scholarly journals Mandating Syndromic Surveillance Reporting from Emergency Departments: The Washington Experience

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Amanda D. Morse ◽  
Natasha Close ◽  
Cynthia Harry ◽  
Kevin Wickersham
Keyword(s):  
Public Health ◽  
Emergency Departments ◽  
Syndromic Surveillance ◽  
Meaningful Use ◽  
Data Access ◽  
Washington State ◽  
State Agencies ◽  
Local Health ◽  
Diverse Group ◽  
Legislative Session

ObjectiveTo protect syndromic surveillance data reporting from emergency departments in Washington State beyond the cessation of Meaningful Use incentive funding in 2021.IntroductionAs 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.1Considering 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.MethodsStakeholder negotiations occurred in four distinct phases: initial outreach to gauge support for the proposed legislation and solicit comments on items for inclusion in the bill language (April to October 2016), negotiations on the proposed text (October 2016 to January 2017), sustained contact with key groups during the legislative session (January to May 2017), and targeted messaging and comment solicitation to inform the development of the administrative codes to accompany the statute (May 2017 to March 2018) (Figure 1). WA DOH secured funding from the Washington Traffic Safety Commission (WTSC) to hire a designated staff member to coordinate and lead the syndromic surveillance program’s legislative agenda.ResultsDuring the first phase, WA DOH contacted a diverse group of stakeholders, including 7 state agencies, 5 data provider groups, 3 professional associations, 3 public health non-profits, 35 local health jurisdictions, and 29 Tribal Organizations to provide information on syndromic surveillance and gauge interest in the proposed legislation. Key partners included the WTSC, the Washington State Hospital Administration (WSHA), the Washington Poison Center (WAPC), and several large to medium-sized local health jurisdictions (LHJs).Early stakeholder negotiations indicated broad support among local health jurisdictions, state agencies, programs handling violence and injury topics, communicable disease specialists, the Department of Labor and Industries, and the Office of Financial Management; however, support from data providers was more cautious. Early relationship-building and maintaining frequent contact was key to securing support from data providers and allowed WA DOH to draft a mid-session amendment to the bill granting greater data access for providers and clarifying the foundational fee structure for data distribution.During the second phase of outreach and communication, areas of more intense negotiation included data access levels for providers, timeliness of data availability, and the proposed inclusion of a “sundown clause” which would end the effective period of the statute when federal incentive spending expired.WA DOH secured bipartisan co-sponsorship for the bill in the Washington State Senate and stakeholder negotiations continued throughout the legislative session (January-May 2017). Common concerns from stakeholders and legislators included the maintenance of patient privacy, the costs associated with participation for emergency departments, and data sharing agreements with facilities providing syndromic data.The bill passed unanimously out of the Washington State Senate and with broad bipartisan support out of the Washington State House. Governor Jay Inslee signed the bill into law on May 5, 2017 and WA DOH has continued negotiations as they develop the administrative codes to accompany the statute.ConclusionsBroad and sustained interactions with a diverse group of stakeholders, as well as willingness to compromise on data sharing and cost issues with providers, was key to Washington State’s successful effort to mandate syndromic surveillance reporting from emergency departments.References1. Medicare and Medicaid Incentive Provider Payments By State, Program Type and Provider Type January 2011 to December 2016. Centers for Medicare and Medicaid. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/December2016_PaymentsbyStateProgramandProvider.pdf Last accessed: 11 September 2017. 

scholarly journals Lessons Learned from a DoD and Virginia Data Sharing Pilot using NSSP ESSENCE

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Erin E. Austin ◽  
Paul E. Lewis ◽  
Arden Norfleet ◽  
Jamaal Russell
Keyword(s):  
Public Health ◽  
Data Sharing ◽  
Syndromic Surveillance ◽  
Data Access ◽  
Pilot Project ◽  
Lessons Learned ◽  
Surveillance Data ◽  
Service Members ◽  
Local Health ◽  
Health Departments

ObjectiveThis panel will focus on the experiences from the Department of Defense (DoD) and Virginia Department of Health (VDH) data sharing project using the National Syndromic Surveillance Program (NSSP) ESSENCE and will discuss lessons learned, challenges, and recommendations within the following areas: 1) data sharing authority, 2) coordination and implementation of data sharing with a focus on personnel, training, and managing access and 3) communication between local, state, and federal agencies.IntroductionThe DoD and VDH both maintain local ESSENCE installations to monitor the health status of their military and civilian populations, respectively, and submit syndromic surveillance data to the NSSP ESSENCE to foster data sharing and collaborative initiatives among public health entities. Military Treatment Facilities (MTFs), housed on DoD installations, provide healthcare to all service members and their beneficiaries stationed in the area. Service members and their beneficiaries represent a substantial portion of the local community and interact with the civilian population throughout daily activities. Sharing syndromic surveillance data between DoD and public health jurisdictions can provide public health situational awareness among both civilian and military populations to support disease surveillance. DoD and VDH engaged in a pilot project to develop processes and procedures for data sharing, data access, and communication with the aim they can serve as best practices for other jurisdictions seeking to share syndromic surveillance data with DoD.DescriptionThe pilot project began in June 2018 with the Centers for Disease Control and Prevention (CDC) NSSP team providing technical support. NSSP ESSENCE users from the VDH state and local health departments across nine Virginia city/counties participated in the project. VDH shared syndromic surveillance data from 34 healthcare facilities (17 urgent cares, 3 emergency care centers, and 14 hospitals) with DoD, which shared syndromic surveillance data from 18 MTFs (16 clinics and 2 hospitals) in Virginia. To standardize the analysis of syndromic surveillance data and use of NSSP ESSENCE across project participants, myESSENCE tabs were created and shared by between VDH and DoD. The goal was to facilitate and enhance communication between local public health departments and their DoD counterparts through the sharing of syndromic surveillance data.How the Moderator Intends to Engage the Audience in Discussions on the TopicThe moderator will solicit feedback from the audience regarding their data sharing experiences with other entities or agencies, data sharing practices, and ideas for use cases when sharing syndromic surveillance data with DoD.

