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Daily Electronic Disease Surveillance System --- Bergen County, Paramus, New Jersey

Brian La Forgia,1 L. Fiorenza,1 S. John,1 M. Paladini2
Bergen County Department of Health Services, Paramus, New Jersey; 2New York City Department of Health and Mental Hygiene, New York, New York

Corresponding author: Brian La Forgia, Bergen County Department of Health Services, 327 E. Ridgewood Ave., Paramus, NJ 07652. Telephone: 201-634-2843; Fax: 201-986-1068; E-mail:

Disclosure of relationship: The contributors of this report have disclosed that they have no financial interest, relationship, affiliation, or other association with any organization that might represent a conflict of interest. In addition, this report does not contain any discussion of unlabeled use of commercial products or products for investigational use.


Emergency Department Surveillance System: The Bergen County Daily Electronic Disease Surveillance System (DEDSS) is composed of three discrete components used to analyze public health data. The core of the system is the Emergency Department Surveillance System (EDSS), which monitors hospital emergency department (ED) data for syndromes based on chief complaint data. Data from six local hospitals are sent daily in batches by file transfer protocol (FTP) to the department's Internet webserver, loaded into a Microsoft™ structured query language (SQL) server, and analyzed with SAS® (SAS Institute, Cary, North Carolina) software by using algorithms developed by Bergen County and the New York City Department of Health. Substantial improvements have been made by using the SQL server rather than the previous SAS database storage format.

First Watch™ System: In 2004, First Watch, a commercially available product, was added to DEDSS. The system adds real-time monitoring of requests for advanced life support through the Mobile Intensive Care Communications (MICCOM) paramedic dispatch center. First Watch monitors MICCOM's computeraided dispatch system for complaint types.

Alerts are generated based on complaint types of interest to public health. The system monitors specified complaint-type syndrome groupings (e.g., respiratory and gastrointestinal) for aberrations. Algorithms are based on a 1-year baseline and compare totals of 1) individual calls in a syndrome category, 2) the ratio of syndrome calls to all calls, and 3) the cumulative sum (CUSUM) calculation of syndrome triggers. The system also includes a geocluster signal that triggers when the number of calls for a syndrome exceeds eight calls in a 1-mile radius.

Provider Surveillance System (PROS): PROS monitors patient visit data from seven affiliated physician groups that are geographically dispersed throughout Bergen and Passaic counties. The medical groups use an integrated electronic clinical information system for all offices. The data collected include two levels of International Classification of Diseases, Ninth Revision (ICD-9), diagnosis coding. Data are sent 4 days after the date of the patient visit to allow for ICD-9 coding, which produces a more accurate syndrome grouping. Patients are grouped by syndromes based on the CDC-recommended syndromic surveillance ICD-9 groupings. The Department of Defense Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) ICD-9 groupings for influenza-like illness (ILI) is used for ILI surveillance. The combination of all three signaling systems will be evaluated and is expected to provide a more effective, real-time picture of disease activity in the county than the original stand-alone ED system.

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Date last reviewed: 8/5/2005


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