Connecting Healthcare Delivery and Public Health: Syndromic Surveillance in the COVID‑19 Era

Why Connecting Care and Public Health Matters

When COVID‑19 hit, one painful lesson became obvious: our data systems did not talk to each other fast enough, even while patients and communities were desperate for timely information (“Lessons from COVID‑19 syndromic surveillance,” 2022).

Professor Linda Travis Macomber’s Renaissance.Health learning lab calls for a shift from “sick care” to true health—using digital tools and AI to connect people, clinicians, and systems so decisions can be smarter at both the bedside and the population level (Renaissance.Health, 2024). Health informatics, as presented in the Renaissance.Health ecosystem, is exactly that bridge: turning raw data into actionable knowledge that improves care for individuals and communities (Renaissance.Health, 2024).

What Is Syndromic Surveillance?

Imagine spotting a wildfire from the first thin line of smoke instead of waiting until the forest is roaring. Syndromic surveillance does something similar for disease. It uses near–real‑time data on symptoms and encounters—like emergency department chief complaints—to catch unusual patterns before lab results confirm a diagnosis (“Lessons from COVID‑19 syndromic surveillance,” 2022).

During COVID‑19, emergency‑department syndromic surveillance helped detect local outbreaks, track how waves were rising or falling, and forecast where hospital beds and ventilators were about to be in short supply (“Lessons from COVID‑19 syndromic surveillance,” 2022). Most systems rely on automated data feeds from hospitals and urgent care, while analysts monitor dashboards and trend lines for signals that something new—or worrying—is happening (“Lessons from COVID‑19 syndromic surveillance,” 2022).

CDC Systems: NSSP, BioSense, and ESSENCE

Behind the scenes in the United States, the CDC’s National Syndromic Surveillance

Program (NSSP) runs on the cloud‑based BioSense Platform, which collects and standardizes data from emergency departments and other clinical sites to support early outbreak detection (“Electronic Surveillance System for the Early Notification of Community‑Based Epidemics,” 2021). Inside BioSense, ESSENCE (Electronic Surveillance System for the Early Notification of Community‑Based Epidemics) turns those data into maps, alerts, and queries that help public health teams see emerging problems in time to act (“Electronic Surveillance System for the Early Notification of Community‑Based Epidemics,” 2021).

Peer‑reviewed work on ESSENCE’s rollout found that standardizing the chief‑complaint field and upgrading analytic tools made biosurveillance stronger, even though analysts had to rethink how they wrote queries (“Electronic Surveillance System for the Early Notification of Community‑Based Epidemics,” 2021). During COVID‑19, these systems were used to follow trends in COVID‑like illness and monitor changes in health outcomes over different phases of the pandemic, illustrating how routine clinical data streams can double as population‑level sensors (“Lessons from COVID‑19 syndromic surveillance,” 2022).

WHO Systems: GOARN, EIOS, and Wastewater Dashboards

At the global level, WHO’s Global Outbreak Alert and Response Network (GOARN) connects institutions around the world to find and fight outbreaks that cross borders, while its newer Epidemic Intelligence from Open Sources (EIOS) system continuously scans news, web content, and other open sources for early signals of emerging health threats (World Health Organization, 2025). WHO’s EIOS strategy for 2024–2026 describes how AI and natural language processing are being used to strengthen this form of “epidemic intelligence,” turning information noise into early warning (World Health Organization, 2025).

WHO and its partners also maintain global dashboards for wastewater surveillance of SARS‑CoV‑2, combining environmental data submitted by countries to complement clinical case reporting as part of a broader public‑health intelligence approach (World Health Organization, 2025). Reviews of wastewater‑based approaches consistently describe them as non‑invasive, relatively low‑cost, and capable of detecting community‑level trends and variants days to weeks before traditional case data (“Lessons from COVID‑19 syndromic surveillance,” 2022).

Promising Information Systems Connecting Healthcare and Public Health

1. Electronic Health Records and Interoperable Data Exchange

Electronic health records (EHRs) are increasingly viewed as core public‑health infrastructure, not just “charts on a screen,” because they capture near–real‑time, patient‑level data that can support surveillance for both chronic and infectious diseases (“Electronic Surveillance System for the Early Notification of Community‑Based Epidemics,” 2021). When EHRs are linked through interoperable platforms—using shared data standards and interfaces—the same clinical information that guides bedside decisions can feed directly into local and national public‑health monitoring (Renaissance.Health, 2024).

