Meaningful Use

Current local, state, and national initiatives related to meaningful use and the modernization of electronic health records, and the growing availability of electronic information exchanges, have become important drivers to establishing syndromic surveillance systems. Effective implementation of electronic syndromic surveillance interfaces requires approaches that ensure the receipt of quality, timely, and reliable information.

While there are published specifications for the HL7 ADT message and National Institute of Standards and Technology (NIST) validation tools, there has been little documentation about the necessary steps for a local public health department to validate and confirm that an interface that is producing consistent and quality information. The lack of effective validation efforts has led to incomplete or inconsistent data utilized by syndromic systems and their intended audiences.

The County of San Diego has developed and utilized a framework for validating new syndromic interfaces. This presentation will highlight several pragmatic methods to validate the HL7 message content, provide specific examples of validation, and describe the pitfalls that could result from a poorly validated syndromic interface.

The Environmental Public Health Tracking Network (Tracking Network) is a national surveillance system that integrates environmental hazard, exposure, and health outcome data into one system. The Tracking Network launched in July 2009, and has since been receiving data from 23 funded state and local health departments, and several national partners, e.g., Environmental Protection Agency. Despite this success, some challenges exist in obtaining more timely and complete data to link risk factors, and assign exposure for health outcomes with long latency periods before their detection.

The Health Information Technology for Economic and Clinical Health (HITECH) Act (2009) facilitates the adoption of electronic health records (EHR) through incentivizing the meaningful use of certified EHR Technology. Meaningful use is a set of specific objectives and data exchange standards that eligible healthcare professionals and hospitals must achieve to qualify for the Centers for Medicare and Medicaid Services (CMS) Electronic Health Records Incentive Programs. Public health agencies in turn need to have the capacity to accept these data in the mandated standard and determine the potential and use of this increased data.

This presentation will discuss how the Tracking Network is exploring the use of EHR to meet Tracking Network surveillance challenges and provide other opportunities to enhance environmental public health surveillance. We will also present some results of these efforts.

Objective

This presentation will discuss how the Tracking Network is exploring the use of EHR to meet Tracking Network surveillance challenges and provide other opportunities to enhance environmental public health surveillance

Data from the Emergency Departments (EDs) of 49 hospitals in New York City (NYC) is sent to the Department of Health and Mental Hygiene (DOHMH) daily as part of the syndromic surveillance system. Currently, thirty-four of the EDs transmit data as flat files. As part of the Center for Medicare and Medicaid Services Electronic Health Record Incentive Program, otherwise known as Meaningful Use, many EDs in our system have switched or are in the process of switching to HL7 Messaging Standard Version 2.5.1. Given there may be differences in data completeness, quality, and content between the new HL7 data and legacy data, we evaluated data sent in both formats in parallel by several EDs.

Objective

To evaluate potential changes in emergency department (ED) syndromic surveillance data quality, as hospitals shift from sending data as flat file format (Legacy Data) to real-time/batch HL7 Messaging Standard Version 2.5.1, in compliance with Meaningful Use requirements.

In 2012, the Oregon Public Health Division (OPHD) took advantage of the opportunity created by Meaningful Use, a Centers for Medicare & Medicaid Services (CMS) Incentive Program, to implement statewide syndromic surveillance. The Oregon syndromic surveillance project, or Oregon ESSENCE, began accepting MUcompliant HL7 2.5.1 data in late 2013. Early onboarding efforts were labor-intensive and led to the creation of a testing queue. As interest in submitting syndromic data increased, Oregon ESSENCE streamlined the onboarding process by creating guidance for HL7 message construction, message testing and submitter business process details (collectively referred to as “onboarding documents”). Oregon ESSENCE also built a project management database to track MU testing statuses and data quality variations. With this system, Oregon ESSENCE collected, tested and approved all 32 eligible health systems (56 hospitals) for production-level submission by mid-2015. One health system (with four hospitals) continued to send non-MU compliant syndromic data for the duration of the project period.

Objective

To design a low budget process to enroll, track and approve syndromic submitters for ongoing submission of data to the Oregon Public Health Division.