Analytics and the Shoe Leather Epidemiologists

August 24, 2018

In a response to the threat of biological warfare during the Korean War, in 1951 the federal government established the Epidemic Intelligence Service (EIS) training program. EIS officers soon became known as disease detectives, looking for the next infectious disease threat. A drawing of a worn out shoe with a hole in the sole became the logo for these intrepid investigators who traveled at a moment’s notice to search for the cause of the next healthcare threat.

In 1955, EIS officers established one of the first national surveillance systems that led to the identification of 260 polio cases that were traced to unsafe vaccines made by a single California pharmaceutical company. Identifying the cause of the illness allowed other manufacturers to claim their vaccines as being safe and restored public confidence in the immunization program, saving hundreds of children from a lifetime of disability.

Today, EIS officers research infectious, chronic, and occupation-related illnesses while providing assistance around the world to government health departments struggling to understand disease outbreaks.

Another Type of Surveillance

So, what does this have to do with analytics? Making analytics valuable to an organization requires managers to apply surveillance techniques, first proven effective by EIS officers 60 years ago, to their reports.

The power of data analytics software combined with the abundance of data sets creates an environment where the volume of reports overwhelms the ability of managers to parse the reports to obtain valuable, actionable information.

Therefore, analytics software presents an ever-present danger to organizations that do not understand how to best utilize the reports generated. Careful governance rules must be followed to best use the software to improve the quality of care and reduce costs.

Set objectives – Effective data governance requires that an overall objective for the analytics be set before running reports. Organizations need to consider the purpose of the reports and the expected outcome. Objectives include items such as improvements in medication error rates, length of stay, operating room time for hip replacement surgery, and emergency ward wait times.

Build and connect the right data sources – The explosive growth of healthcare IT systems presents organizations with a large set of data sources to be used to build reports. Robust interoperability tools allow the data to be brought together in a meaningful way that can be used to build comprehensive reports. These reports then offer managers a complete rather than fragmented view of their processes and outcomes.

Focus reports on manager’s role and responsibility – Rather than allow managers to run an unlimited number of reports at will, reports must focus in on delivering information relevant to managing to a specific objective that the manager controls.

Use reports as a surveillance tool – To create focused reports requires adherence to the principles of typical public health surveillance activities. Rather than wait for an epidemic to grow large enough that it can no longer be ignored, public health officials established surveillance activities that continually collect data on a variety of diseases. By tracking the diseases this way, any abnormality in the disease reporting pattern generates the effort to further investigate the change. Most disease surveillance reports lead to no action, which is the expected response to most reports.

This same “no action required” approach to analytical reporting offers the best means to get value from analytics. Reports should focus the manager’s attention on only those activities that may be a problem, with most reports indicating “all is going well.” Only when the report indicates a potential problem does the manager investigate the anomaly through the generation of additional reports and review of related clinical and administrative workflow.

Build the reports and response into workflow - Effective use of analytical reports builds the review and response to reports into the daily workflow of the manager. This ensures that the reports are utilized and evaluated regularly. Over time unhelpful reports get replaced with those that provide valuable and actionable information.

Valuing analytics software as a surveillance tool for clinical and administrative activities offers a better way to leverage these tools to improve quality of care and financial outcomes. There is great value in not following the next bright shiny object, but rather focusing on the information that truly matters.

Barry P. Chaiken, MD, MPH

Barry Chaiken is the president of DocsNetwork Ltd. and has more than 25 years of experience in medical research, epidemiology, clinical information technology, and patient safety. He is board certified in general preventive medicine and public health and is a fellow, and former board member and chair of HIMSS. He is currently an adjunct professor of informatics at Boston University’s School of Management and serves as a consultant to Infor’s Public Sector Healthcare team. Chaiken may be contacted at

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