Comments on ‘Some methodological issues in biosurveillance’

I would first like to compliment Dr Fricker on the outreaching, cross-disciplinary nature of this work. Underlying his discussion of several important methodological issues in biosurveillance is an important theme: successful methods and approaches from other fields of endeavor have much to offer for the analysis and exploitation of public health data. Dr Fricker focuses on three topics from which applied public health surveillance and biosurveillance can certainly benefit: techniques for measuring change from the field of statistical process control, examples from perception and cognition theory (e.g. the ‘looking for everything’ analogy to sydromic surveillance), and the value of using simulation for substantiating new methodological applications. His development of concepts remains rooted in the goals of early disease event detection in a population and extends to the less rigorously defined but more intuitive goal of acquiring and maintaining situational awareness. Dr Fricker also clearly acknowledges various disciplines and problem areas of research necessary for more successfully addressing these goals. In addition to adding my emphasis to the value of using simulation for knowledge discovery in public health, I will comment on three areas of considerable importance that affect biosurveillance, (1) the use of multiple sources and types of data and other information, (2) activities surrounding the implementation of electronic medical records (EMRS) and clinical information exchange as it pertains to biosurveillance, and (3) locating the biosurveillance operations focus within the public health structure and organization. Practical necessities and current operational status are large determinants of priorities for biosurveillance and how it may reasonably be implemented.