Dearth Shandy

In 2011, the Centers for Disease Control and Prevention (CDC) released the PHIN Messaging Guide for Syndromic Surveillance v. 1. In the intervening years, new technological advancements including Electronic Health Record capabilities, as well as new epidemiological and Meaningful Use requirements have led to the periodic updating and revision of the Message Guide. These updates occurred through informal and semi-structured solicitation and in response to comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the Message Guide v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the Message Guide in a more systematic manner and released further updates via an Erratum and a technical document developed with the National Institute of Standards and Technology (NIST) to clarify validation policies and certification parameters. This trio of documents were consolidated into the Message Guide v.2.1 release and used to inform the development of the NIST Syndromic Surveillance Test Suite (http://hl7v2-ss-r2-testing.nist.gov/ss-r2/#/home), validate test cases, and develop a new rules-based IG built using NIST's Implementation Guide Authoring and Management Tool (IGAMT). As part of a Cooperative Agreement (CoAg) initiated in 2017, CDC partnered with ISDS to build upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the Message Guide. The goal of this CoAg is have the final product become an HL7 Standard for Trial Use following the second phase of formal HL7 balloting in Fall 2018.

Objective: To describe the latest revisions and modifications to the œHL7 2.5.1 Implementation Guide for Syndromic Surveillance (formerly the PHIN Message Guide for Syndromic Surveillance) that were made based on community commentary and resolution of feedback from the HL7 balloting process. In addition, the next steps and future activities as the IG becomes an HL7 Standard for Trial Use will be highlighted.

An increase in tuberculosis (TB) among homeless men residing in Marion County, Indiana was noticed in the summer of 2008. The Marion County Public Health Department (MCPHD) hosted screening events at homeless shelters in hopes of finding unidentified cases. To locate men who had a presumptive positive screen, the MCPHD partnered with researchers at Regenstrief Institute (RI) to create an alert for health care providers who use the Gopher patient management system in one of the city's busiest emergency departments. A similar process was used at this facility to impact prescription behavior.[1] A similar method was also used at the New York City Department of Health and Mental Hygiene.[2]

In 2004, the Marion County Public Health Department (MCPHD), which serves a county population over 890,000, began using a real time syndromic surveillance system, ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) to assist in detecting possible disease outbreaks. Today, about 1600 emergency department visits occur daily in Marion County's 14 emergency departments. Epidemiologists from MCPHD have contributed to the city's Extreme Temperature plans for the last few years. While most of the previous increases in heat related illnesses in Marion County have been attributed to prolonged heat exposure in connection with local auto races, the county had not activated the county wide emergency response plan in several years. From Tuesday, July 19 through Friday, July 22, 2011 the Marion County Extreme Temperature plan was put into action in response to several days of a high heat index.

Objective

To evaluate the usefulness of utilizing real time hospital emergency department chief complaint data to estimate counts of patients presenting at emergency departments with heat related illness during the July 2011 Heat Wave in Indianapolis.

In addition to utilizing syndromic surveillance data to respond to public health threats and prepare for major incidents, local health departments can utilize the data to examine patient volumes in the emergency departments (EDs) of local hospitals. The information obtained may be valuable to hospital and clinic administrators who are charged with allocating resources. 

Indianapolis represents 92% of Marion County’s population. The county’s public hospital and clinic network provide care for 1 in 3 county residents who are Medicaid enrollees or uninsured. To assess the need for extended hours at eight public primary care clinics in Marion County, Indiana, this study examined the hospital’s ED volume. We hypothesize that

changes in the ED volume trends that corresponded to the start or end of usual clinic hours (8am-5pm) would be evidence of clinic hours’ impact on ED use.

Objective

This paper highlights the use of syndromic surveillance data to examine daily trends in ED volume at an urban public hospital.

