Interoperability

The ability to harness data science for use in improving population health and public health surveillance begins with the application of interoperability standards to electronic messaging for data exchange between HIT used by public health authorities (PHAs) and the providers who submit patient data to them. When electronic transmissions between these entities are not based on interoperability standards, the patient data that are exchanged may be incomplete, inaccurate, invalid, and/or untimely. As a result, local PHAs and the Centers for Disease Control and Prevention (CDC) may be unable to fulfill their goals of monitoring public health trends and improving population health.

Objective: To provide tools to generate national and local syndromic surveillance electronic messaging specifications and to test implementations in which the set of requirements have been implemented in order to confirm or refute the conformance to those requirements, thereby promoting healthcare information technology (HIT) interoperability in the public health sector.

Adverse Childhood Experiences (ACEs) have been linked to a variety of detrimental health and social outcomes. In the last 20 years, the association between ACEs with several adult health risk behaviors, conditions, and diseases including suicides, and substance abuse, mental health disturbances and impaired memory, nervous, endocrine and immune systems impairments, and criminal activities have been studied. One of the challenges in studying and timely diagnosis of ACEs is that the links between specific childhood experiences and their health outcomes are not totally clear. Similarly, an integrated dataset builtfrom multiple sources is often required for effective ACEs surveillance. The SPACES project aims at providing a semantic infrastructure to facilitate data sharing and integration and answer causal queries to improve ACEs surveillance.

Objective: We introduce the Semantic Platform for Adverse Childhood Experiences (ACEs) Surveillance (SPACES). It facilitates the access to the relevant integrated information, enables discovering the causality pathways and assists researchers, clinicians, public health practitioners, social workers, and health organization in studying the ACEs, identifying the trends, as well as planning and implementing preventive and therapeutic strategies.

Oregon Health Authority (OHA), in collaboration with the Johns Hopkins University Applied Physics Laboratory, recently implemented Oregon ESSENCE, an automated, electronic syndromic surveillance system. One way to strengthen syndromic surveillance is to include data from multiple sources. We are integrating data from emergency departments, state notifiable conditions and vital statistics, and the Oregon Poison Center (OPC). Implementing ESSENCE in Oregon provided the opportunity to automate poison center surveillance, which was previously done manually. In order to achieve this, OHA needed a daily data feed of OPC data to upload into Oregon ESSENCE servers. For OPC to do this directly, they would have incurred significant costs to develop the necessary electronic infrastructure to query and send the data; furthermore, OPC does not employ IT staff. OHA does not currently have funding available to support IT system interoperability with Oregon ESSENCE, so we sought a low-cost solution that would build upon existing systems that utilized the National Poison Data System (NPDS) web service.

Objective

Enhance Oregon ESSENCE by integrating data from the Oregon Poison Center (OPC) in a cost-effective manner.

National Health IT Initiatives are helping to advance the state of automated disease surveillance through incentives to health care facilities to implement electronic medical records and provide data to health departments and use collaborative systems to enhance quality of care and patient safety. While the emergence of a standard for the transfer of surveillance data is urgently needed, migrating from the current practice to a future standard can be a source of frustration. This project represents collaboration among the CDC BioSense Program, Tarrant County Public Health and the ESSENCE Team at the Johns Hopkins University APL. The objectives of the project are to: develop reusable meaningful use messaging software for ingestion health information exchange data available in Tarrant County, demonstrate the use of this data for supporting surveillance, demonstrate the ability to share data for regional and national surveillance using the messaging guide model, and demonstrate how this model can be proliferated among health departments that use ESSENCE by investigating the potential use of cloud technology. The presentation will outline the steps for achieving this goal.

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.

The development of a real time surveillance system for Forces on duty areas is one of the 5 initiatives of the November 2002 Prague’s NATO meeting. The French Military Health Service has decided to implement a military demonstrator within Forces in operations in a tropical area. This military prototype has three main objectives : i) to study the feasability of real time surveillance system within Forces in operations ii) to evaluate the benefit of such a system and iii) to develop a interoperable system for NATO. This French real time system has been developped by a multidisciplinary team, with military people but also with civilian experts from Pasteur Institute and Mediterranean University of Marseille.

Objective

This paper describes the new real time surveillance system, which has been installed within the French Forces in French Guiana.