Where is the wisdom we have lost in knowledge? Where is the knowledge we have lost in information? - T. S. Eliot1

We are all increasingly bombarded with information, thanks to technological advances in communications and the availability of gargantuan quantities of electronic data. No segment of industrialized society is immune to the challenge of information overload. Public agencies have the additional challenge of meeting the public's and policy maker's expectations of being provided the information they want, when they want it, and how they want it. Transforming information into the knowledge needed to forge wise policy has been and will remain the public health challenge. Today's information environment changes the timeline of our actions and places significant demands on us to rethink and redesign our surveillance infrastructure.

Surveillance is undergoing profound changes as a result of advances in technology. In 1963, long before the age of computers and the availability of terabytes of health data, Langmuir2 described surveillance as the collection and evaluation of morbidity and mortality reports and other relevant data, and the dissemination of the data with interpretation to all who need to know. But the increasing number of ways of gaining health information on populations is prompting new consideration of the boundaries of surveillance.3 While the purpose of surveillance has not changed, the available data and the systems used for accessing and processing the information have changed significantly.4 Surveillance now depends on sophisticated electronic information systems, often involving numerous partners who have their own specific information system needs. Electronic laboratory reporting is a good example of a new technique that is quickly becoming an essential component of modern surveillance. Implementing electronic laboratory reporting, however, has not been easy. It has required public health epidemiologists to participate in technical system design and standards development, understand the language of informatics, work with other stakeholders (eg, laboratory and informatics specialists), and establish new work flows for processing and evaluating huge increases in laboratory reports that were not possible in previous years with manual reporting. New data, such as information from electronic health records, are becoming available and require proper assessment of their validity and utility for effectively tracking population morbidity and mortality. The speed with which these changes are occurring threatens to exceed the ability of public health to assess the new information and build electronic systems to collect and process the data at a time of diminishing public health resources.5 In addition, technology is offering new opportunities for disseminating information "to all who need to know," such as providing point-of-care decision support to clinicians at the time of patient contact.

How can public health best respond to these challenges, with the goal of discerning and using the most effective available information and technology for surveillance with given public resources? The responsibility for achieving this goal falls primarily on surveillance practitioners, who tend to be public health epidemiologists. Considerable work has been done to define the competencies of effective epidemiologists.6 In today's changing surveillance environment, there are 2 competency areas that are especially important: evaluation and informatics.

Surveillance data and systems need to be evaluated for such characteristics as sensitivity, positive predictive value, data quality, flexibility, and acceptability.7 This is especially important in today's environment of new data sources, such as electronic health records and social media, where the data elements have been collected, recorded, and transmitted by any number of people outside of public health and for purposes other than public health. Newer surveillance methods, such as the analysis of anonymous clinical data for syndromic surveillance or information from social media sources,8 should be evaluated for their usefulness and cost-effectiveness. Today, the need for emergency preparedness calls for faster access by the public to surveillance information; in fact, the public is increasingly becoming a source of information on emergencies. But urgency for information must not curtail or obviate appropriate public health evaluation of surveillance data and methods.

This issue of the Journal contains 4 articles that reflect efforts to evaluate some of the new opportunities that technology presents to surveillance. Researchers at the University of Michigan assessed administrative Medicaid data for their utility in identifying children with asthma9 and for use in alerting physicians about their high-risk pediatric patients who would especially benefit from seasonal influenza vaccination.10 Allen-Dicker and Klompas11 assess the use of electronic laboratory reports, administrative claims, and electronic health records for conducting acute hepatitis A and B surveillance. And Wu et al12 evaluate the utility of clinical decision support in prompting clinicians to order laboratory tests during foodborne outbreaks. These types of studies are important since they provide the base of evidence on which to build sound surveillance practice for the future. Without critical evaluation of this type, new surveillance activities risk wasting limited resources on ineffective collection and analysis of questionable data, with little potential benefit for the public's health. More such studies are needed.

Epidemiologists conducting surveillance today must also be knowledgeable about informatics principles and concepts. The informatics competencies necessary for public health care professionals have been described in detail.13,14 Epidemiologists do not need to be trained informaticians, but they do need to understand the basics of informatics and to effectively partner with informaticians in the design and use of surveillance systems. The need for educating epidemiologists in informatics and involving them in designing surveillance systems using informatics methodology is becoming better recognized, as evidenced by projects and training opportunities geared to the needs of epidemiologists.15

Public health stands the best chance of meeting the challenges facing surveillance today through careful evaluation of new data and methods and effective use of modern informatics principles. This approach is essential if we are to use surveillance information optimally to create knowledge about population health and glean the wisdom to take action to improve people's health.

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