Trepanier Dave

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.

The Indiana Public Health Emergency Surveillance System (PHESS) currently receives approximately 5,000 near real-time chief complaint messages from 55 hospital emergency departments daily.  The ISDH partners with the Regenstrief Institute to process, batch, and transmit data every three hours.  The Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) tool is utilized to analyze these chief complaint data and visualize generated alerts.1   

 

The ISDH syndromic surveillance team discovered that certain chief complaints of interest were coded into the “other” syndrome and not visible in typical daily alert data.  Staff determined that even a single chief complaint containing keywords related to specific reportable diseases could be of significant public health value and should be made available to investigating epidemiologists.2 

 

In addition, data quality is critical to the success of the program and must be evaluated to ensure optimal system performance.  Metrics related to data flow and completeness were identified to serve as indicators of hospital connectivity or coding problems.  These measures included the percent change in daily admits and the proportion of chief complaints missing the patient address.

Objective

This paper describes the development of targeted query tools and processes designed to maximize the extraction of information from, and improve the quality of, the hospital emergency department chief complaint data stream utilized by the Indiana State Department of Health (ISDH) for syndromic surveillance.

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.

In 2011, the CDC released the PHIN Implementation Guide (IG) for Syndromic Surveillance v.1 under the Public Health Information Network. In the intervening years, new technological advancements, EHR capabilities as well as epidemiological and Meaningful Use requirements have led to the periodic update and revision of the IG through informal and semi-structured solicitation and collection of comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the IG v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the IG in a more systematic manner and released further updates via an Erratum and a technical document developed with NIST to clarify validation policies and testing parameters. These 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), Validation 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 initiated in 2017, CDC and ISDS built upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the IG with the goal of having the final product to become an "HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance Standard for Trial Use" following a formal HL7 balloting process in 2018.

Objective:

To describe the process to update the Implementation Guide (IG) for Syndromic Surveillance via community and stakeholder engagement and highlight significant modifications as the IG is vetted through the formal HL7 balloting process.