Ishikawa Charlie

Intense stress can severely degrade one's ability to process and utilize new kinds of information.1 This psychological phenomena may partially explain why epidemiologist are challenged to communicate and establish the value of SyS information with emergency management professionals (EMPs). Despite the timely and useful insights that SyS data and methods can provide, it is very difficult to convey what these data are when EMPs and epidemiologists are working to make intense, highly-scrutinized and high-consequence emergency decisions. If state and local authorities want emergency plans and responses that benefit from the powerful insights that SyS can provide, epidemiologists need to learn how to best report information and establish a strong rapport before emergencies strike. Over the past ten months, ISDS’s NSSP’s Syndromic Surveillance and Public Health Emergency Preparedness, Response and Recovery (SPHERR) Committee has worked to identify gaps, potential best practices, document use cases, and identify tools for integration of SyS data in EM activities. During SPHERR practice exchange meetings, SyS professionals have consistently cited effective communication between SyS staff and emergency preparedness staff as a top priority in integrating SyS more fully into all phases of emergencies.

Objective: Identify and document strategies that enhance the value of syndromic surveillance (SyS) data and information for the response, recovery, mitigation and preparedness needs of local and state emergency management professionals in the U.S.

During the past decade, public health practitioners have implemented various new syndromic and other advanced surveillance systems to supplement their existing laboratory testing and disease surveillance toolkit. While much of the development and widespread implementation of these systems had been supported by public health preparedness funding, the reduction of these monies has greatly constrained the ability of public health agencies to staff and maintain these systems. The appearance of H3N2v and other novel influenza A viruses, requires agencies to carefully choose which systems will provide the most cost-effective data to support their public health practice. The global emergence of influenza A H7N9, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and other viruses associated with high mortality, emphasize the importance of maintaining vigilance for the presence of emerging disease.

Objective

To review approaches used by public health agencies for alerting health care providers and enhancing surveillance systems to identify the presence of novel respiratory disease and to characterize their recent experience in searching for globally emerging viruses.

The field of syndromic surveillance has received increased attention over the past decade as an expansion of traditional disease detection methods. There is, however, little or no consensus, regarding a standard definition encompassing the full scope of the term 'syndromic surveillance'. Several researchers have proposed at least 36 alternative names to differentiate various forms of syndromic surveillance but none has taken hold (including early warning, health indicator surveillance, enhanced surveillance, among others). Katz et al presented a redefining of syndromic surveillance as two overarching categories of 'syndrome based'“ versus 'syndrome non-specific'“ surveillance1. In addition, the Meaningful Use Stage 2 standard for syndromic surveillance includes both pre-diagnostic and diagnostic data elements, further broadening the scope of this surveillance method.

Objective

To provide a forum for stakeholders from various sectors of syndromic surveillance research and practice to discuss and establish a more accurate and comprehensive yet succinct definition of syndromic surveillance, based on lessons learned and innovations in public health surveillance practice.

In the U.S., federal programs are accelerating the meaningful use of electronic health record (EHR) technology and encouraging greater standardization in how governmental public health agencies (PHAs) establish surveillance data partnerships with healthcare providers. To qualify for the benefits of these federal programs (a.k.a., Meaningful Use), healthcare professionals and hospitals must determine: 1) Whether their jurisdictional PHA collects health data for immunization or cancer registries, reportable diseases, and/or syndromic surveillance; and 2) If the PHA does collect this data, then they must register for data on-boarding with the PHA and actively work with them to establish on-going data exchange. These requirements are predicated on participating state and local PHAs either establishing new or expanding the capacity of their existing public health data reporting services. To assist state and local PHAs in this effort, the U.S. Centers for Disease Control and Prevention (CDC) facilitates a national task force, known as the Stage 2 MU Public Health Reporting Requirements Task Force, which has recommended guidelines and clarified requirements for these new processes.

Objective

To exchange lessons learned and refine national guidelines for public health agencies to declare Meaningful Use readiness, register eligible professionals and hospitals for the public health meaningful use objectives, on-board data providers, and perform "on-going" data submission.

In 2010, as rules for the Centers for Medicaid and Medicare Electronic Heatlh Record (EHR) Incentive Programs (Meaningful Use)(1), were finalized, ISDS became aware of a trend towards new EHR systems capturing or sending emergency department (ED) chief complaint (CC) data as structured variables without including the free-text. This perceived shift in technology was occurring in the absence of consensus-based technical requirements for syndromic surveillance and survey data on the value of free-text CC to public health practice. On 1/31/11, ISDS, in collaboration with CDC BioSense, recommended a core set of data for public health syndromic surveillance (PHSS) to support public health's participation in Meaningful Use.

Objective

This study was conducted to better support a requirement for ED CC as free-text, by investigating the relationship between the unstructured, free-text form of CC data and its usefulness in public health practice. To better inform health IT standardization practices, specifically related to Meaningful Use, by describing how US public health agencies use unstructured, free-text EHR data to monitor, assess, investigate and manage issues of public health interest.

Lack of speed, reliability, and uniformity of data collection limit the ability of syndromic surveillance (SyS) systems to provide public health authorities (PHAs) with timely information on community health threats and trends. Electronic information technologies have long been used to accelerate and automate data collection for more real-time surveillance. There is, however, irregularity in how SyS data are packaged and sent by healthcare providers. In the US, federal programs to improve patient and population health outcomes are promoting enhanced EHR technology interoperability with a newly mandated standard for SyS data communication. Under a federal rule tied to Medicare and Medicaid reimbursement rates, hospitals are now required to provide SyS data to PHAs using HL7 2.5.1 messages that are in conformance with the CDC’s Public Health Information Network (PHIN) guide for SyS. Merely mandating this standard, however, does not necessarily mean that it will be used as intended or that EHR SyS data will be interoperable among systems. Technology standards are frequently implemented with inconsistencies that spring from guidance ambiguities or misinterpretations. Inserting thorough conformance testing early in the technology development life cycle can increase the probability of conformance to standards, interoperability, and product reliability while reducing overall costs.

Objective

Describe how the National Institute of Standards and Technology's (NIST) Syndromic Surveillance Messaging Validation Suite supports federal efforts to increase electronic health record (EHR) interoperability for timelier public health surveillance capabilities in the US.

Inter-jurisdictional data sharing can enhance disease surveillance capabilities for local, state, regional and national public health situational awareness and response. BioSense 2.0, a cloud-based computing platform for syndromic surveillance, provides participating local, state and federal health jurisdictions with the ability to share aggregated data; a functionality that is easily activated by selecting an administrative checkbox within the BioSense application. Checking the data-sharing box, however, is a considerable decision that comes with benefits and consequences. On May 20-21, 2013, nine city, county, and state public health department jurisdictions (mainly from the mid-western region of the U.S.) met to explore data sharing for Heat Related Illness (HRI) surveillance using BioSense 2.0. During the workshop, all participants agreed to share data (using the BioSense 2.0 front-end application) in real-time to investigate HRI trends in regional populations during May-August 2012, evaluated HRI case-definitions, and documented benefits and barriers to inter-jurisdictional data sharing. The workshop was convened by ISDS, in collaboration with the Association of State and Territorial Health Officials (ASTHO), with the support of the U.S. Centers for Disease Control and Prevention. Staff from BioSense programmatic and technical teams were also present for the workshop.

Objective

Build upon the findings of a Regional Data Sharing workshop with the larger surveillance community to more clearly describe the benefits, barriers, and needs for data sharing on the BioSense 2.0 platform.