2. Health Information Exchanges (HIEs)

Health Information Exchanges (HIEs) act like regional data highways: they aggregate clinical data from multiple organizations and make them accessible to public health for surveillance and situational awareness (Renaissance.Health, 2024). During COVID‑19, HIEs that were tightly connected to public‑health agencies helped hospitals and officials get a clearer view of where cases, hospitalizations, and resource needs were rising, supporting the “care anywhere” vision where data follow the patient instead of staying locked in organizational silos (Renaissance.Health, 2024).

3. Wastewater and Environmental Surveillance

Wastewater surveillance has become a powerful complement to traditional clinical reporting. By testing sewage for viral markers, public‑health teams can detect SARS‑CoV‑2 trends days to weeks before clinical case data, offering an early look at whether infections are rising or falling (World Health Organization, 2025). Because everyone who uses the sewer system contributes to the signal—regardless of healthcare access or testing behavior—wastewater monitoring is often described as an inherently equitable population‑level tool (“Lessons from COVID‑19 syndromic surveillance,” 2022).

4. AI, Telehealth, and Digital Front Doors

Renaissance.Health frequently highlights AI, telehealth, and virtual care as key to a “health tech discovery” ecosystem where care can come to you, not just the other way around (Renaissance.Health, 2024). Peer‑reviewed work on telemedicine during and after COVID‑19 shows that virtual visits and remote monitoring can improve access, support earlier intervention for high‑risk patients, and contribute to better outcomes when combined with thoughtful clinical workflows (“Revolutionizing healthcare: How telemedicine is improving patient outcomes and expanding access to care,” 2024). As these virtual encounters generate continuous data streams from homes and communities, they can be integrated—under strong privacy and governance frameworks—into broader public‑health surveillance and preparedness systems (Renaissance.Health, 2024; “Revolutionizing healthcare: How telemedicine is improving patient outcomes and expanding access to care,” 2024).

Takeaways for Health Informatics Professionals

COVID‑19 proved that when real‑time clinical data are standardized and shared, they can guide both individual care and population‑level decisions (“Lessons from COVID‑19 syndromic surveillance,” 2022). Systems like CDC’s NSSP/ESSENCE, WHO’s EIOS and wastewater dashboards, EHR‑based data flows, HIEs, and AI‑enhanced telehealth are converging into a new, integrated health‑intelligence ecosystem (“Electronic Surveillance System for the Early Notification of Community‑Based Epidemics,” 2021; World Health Organization, 2025; “Revolutionizing healthcare: How telemedicine is improving patient outcomes and expanding access to care,” 2024).

For health informatics students and professionals—especially those exploring the Renaissance.Health lab—the opportunity is to design and lead systems where clinical and public‑health data move seamlessly, securely, and ethically, ultimately adding both years to life and life to years (Renaissance.Health, 2024). That means mastering interoperability fundamentals, understanding surveillance methods, and living out Macomber’s guidance: for every dose of technology, double down on humanity (Renaissance.Health, 2024).

References

Electronic Surveillance System for the Early Notification of Community‑Based Epidemics (ESSENCE): Overview, components, and public health applications. (2021). JMIR Public Health and Surveillance, 7(6), e26303. https://pubmed.ncbi.nlm.nih.gov/34152271/

Lessons from COVID‑19 syndromic surveillance through emergency department activity: A prospective time series study from western Switzerland. (2022). BMJ Open, 12(5), e054504. https://pmc.ncbi.nlm.nih.gov/articles/PMC9082728/

Renaissance.Health. (2024). Renaissance.Health – Experience AI/Digital Health. https://health-it-sim-lab.weebly.com

Revolutionizing healthcare: How telemedicine is improving patient outcomes and expanding access to care. (2024). Cureus, 16(7), e63881. https://pmc.ncbi.nlm.nih.gov/articles/PMC11298029/

World Health Organization. (2025). Epidemic Intelligence from Open Sources (EIOS) strategy 2024–2026. https://www.who.int/publications/i/item/B09476