From Wikipedia,
the free encyclopedia.
Introduction
Clinical
surveillance refers to the act
of surveilling a clinical
syndrome that have a
significant impact on
public health. Such techniques
have been used in particular for
infectious diseases. Many large
institutions, such as the
WHO, or the
Centers for Disease Control and
Prevention, have created data
bases, and modern computer systems
that can tract and monitor
emerging outbreaks of illnesses
such as influenza,
SARS, HIV, to biologic
terrorism, such as the recent
Anthrax attack on the post
office system in the United
States. Many states have cancer
registries to monitor the
incidence of cancers to determine
the prevalence, and possible cause
of these illnesses.
Other illnesses such as chronic
diseases such as obesity, and
diabetes, as well as social
illness such as domestic violence,
are increasingly being integrated
into
epidemiologic data bases that
are being used in
Cost Benefit Analysis in
determining governmental funding
for research and prevention. The
benefits of such data cannot be
underscored, but much of the
statistics involves attaching
worth to human lives, or years
lived, with complex concepts as
the converging of survival,
quality of life, and productivity
measures. The promotion of
population based health care, that
designed to reach an entire
population, increasingly is
integrated with converging
registries, and outcomes
increasingly being monitored as
measurement of performance is a
form of clinical surveillance.
Pharmaceutical Surveillance
and Marketing
Pharmaceutical companies, in an
effort to maintain a competitive
edge, have engaged in physician
profiling for the purposes of
marketing and
advertisement to key
physicians within a particular
community. The effectiveness of
monitoring, and cater marketing to
individuals has a tremendous cost
on society, in that surveillance
of prescribing habits has lead to
many physicians prescribing
unnecessary medicines for the
elderly, as well as the young. So
hence, a clinical syndrome is
monitored in terms of how a
syndrome can be treated, such as
that found in
Alzheimer's disease. Also,
with recent laws on electronic
privacy, items purchased in retail
drug stores that are not
medicines, or are over the counter
medicines, are items that
manufactures can collect data on
the purchasing consumers for
marketing purposes, and is HIPAA
compliant.
The emphasis of patient
centered care, is in contrast to
the above emphasis of population
based health care and is a form of
clinical sousveillance.
Patient Autonomy
A very basic and intuitive way of
understanding the importance
between surveillance, and clinical
sousveillance stems from patients
keeping track and understanding
which medicines they have been
prescribed. It is often wise to
check medication lists, and for
patients to ask nurses what
certain pills are prior to taking
them: a note book, or log, will
help the patient keep track of the
intricate detail of ones treatment
plan during a hospitalization. The
nurses need to know what the
patient is taking, and if any
adverse drug effect has occurred,
and the patient needs to know
which medicines have been
prescribed, to ensure correct
treatment plan. When this evolves
as a collaborative environment,
medication errors are less likely
to occur.
Another way of looking at the
balance between Clinical
Surveillance and Clinical
Sousveillance is in regards to
breast cancer screening: it is
a well established fact that most
breast masses are found by the
patients themselves, and this is
an important form self evaluation
that works best if done regularly.
This form of self evaluation is
most efficacious if coupled with
Mammography, and physician
evaluation. So hence, the balance
between self surveillance, and
clinical surveillance, increases
ones odds of early detection of
breast cancer. So hence, the act
of surveillance is a form of
clinical monitoring that can range
from self monitoring, to
monitoring yearly mammograms. The
patient's active participation is
clinical
sousveillance.
Surveillance of Medical Errors
The fact that everyday,
medical errors occur in all
parts of the medical industry: how
we are to deal with such errors
raises a serious challenge for
society and intersects with the
field of disclosure. An
institution that has in place
systems of conflict resolution and
transparency, will in the long run
have less errors occur. The active
participation of all members upon
a medical team, including the
patient and his/her advocates.
This is quickly posing complex
questions of who tells the patient
when an error has occurred, and
intersects with the complexity of
privacy ( referred to
HIPAA in the United States)
laws that can favor the privacy of
the institution versus the
individual.
Equiveillance represents a
balance where all parties have at
their disposal the tools of
information gathering.
Future and Advocacy
Increasingly, as information
technology converges with
bio-informatics, with the ability
to map and categorize illness into
the concept of
real time, the issues of
human freedom and
privacy are brought to
surface. Institutions such as the
EFF, as well as advocates,
such as
Dan Gilmore,
Steve Mann, and
Stephanie Perrin have been
collecting empirical data on the
nature of authority in the context
of
surveillance via the
development of multiple personal
cyborglogs. An extreme form of
patient monitoring is evolving
with implantable
RFID chipping, that has been
traditionally used for monitoring
migration patterns of animals, and
more recently, for monitoring
domestic cattle, has further
raised concerned that unbalanced
surveillance can create tremendous
social problems with yet to be
understood consequences. The
evolution of
social sorting has created a
trend of clinical counter
surveillance, or clinical
sousveillance. The evolution
of
peer to peer personal area
network that can collect
information and be communicated
machine to machine is a
natural anthropologic response to
humans interacting with machines
and correlates with
human computer interaction
research. The ability for persons
to be aware of how they are being
surveillanced touches upon the
theory of
wearable computing and
personal empowerment of human
destiny.
As society begins to look at new
methods of reducing medication and
hospital errors, informatic
systems are converging with RFID
systems. An extreme method has
been brought forward by the
Verichip product,where a RFID
chip is implanted into the
subject's arm.
Hacking
[1]implantable RFID chips has
also been described as a form of
clinical sousveillance.
Maintaining a license free
operation system that works with
ones body has been suggested by
many privacy activists, and the
concern of maintaining self
determination has been posed by
writers such
David Brin.
References
-
- University of Washington,
Dept of Epidemiology,
on-course on Epidemiology:
Introduction to Epidemiologic
Methods[[2]]
- University of Washington,
Dept of Epidemiology,
on-course on Epidemiology:
Cost & Outcomes Research[[3]]
- Anoequity Blog: issues in
privacy and computing[[4]]
- JAMIA: Implementing
Syndromic Surveillance: A
Practical Guide Informed by
the Early Experience [[5]]
- JAMIA: Automated Syndromic
Surveillance for the 2002
Winter Olympics [[6]]
- Healthcare IT
Collaboration in
Massachusetts: The Experience
of Creating Regional First
published July 27, 2005 as
JAMIA PrePrint;
doi:10.1197/jamia.M1866[[7]]
- RFID and Global Privacy
Policy [[8]]
- Lecture notes from Thomas
E. Finucane, M.D. [[9]]
- Up to date public comments
by Thomas E. Finucane, M.D[[10]]
- Medical Error Disclosure,
Mediation Skills, and
Malpractice Litigation: A
Demonstration Project in
Pennsylvania. Albert W. Wu,
MD, MPH Special Article Review
[[11]]
