Meaningful Use

Timeliness of emergency room (ER) data is arguably its strongest attribute in terms of its contribution to disease surveillance. Timely data analyses may improve the efficacy of prevention and control measures. There are a number of studies that have looked at timeliness prior to the advent of Meaningful Use, and these studies note that ER data were not fast enough for them to be useful in real time2,3. However, the change in messaging practices in the Meaningful Use era potentially changes this. Other studies have shown that changes in processes and protocol can dramatically improve timeliness1,4 and this motivates the current study of timeliness to identify processes that can be changed to improve timeliness.

Objective:

To explore the timeliness of emergency room surveillance data after the advent of federal Meaningful Use initiatives and determine potential areas for improvement.

With increasing availability of syndromic meaningful use data, new approaches to disease surveillance utilizing linkages to other data systems are possible. Expanded communicable disease information may be valuable during outbreaks or other public health emergencies. San Diego County is experiencing a significant and protracted hepatitis A outbreak. The disease has been transmitted person-to-person through close contact or through a fecally-contaminated environment, and has been primarily affecting homeless people and injection and non-injection illicit drug users. As of August 31, 2017, there were nearly 400 cases with 15 deaths. Approximately, 70% of the cases were hospitalized. This is one of the nation’s largest hepatitis A outbreaks since the introduction of the hepatitis A vaccine in 1995. Additional cases are expected over the next twelve months. The population affected by this outbreak presents some challenges for outbreak response. It is often a difficult population to reach. In addition, many have multiple comorbidities and often have health care seeking behaviors that differ from the general population. Using the medical record number (MRN) to link hepatitis A disease cases from the communicable disease registry to syndromic HL7 messages for emergency department visits and hospitalizations enabled the identification of additional hospital encounters the cases may have had before, during, or following their hepatitis A disease incident. This allowed an exploration of the ways in which this unique population interacted with the health care system in the context of a communicable disease outbreak. This presentation will highlight the steps to link information across surveillance systems, the results, the challenges, and the benefits of linked information to public health departments.

Objective:

To describe how the County of San Diego linked information from a communicable disease registry and syndromic surveillance system to further describe cases associated with a large hepatitis A outbreak. Specifically, to detail the linkage process which resulted in a longitudinal understanding of individuals’ hospital visits before, during, and after the reported hepatitis A incident.

In 2005, the Cook County Department of Public Health (CCDPH) began using the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) as an emergency department (ED)-based local syndromic surveillance program (LSSP); 23 (100%) of 23 hospitals in suburban Cook County report to the LSSP. Data are transmitted in delimited ASCII text files (i.e., flat files) and contain a unique patient identifier, visit date and time, zip code, age, sex, and chief complaint. Discharge diagnosis and disposition are optional data elements. Prior to 2017, the Illinois Department of Public Health placed facilities participating in the Cook LSSP in a holding queue to transform their flat file submissions into a HL7 compliant message; however as of 2017, eligible hospitals must submit HL7 formatted production data to IDPH to fulfill Meaningful Use. The primary syndromic surveillance system for Illinois is the National Syndromic Surveillance Program (NSSP), which transitioned to an ESSENCE interface in 2016. As of December 2016, 20 (87%) of 23 hospitals reporting to the LSSP also reported to IDPH and the NSSP. As both syndromic surveillance systems aim to collect the same data, and now can be analyzed with the same interface, CCDPH sought to compare the LSSP and NSSP for data completeness, consistency, and other attributes.

Objective:

This analysis was undertaken to determine how the data completeness, consistency, and other attributes of our local syndromic surveillance program compared to the National Syndromic Surveillance Platform.

As syndromic surveillance reporting became an optional activity under Meaningful Use Stage 3 and incentive funds are slated to end completely in 2021, Washington State sought to protect syndromic reporting from emergency departments. As of December 2016, Washington State emergency departments had received $765,335,529.40 in incentive funding, with facilities receiving an average of three payments of $479,974.04 each.1 Considering the public health importance of syndromic surveillance reporting and the fiscal impact of mandatory reporting, the Washington State Department of Health (WA DOH) sought a new statute to require reporting from all emergency departments within the state.

Objective:

To protect syndromic surveillance data reporting from emergency departments in Washington State beyond the cessation of Meaningful Use incentive funding in 2021.