Pavlin Julie

Since the largest epidemic of Zaire ebolavirus (EBOV) in recorded history began in Guinea in December 2013, the epidemic has spread to neighboring countries of Liberia and Sierra Leone resulting in an estimation of over 27,000 total cases and over 11,000 deaths to date. In response to the widespread social disruption caused by this epidemic in West Africa, President Obama committed approximately 2,000 US service members to deploy to the region and provide humanitarian aid. US military physicians were called upon to evaluate service members returning from West Africa (WA) to rule out EVD. The US military also has a considerable number of beneficiaries who travel to WA to visit friends and relatives placing them at risk for exposure to EBOV and the development of illness upon returning to the US.

We are conducting an expanded surveillance program that employs a standard questionnaire that all providers can use when evaluating a patient at-risk for EVD that will also capture information from historical encounters. The data collected from the questionnaire will be used to assess the frequency with which clinicians are called to evaluate patients for EVD and the resources required. However, we realize that many encounters may not be captured with this method, especially those that are not high enough risk to require consultation with infectious disease (ID) specialists, and are developing ways to screen the Electronic Health Record (EHR) to find additional patients.

Objective

To present methods of screening chief complaints and laboratory orders to find patients who presented for Ebola Virus Disease (EVD) screening, in order to determine the impact Ebola concern had on the Military Health System (MHS).

On October 1, 2015, the number of ICD codes will expand from 14,000 in version 9 to 68,000 in version 10. The new code set will increase the specificity of reporting, allowing more information to be conveyed in a single code. It is anticipated that the conversion will have a significant impact on public health surveillance by enhancing the capture of reportable diseases, injuries, and conditions of public health importance that have traditionally been the target of syndromic surveillance monitoring. For public health departments, the upcoming conversion poses a number of challenges, including: 1) Constraints in allocating resources to modify existing systems to accommodate the new code set, 2) Lack of ICD-10 expertise and training to identify which codes are most appropriate for surveillance, 3) Mapping syndrome definitions across code sets, 4) Limited understanding of the precise ICD-10 CM codes that will be used in the US Healthcare system, and 5) Adjusting for changes in trends over time that are due to transitions in usage of codes by providers and billing systems. To accommodate the ICD-9 to ICD-10 transition, the Centers of Disease Control and Prevention (CDC) partnered with the International Society of Disease Surveillance (ISDS) CoP to form a workgroup to develop the Master Mapping Reference Table (MMRT). This tool maps over 130 syndromes across the two coding systems to assist agencies in modifying existing database structures, extraction rules, and messaging guides, as well as revising established syndromic surveillance definitions and underlying analytic and business rules.

Objective

This roundtable will provide a forum for the syndromic surveillance Community of Practice (CoP) to discuss the public health impacts from the ICD-10-CM conversion, and to support jurisdictional public health practices with this transition. It will be an opportunity to discuss key impacts on disease surveillance and implementation challenges; and identify solutions, best practices, and needs for technical assistance.

As of October 1, 2015, all HIPAA covered entities transition from the use of International Classification of Diseases version 9 (ICD-9-CM) to version 10 (ICD-10-CM/PCS). Many Public Health surveillance entities receive, interpret, analyze, and report ICD-9 encoded data, which will all be significantly impacted by the transition. Public health agencies will need to modify existing database structures, extraction rules, and messaging guides, as well as revise established syndromic surveillance definitions and underlying analytic and business rules to accommodate this transition. Implementation challenges include resource, funding, and time constraints for code translation and syndrome classification, and developing statistical methodologies to accommodate changes to coding practices.

To address these challenges, the International Society for Disease Surveillance (ISDS), in consultation with the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE), has conducted a project to develop consensus-driven syndrome definitions based on ICD- 10-CM codes. The goal was to have the newly created ICD-9-CM to-ICD-10-CM mappings and corresponding syndromic definitions fully reviewed and vetted by the syndromic surveillance community, which relies on these codes for routine surveillance, as well as for research purposes. The mappings may be leveraged by other federal, state, and local public health entities to better prepare and improve the surveillance, analytics, and reporting activities impacted by the ICD-10-CM transition.

Objective

To describe the process undertaken to translate syndromic surveillance syndromes and sub-syndromes consisting of ICD-9 CM diagnostic codes to syndromes and sub-syndromes consisting of ICD-10-CM codes, and how these translations can be used to improve syndromic surveillance practice.

The Joint Incentive Fund (JIF) Authorization creates innovative DoD/VA sharing initiatives. In 2009, DoD and VA commenced a biosurveillance JIF project whose principle objectives include improved situational awareness of combined VA/ DoD populations 1 and determining the optimal business model allowing both agency biosurveillance programs to operate more efficiently by: 1) consolidating information technology assets; 2) targeting enhanced collaboration for improved public health outcomes; and 3) improving buying power, and return on investment. We analyzed various interoperability models aimed at biosurveillance data sharing, asset consolidation and enhanced collaboration. Potential end states to be evaluated include maintaining separate Departmental systems, bidirectional exchange of data to separately managed systems, consolidation of data within one Department and shared access to a common system, consolidation of data in a neutral repository accessed by separately run legacy systems, or a custom developed biosurveillance solution utilizing a common data repository.

Objective

Determine an optimal course of action for achieving a more mission and cost-effective model for implementing combined or collaborative biosurveillance across the Departments of Veterans Affairs (VA) and Defense (DoD).