we trying to detect, and what is the data being used for, and how do we build a system around that?’ We go from the point of view of ‘We need to detect stuff, let’s put something together, here’s some convenient data, let's feed that into it.’ A systems engineer would be in horror because it’s not approached from a mature system design point of view.”

Ironically enough, it may be BioSense's new bottom-up approach that will ultimately lead to better biosurveillance system design, because more local jurisdictions will feel more comfortable sharing data with researchers, without feeling burdened to conduct research themselves.

“We're each our own little crucibles,” Hanni said “We're talking here about maybe expanding to a few more counties locally, or partnering with other academic institutions to get more of the computer science aspect – but at the same time, we are not a research institution for public health, so we need to be doing it for our daily routine. And if we can do more on the side to help advance the field, that's where I see, as a local smaller health department, where I can get support for that role.”

Cloud and federated governance on tap

Numerous public health organizations, including the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), the Council of State and Territorial Epidemiologists (CSTE), the International Society for Disease Surveillance (ISDS) and the CDC, will craft the governance mechanism for the new program.
Partnerships between the agencies are widening the pool of stakeholders both in governance and technology, according to the CDC’s Kass-Hout. ASTHO will be responsible for the new collaborative environment, which will be cloud-based, with a mix of open source and proprietary platforms. CSTE is drafting a data use agreement that will ease local officials' concerns about sharing data.

“It doesn't force anybody to do it, but gives them the option to do it,” Kass-Hout said. “The user interface could be as simple as ‘Click this box and data will be available publicly or for research.’ That subset will pretty much be like the ED data in Tarrant County, stripped of identifiers, and maybe aggregated, but in a meaningful way. And CSTE will be working with CDC and ISDS to really give us their best advice to the language to advance research and science.”

Kass-Hout is optimistic the new BioSense may signal the beginning of a truly mature biosurveillance strategy, one based on mutual trust.

“Local and state health departments have the best relationship with providers. They understand the context in which an event has happened, and they understand their population more than anybody else,” Kass-Hout said. “So if we can make sure they have ownership of that data and the initial vetting of it is there, that would be the basis to truly start stitching a regional and national picture.”