Onboarding

The federal meaningful use initiative is a major driver to the establishment of expanded electronic syndromic surveillance capacity across the United States. Much has been documented about the background and requirements for eligible hospitals to achieve the syndromic meaningful use objectives. However, the role and efforts by public health agencies in the syndromic onboarding process, which varies by jurisdiction, is a significant component of the success of meaningful use. 

Objective

This presentation aims to highlight technical approaches, validation activities, outcomes, and lessons learned while onboarding local hospitals through a local health information exchange (HIE) for Meaningful Use Stage 2 syndromic surveillance

One of the greatest hurdles for BioSense Onboarding is the process of validating data received to ensure it contains Data Elements of Interest (DEOI) needed for syndromic surveillance. Efforts to automate this process are critical to meet existing and future demands for facility onboarding requests as well as provide a foundation for data quality assurance efforts. By automating the validation process, BioSense hopes to:

1. Reduce costs associated with the iterative validation process.

2. Improve BioSense response times for assistance with onboarding.

3. Improve documentation to partners about requirements and communicate changes to DEOI.

4. Provide a better foundation for data quality initiatives.

Efforts to improve data validation are being developed in alignment with BioSense future initiatives and will apply to both BioSense, Essence and other BioSense program applications.

BioSense Onboarding identified critical success factors by participating in ISDS workgroup initiatives for Onboarding and Data Quality and soliciting feedback from key jurisdictional partners. These critical success factors include; improved documentation, access to raw data, and faster validation response time.

Objective

This session will inform the BioSense Community about data validation advancements implemented this past year as well as future plans to improve the BioSense validation process to achieve emergency department representativeness goals.

The CMS EHR Incentive Programs include a measure for meaningful use of EHR systems for submitting syndromic surveillance messages to public health. The Stage 2 measure defines the standard for transmission to be HL7 v2.5.1 Admit/Discharge/Transfer messages according to the PHIN Messaging Guide for Syndromic Surveillance and Conformance Clarification for EHR Certification of Electronic Syndromic Surveillance, Addendum to PHIN Messaging Guide for Syndrome Surveillance. The National Institute of Standards and Technology (NIST) provides an online testing tool for validating messages. While some jurisdictions use the Biosense platform for receiving, managing, and analyzing syndromic surveillance data, there is no consistent tool that is available to jurisdictions to assess the quality and conformance of data submissions both at the time of on-boarding a new reporting facility and on an ongoing basis during production operations.

The New York City Citywide Immunization Registry (CIR), the immunization information system for NYC that has been operational since 1997, has as part of its software suite an Open Source, webbased data quality assurance (QA) tool used by its research scientists to qualify new sites for reporting data electronically via HL7 v2 messages, and for monitoring the ongoing quality of data submissions over time. A validation process evaluates incoming messages against the rules established by an implementation guide (IG) and stores the result of the evaluation in a CIR database table that is accessible by the QA Tool which displays the data to an administrative user. This project served as a proof-of-concept for implementing a similar process for syndromic surveillance.

Objective

To leverage an existing open source quality assurance software tool created for the immunization domain and modify it to serve as a quality assurance tool for syndromic surveillance messages.

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.