scholarly journals Precision public health through clinic-based syndromic surveillance in communities

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Ta-Chien Chan ◽  
Yung-Chu Teng ◽  
Yen-Hua Chu ◽  
Tzu-Yu Lin
Keyword(s):  
Public Health ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Syndromic Surveillance ◽  
Early Stage ◽  
Age Distribution ◽  
Local Health ◽  
Syndromic Surveillance System ◽  
Taipei City ◽  
Kaohsiung City

ObjectiveSentinel physician surveillance in the communities has played an important role in detecting early aberrations in epidemics. The traditional approach is to ask primary care physicians to actively report some diseases such as influenza-like illness (ILI), and hand, foot, and mouth disease (HFMD) to health authorities on a weekly basis. However, this is labor-intensive and time-consuming work. In this study, we try to set up an automatic sentinel surveillance system to detect 23 syndromic groups in the communites.IntroductionIn December 2009, Taiwan’s CDC stopped its sentinel physician surveillance system. Currently, infectious disease surveillance systems in Taiwan rely on not only the national notifiable disease surveillance system but also real-time outbreak and disease surveillance (RODS) from emergency rooms, and the outpatient and hospitalization surveillance system from National Health Insurance data. However, the timeliness of data exchange and the number of monitored syndromic groups are limited. The spatial resolution of monitoring units is also too coarse, at the city level. Those systems can capture the epidemic situation at the nationwide level, but have difficulty reflecting the real epidemic situation in communities in a timely manner. Based on past epidemic experience, daily and small area surveillance can detect early aberrations. In addition, emerging infectious diseases do not have typical symptoms at the early stage of an epidemic. Traditional disease-based reporting systems cannot capture this kind of signal. Therefore, we have set up a clinic-based surveillance system to monitor 23 kinds of syndromic groups. Through longitudinal surveillance and sensitive statistical models, the system can automatically remind medical practitioners of the epidemic situation of different syndromic groups, and will help them remain vigilant to susceptible patients. Local health departments can take action based on aberrations to prevent an epidemic from getting worse and to reduce the severity of the infected cases.MethodsWe collected data on 23 syndromic groups from participating clinics in Taipei City (in northern Taiwan) and Kaohsiung City (in southern Taiwan). The definitions of 21 of those syndromic groups with ICD-10 diagnoses were adopted from the International Society for Disease Surveillance (https://www.surveillancerepository.org/icd-10-cm-master-mapping-reference-table). The definitions of the other two syndromic groups, including dengue-like illness and enterovirus-like illness, were suggested by infectious disease and emergency medicine specialists.An enhanced sentinel surveillance system named “Sentinel plus” was designed for sentinel clinics and community hospitals. The system was designed with an interactive interface and statistical models for aberration detection. The data will be computed for different combinations of syndromic groups, age groups and gender groups. Every day, each participating clinic will automatically upload the data to the provider of the health information system (HIS) and then the data will be transferred to the research team.This study was approved by the committee of the Institutional Review Board (IRB) at Academia Sinica (AS-IRB02-106262, and AS-IRB02-107139). The databases we used were all stripped of identifying information and thus informed consent of participants was not required.ResultsThis system started to recruit the clinics in May 2018. As of August 2018, there are 89 clinics in Kaohsiung City and 33 clinics and seven community hospitals in Taipei City participating in Sentinel plus. The recruiting process is still ongoing. On average, the monitored volumes of outpatient visits in Kaohsiung City and Taipei City are 5,000 and 14,000 per day.Each clinic is provided one list informing them of the relative importance of syndromic groups, the age distribution of each syndromic group and a time-series chart of outpatient rates at their own clinic. In addition, they can also view the village-level risk map, with different alert colors. In this way, medical practitioners can know what’s going on, not only in their own clinics and communities but also in the surrounding communities.The Department of Health (Figure 1) can know the current increasing and decreasing trends of 23 syndromic groups by red and blue color, respectively. The spatial resolution has four levels including city, township, village and clinic. The map and bar chart represent the difference in outpatient rate between yesterday and the average for the past week. The line chart represents the daily outpatient rates for one selected syndromic group in the past seven days. The age distribution of each syndromic group and age-specific outpatient rates in different syndromic groups can be examined.ConclusionsSentinel plus is still at the early stage of development. The timeliness and the accuracy of the system will be evaluated by comparing with some syndromic groups in emergency rooms and the national notifiable disease surveillance system. The system is designed to assist with surveillance of not only infectious diseases but also some chronic diseases such as asthma. Integrating with external environmental data, Sentinel plus can alert public health workers to implement better intervention for the right population.References1. James W. Buehler AS, Marc Paladini, Paula Soper, Farzad Mostashari: Syndromic Surveillance Practice in the United States: Findings from a Survey of State, Territorial, and Selected Local Health Departments. Advances in Disease Surveillance 2008, 6(3).2. Ding Y, Fei Y, Xu B, Yang J, Yan W, Diwan VK, Sauerborn R, Dong H: Measuring costs of data collection at village clinics by village doctors for a syndromic surveillance system — a cross sectional survey from China. BMC Health Services Research 2015, 15:287.3. Kao JH, Chen CD, Tiger Li ZR, Chan TC, Tung TH, Chu YH, Cheng HY, Liu JW, Shih FY, Shu PY et al.: The Critical Role of Early Dengue Surveillance and Limitations of Clinical Reporting -- Implications for Non-Endemic Countries. PloS one 2016, 11(8):e0160230.4. Chan TC, Hu TH, Hwang JS: Daily forecast of dengue fever incidents for urban villages in a city. International Journal of Health Geographics 2015, 14:9.5. Chan TC, Teng YC, Hwang JS: Detection of influenza-like illness aberrations by directly monitoring Pearson residuals of fitted negative binomial regression models. BMC Public Health 2015, 15:168.6. Ma HT: Syndromic surveillance system for detecting enterovirus outbreaks evaluation and applications in public health. Taipei, Taiwan: National Taiwan University; 2007. 

