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Standards

Description

Domains go through phases of existence, and the electronic disease surveillance domain is no different. This domain has gone from an experimental phase, where initial prototyping and research tried to define what was possible, to a utility phase where the focus was on determining what tools and data were solving problems for users, to an integration phase where disparate systems that solve individual problems are tied together to solve larger, more complex problems or solve existing problems more efficiently. With the integration phase comes the desire to standardize on many aspects of the problem across these tools, data sets, and organizations. This desire to standardize is based on the assumption that if all parties are using similar language or technology then it will be easier for users and developers to move them from one place to another.

Normally the challenge to the domain is deciding on a vocabulary or technology that allows seamless transitions between all involved. The disease surveillance domain has accomplished this by trying to use some existing standards, such as HL7, and trying to develop some of their own, such as chief complaint-based syndrome definitions. However, the standards that are commonly discussed in this domain are easily misunderstood. These misunderstandings are predominantly a communication and/or educational issue, but they do cause problems in the disease surveillance domain. With the increased use of these standards due to meaningful use initiatives, these problems will continue to grow and be repeated without improved understanding and better communication about standards.

 

Objective

This talk will point out the inconsistencies and misunderstandings of the word "standard". Specifically, it will discuss HL7, syndrome definitions, analytical algorithms, and disease surveillance systems.

Submitted by elamb on
Description

The Decrease Epidemiological Threats with Environmental Controls and Testing (DETECT) program consisted of a four month initiative to provide a two-day in-depth training modified from the National Environmental Health Association (NEHA) Epi-Ready training. In each Public Health Area, Central Office Epidemiology (EPI), Environmental, and Laboratory staff presented FBO information to county and area Public Health staff. To train and equip field staff in the management of foodborne outbreak processes, to establish a Foodborne Outbreak (FBO) Team in each Public Health Area, to establish defined processes and protocols for FBO for improved response.

Submitted by elamb on
Description

Syndromic surveillance systems were designed for early outbreak and bioterrorism event detection. As practical experience shaped development and implementation, these systems became more broadly used for general surveillance and situational awareness, notably influenza-like illness (ILI) monitoring. Beginning in 2006, ISDS engaged partners from state and local health departments to build Distribute, a distributed surveillance network for sharing de-identified aggregate emergency department syndromic surveillance data through existing state and local public health systems. To provide more meaningful cross-jurisdictional comparisons and to allow valid aggregation of syndromic data at the national level, a pilot study was conducted to assess implementation of a common ILI syndrome definition across Distribute.

 

Objective

Assess the feasibility and utility of adopting a common ILI syndrome across participating jurisdictions in the ISDS Distribute project.

Submitted by elamb on
Description

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.

Submitted by knowledge_repo… on
Description

Meaningful Use has increased interest in submission of ELR to public health agencies, prompting these agencies to analyze their reporting process. Tennessee’s reporting regulations require anyone with knowledge of or suspecting a reportable disease or event report to the local health department. Although it is understood that laboratories are more diligent and routine reporters, focus in listing of these events is from the healthcare provider perspective. Public health agencies must acknowledge the differences in provider case reporting and laboratory result reporting. Despite Tennessee Department of Health's (TDH) required use of standardized vocabulary for ELR such as Logical Observation Identifiers Names and Codes (LOINC) to identify the test performed and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) to identify organism names, ordinal results, and specimen type, internally inconsistent information in messages has been identified. For example, a performed test with LOINC value 13950-1 encodes for a hepatitis A virus IgM antibody test from serum or plasma using an enzyme immunoassay (EIA) and calls for an ordinal result. However the sender describes a Hepatitis C Antibody (Anti HCV) test and provides a numeric result. In order to achieve semantic understanding of the actionable content of ELR messages, a systematic means to document and validate vocabulary is needed.

Objective

To develop a means for validating standardized vocabulary used to report laboratory events via prescribed electronic laboratory reporting (ELR) standards and implementation guides in order to limit internally inconsistent information within ELR messages intended for public health action.