When the Chicago Bears met the Indianapolis Colts for Super Bowl XLI in Miami in January, 2007, fans from multiple regions visited South Florida for the game. In the past, public health departments have instituted heightened local surveillance during mass gatherings due to concerns about increased risk of disease outbreaks. For the first time, in 2007, health departments in all three Super Bowl-related regions already practiced daily disease surveillance using biosurveillance information systems (separate installations of the ESSENCE system, developed at JHUAPL). The situation provided an opportunity to explore ways in which separate surveillance systems could be coordinated for effective, short-term, multijurisdictional surveillance.

Objective

This paper describes an inter-jurisdictional surveillance data sharing effort carried out by public health departments in Miami, Chicago, and Indianapolis in conjunction with Super Bowl XLI.

In 2004, the Indiana State Department of Health (ISDH) partnered with the Regenstrief Institute to begin collecting syndromic data from 14 ED’s to monitor bioterrorism-related events and other public health emergencies. Today, Indiana’s public health emergency surveillance system (PHESS) receives approximately 5,000 daily ED visits as real-time HL7 formatted surveillance data from 55 hospitals. The ISDH analyzes these data using ESSENCE and initiates field investigations when human review deems necessary.1 The Marion County Health Department, located in the state’s capitol and most populous county, is the first local health department in Indiana using ESSENCE.

Objective

This paper describes how local and state stakeholders interact with Indiana’s operational PHESS, including resources allocated to syndromic surveillance activities and methods for managing surveillance data flow. We also describe early successes of the system.

Since October 2004, the Indiana State Health Department and the Marion County Health Department have been developing and using a syndromic surveillance system based on emergency department admission data. The system currently receives standards-based HL7 emergency department visit data, including free-text chief complaints from 72 hospitals throughout the state. Fourteen of these hospitals are in Marion County, which serves the Indianapolis metropolitan region (population 865,000).

Objective

This paper describes how a syndromic surveillance system based on emergency department data may be leveraged for other public health uses.

Syndromic surveillance seeks to systematically leverage health-related data in near "real-time" to understand the health of communities at the local, state, and federal level. The product of this process provides statistical insight on disease trends and healthcare utilization behaviors at the community level which can be used to support essential surveillance functions in governmental public health authorities (PHAs). Syndromic surveillance is particularly useful in supporting public health situational awareness, emergency response management, and outbreak recognition and characterization. Patient encounter data from healthcare settings are a critical inputs for syndromic surveillance; such clinical data provided by hospitals and urgent care centers to PHAs are authorized applicable local and state laws. The capture, transformation, and messaging of these data in a standardized and systematic manner is critical to this entire enterprise. In August 2015, a collaborative effort was initiated between the CDC, ISDS, the Syndromic Surveillance Community, ONC and NIST to update the national electronic messaging standard which enables disparate healthcare systems to capture, structure, and transmit administrative and clinical data for public health surveillance and response. The PHIN Messaging Guide for Syndromic Surveillance -Release 2.0 (2015) provided an HL7 messaging and content reference standard for national, syndromic surveillance electronic health record technology certification as well as a basis for local and state syndromic surveillance messaging implementation guides. This standard was further amended with the release of the PHIN Messaging Guide for Syndromic Surveillance - Release 2.0, Erratum (2015) and the HL7 Version 2.5.1 PHIN Messaging Guide for Syndromic Surveillance- Release 2.0, NIST Clarifications and Validation Guidelines, Version 1.5 (2016). ISDS is now engaged in a process, supported by a CDC Cooperative Agreement, to formally revise the existing guide and generate an HL7 V 2.5.1 Implementation Guide (IG) for Syndromic Surveillance v2.5 for HL7 balloting in 2018. This roundtable will provide a forum to present and discuss the HL7 Balloting process and the outstanding activities in which the Syndromic Surveillance community must participate during the coming months for this activity to be successful.

Objective:

To provide a forum to engage key stakeholders to discuss the process for updating and revising the Implementation Guide (IG) for Syndromic Surveillance (formerly the PHIN Message Guide for Syndromic Surveillance) and underscore the critically of community and stakeholder involvement as the Implementation Guide is vetted through the formal Health Level Seven (Hl7) balloting process in 2018.