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Meaningful Use

In response to the terrorist attack of September 11, 2001, the NH Department of Health and Human Services (NH DHHS) engaged state and external partners in the design of an early warning surveillance system to support bioterrorism and emergency preparedness. Initially, NH DHHS began collecting four syndrome counts from thirteen hospital Emergency Departments (ED) by fax. Automation began in 2002, when an over the counter (OTC) syndromic surveillance pilot system was implemented by Scientific Technologies Corporation (STC). In 2003-2004 this system, the Syndromic Tracking and Encounter Management System (STEMS), was expanded to include school absentee and occupational health reports. Over time, an internal Death Data application was automated to query vital record deaths, and in 2005 a real-time ED surveillance pilot, the Automated Hospital ED Data System (AHEDD), was developed by STC to replace manual ED surveillance. Over the past decade NH continued to expand the original concept with innovative approaches to identify undetected or under reported disease outbreaks.

Objective

To illustrate development of syndromic surveillance in NH, share innovation experience with the public health community, and contribute to the syndromic surveillance body of knowledge in the new public health Information Technology landscape.

Referenced File
Submitted by elamb on

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.

Referenced File
Submitted by elamb on

There are currently no federal laws mandating the reporting of infectious diseases to public health authorities. Reporting requirements reside at the state level and such laws do not apply to federal agencies including the VA. Heretofore, VA's reporting of infectious diseases to public health authorities has been strictly voluntary, and has been accomplished via traditional methods (phone, mail, and fax) that are highly prone to human error, create a significant administrative burden, and do not adequately safeguard the privacy of Veterans' data. Previously, without a reporting mandate applicable to VA facilities, public health authorities have had an incomplete picture of the VA contribution to the overall infectious disease burden existing in the larger population. Moreover, at a national level, the VA has not had the ability to monitor the prevalence of the various infectious diseases within its own 151 hospitals and 827 community-based outpatient clinics. Nor has the VA been able to meet the spirit of the Health Information Technology for Clinical and Economic Health Act's Meaningful Use requirements, mandating electronic exchange of information.

Objective

In June 2013, in anticipation of the passage of proposed federal legislation (S 875 and HR 1792), the Department of Veterans Affairs (VA) issued a Directive requiring mandatory reporting of infectious diseases to various public health authorities (VHA Directive 2013-008). In terms of implementation strategies, the ideal is to build on an existing technology, optimize the quality and completeness of reporting, and minimize additional work burdens on VA staff.

Submitted by knowledge_repo… on

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

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

Hospital emergency departments in Cook and surrounding counties currently send data to the Cook County Department of Public Health (CCDPH) instance of ESSENCE on CCDPH servers. The cloud instance of ESSENCE has been enhanced to receive and export all meaningful use data elements in the meaningful use format. The NATO summit provided the opportunity for a demonstration project to assess the ability of an Amazon GovCloud instance of ESSENCE to ingest and process meaningful use data, and to export meaningful use surveillance data to the Cook County Locker in BioSense 2.0.

Objective

In May 2012, thousands of protesters, descended on Chicago during the NATO Summit to voice their concern about social and economic inequality. Given the increased numbers of international and domestic visitors to the Windy City and the tension surrounding protesting during the summit, increased monitoring for health events within the city and Chicago metropolitan region was advised. This project represents the first use of cloud technology to support monitoring for a high profile event.

Submitted by uysz on

MUse will make EHR data increasingly available for public health surveillance. For Stage 2, the Centers for Medicare & Medicaid Services (CMS) regulations will require hospitals and offer an option for eligible professionals to provide electronic syndromic surveillance data to public health. Together, these data can strengthen public health surveillance capabilities and population health outcomes (Figure 1). To facilitate the adoption and effective use of these data to advance population health, public health priorities and system capabilities must shape standards for data exchange. Input from all stakeholders is critical to ensure the feasibility, practicality, and, hence, adoption of any recommendations and data use guidelines.

Objective

To develop national Stage 2 Meaningful Use (MUse) recommendations for syndromic surveillance using hospital inpatient and ambulatory clinical care electronic health record (EHR) data

Submitted by uysz on

The International Society for Disease Surveillance held its eleventh annual conference in San Diego on December 4th and 5th, 2012, under the theme Expanding Collaborations to Chart a New Course in Public Health Surveillance.  During these two days, practitioners and researchers across many disciplines gathered to share best practices, lessons learned and cutting edge approaches to timely disease surveillance.  A record number of abstracts were received, reviewed and presented – the schedule included 99 orals, 4 panels, 94 posters, 5 roundtables and 12 system demonstrations.  Presenters represented 24 different countries from Africa, North and South America, Europe, and Asia .  Topics covered included, but were not limited to, statistical methods for outbreak detection, border health, data quality, evaluation of novel data streams, influenza surveillance, best practices and policies for information sharing, social network analysis, data mining techniques, surveillance during weather events and mass gatherings, syndrome development, and novel uses of syndromic surveillance data.  There were also discussions on the impact of regulations and standards development on disease surveillance, including Meaningful Use and the International Health Regulations.

Submitted by Magou on

In November of 2011 BioSense 2.0 went live to provide tools for public health departments to process, store, and analyze meaningful use syndromic surveillance data. In February of 2012 ESSENCE was adapted to support meaningful use syndromic surveillance data and was installed on the Amazon GovCloud. Tarrant County Public Health Department agreed to pilot the ESSENCE system and evaluate its performance compared to a local version ESSENCE they currently used. The project determined the technical feasibility of utilizing the Internet cloud to perform detailed public health analysis, necessary changes needed to support meaningful use syndromic surveillance data, and any public health benefits that could be gained from the technology or data.

Objective:

This project represents collaboration among CDC’s BioSense Program, Tarrant County Public Health and the ESSENCE Team at the Johns Hopkins University APL. For over six months the Tarrant County Public Health Department has been sending data through the BioSense 2.0 application to a pilot version of ESSENCE on the Amazon GovCloud. This project has demonstrated the ability for local hospitals to send meaningful use syndromic surveillance data to the Internet cloud and provide public health officials tools to analyze the data both using BioSense 2.0 and ESSENCE. The presentation will describe the tools and techniques used to accomplish this, an evaluation of how the system has performed, and lessons learned for future health departments attempting similar projects.

 

Submitted by Magou on

The survey, developed by the ISDS Meaningful Use Business Process Mapping Subgroup, was designed to facilitate conversations between health care facilities and public health departments before and during Meaningful Use implementation and onboarding.

Submitted by ctong on
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