Submitted by knowledge_repo… on
Description

The use of health information systems to electronically deliver clinical data necessary for notifiable disease surveillance is growing. For health information systems to be effective at improving population surveillance functions, semantic interoperability is necessary. Semantic interoperability is “the ability to import utterances from another computer without prior negotiation” (1). Semantic interoperability is achieved through the use of standardized vocabularies which define orthogonal concepts to represent the utterances emitted by information systems. There are standard, mature, and internationally recognized vocabularies for describing tests and results for notifiable disease reporting through ELR (2). Logical Observation Identifiers Names and Codes (LOINC) identify the specific lab test performed. Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) identify the diseases and organisms tested for in a lab test. Many commercial laboratory and hospital information systems claim to support LOINC and SNOMED CT on their company websites and in marketing materials, and systems certified for Meaningful Use are required to support LOINC and SNOMED CT. There is little empirical evidence on the use of semantic interoperability standards in practice.

Objective:

To characterize the use of standardized vocabularies in real-world electronic laboratory reporting (ELR) messages sent to public health agencies for surveillance.

 

Submitted by Magou on
Description

Advanced surveillance systems require expertise from the fields of medicine, epidemiology, biostatistics, and information technology to develop a surveillance application that will automatically acquire, archive, process and present data to the user. Additionally, for a surveillance system to be most useful, it must adapt to the changing environment in which it operates to accommodate emerging public health events that could not be conceived of when the initial system was developed.

 

Objective

The objective of this presentation is to describe both within-discipline and across-discipline changes to standard methods and operating procedures that must be adopted to achieve automated systems that will be an effective complement and extension to traditional disease surveillance. This presentation describes adaptations already in place, as well as those still needed to rapidly recognize and respond to public health emergencies.

Submitted by elamb on
Description

A syndromic surveillance system has been implemented at Kingston, Frontenac and Lennox & Addington Public Health in Kingston Ontario as part of a pilot project funded by the Ontario Ministry of Health and Long-Term Care – Public Health Division. The information captured by the Real-time Outbreak and Disease Surveillance-based syndromic surveillance system includes Febrile Respiratory Illness screening results (implemented since SARS) for Emergency Department (ED) visits and information detailing hospital admissions.

 

Objective

To use an electronic real-time ED monitoring tool to involve public health, acute care and laboratory stakeholders in an integrated alerting and response process for community-wide influenza.

Submitted by elamb on
Description

This research aims to determine the catchment area of Miami Children's Hospital Emergency Department (ED). The purpose is to identify pediatric populations and territories within Miami-Dade County that are insufficiently covered by this hospital's ED.

Submitted by elamb on
Description

Influenza epidemics occur seasonally, impose a high economic burden on the health care system, and are responsible for substantial morbidity and mortality (1). The past century has seen three influenza A pandemics with variable severity. The recent outbreaks of avian influenza involving different virus strains in Asia, North America and the Netherlands, indicates the increasing potential of a new influenza pandemic (2). Public and political awareness needs to be strengthened while public health surveillance strategies need significant improvements if we are to mitigate such a potentially devastating worldwide pandemic, and provide the healthcare system with as much early warning as possible to enhance preparedness. Telehealth Ontario is a provincial telephone helpline for health information staffed by nurses that, if monitored on a real-time basis, has the potential to identify increases in seasonal respiratory infection rates. A recent study suggested that Telehealth Ontario respiratory calls reflect the seasonality of diagnosed respiratory illnesses in emergency departments (van Dijk et al., unpublished data), but an estimation of how respiratory pathogens contribute to Telehealth Ontario’s respiratory complaint calls has not been studied.

Objective:

This paper will explore the possibility and utility of monitoring Telehealth Ontario respiratory calls as an efficient public health influenza strategy for early warning by comparing this data source to provincial viral lab data.

Submitted by elamb on