scholarly journals Application of Syndromic Surveillance to Describe Gunshot-related Injuries in Houston

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Ryan M. Arnold ◽  
Wesley McNeely ◽  
Kasimu Muhetaer ◽  
Biru Yang ◽  
Raouf R. Arafat
Keyword(s):  
Public Health ◽  
United States ◽  
Health Risk ◽  
Real Time ◽  
Emergency Departments ◽  
Syndromic Surveillance ◽  
The United States ◽  
Public Health Risk ◽  
The Past ◽  
Houston Area

Firearm-related injuries pose a substantial public health risk in the United States, and traditional means of studying this issue rely primarily on retrospective analyses. Syndromic surveillance, collected in over 30 Houston area emergency departments, is well suited to characterize and analyze gunshot injuries in the area in near real-time. Over the past two years, more than 900 gunshot-related injury visits were identified using this method, and ArcGIS effectively identified incident densities in ZIP codes throughout Houston. Most patients were males (86.3%), between the ages of 18 and 34 (64.7%).

scholarly journals Regional Governance of Syndromic Surveillance for the Texas Gulf Coast

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Wesley McNeely ◽  
Eunice R. Santos ◽  
Biru Yang ◽  
Kiley Allred ◽  
Raouf R. Arafat
Keyword(s):  
Public Health ◽  
Communities Of Practice ◽  
Syndromic Surveillance ◽  
Health Department ◽  
Regional Governance ◽  
Local Health ◽  
Health Departments ◽  
Care Providers ◽  
Local Health Departments ◽  
Syndromic Surveillance System

ObjectiveDescribe and explain the transition of the syndromic surveillanceprogram at the Houston Health Department (HHD) from being alocally managed and aging system to an ESSENCE system governedby a regional Consortium of public health agencies and stakeholdersin the 13-county area of the southeast Texas.IntroductionSyndromic surveillance systems are large and complex technologyprojects that increasingly require large investments of financial andpolitical capital to be sustainable. What was once a minor surveillancetool in the mid-2000s has evolved into a program that is regardedas valuable to public health yet is increasingly difficult to maintainand operate for local health departments. The Houston HealthDepartment installed a syndromic surveillance system (SyS) sixyears before Meaning Use became known to healthcare communities.The system chosen at the time was the Real-time Outbreak DiseaseSurveillance System (RODS) which, at the time and for its purpose,was a suitable platform for syndromic surveillance. During the past13 years however, maintaining, operating, and growing a SyS by alocal health department has become increasingly difficult. Inclusionin Meaningful Use elevated the importance and profile of syndromicsurveillance such that network growth, transparency of operations,ease of data sharing, and cooperation with other state systems inTexas became program imperatives.MethodsWith support from the informatics group at Tarrant County PublicHealth (TCPH) in the form of mentoring, HHD devised a two prongstrategy to re-invigorate the syndromic program. The first was toreplace RODS with ESSENCE from Johns Hopkins Applied PhysicsLaboratory (JH/APL). The second was to strengthen the regionalnetwork by creating a governance structure that included outsideagencies and stakeholders. The product of this second effort wasthe creation of the Syndromic Surveillance Consortium of SoutheastTexas (SSCSeT) on the Communities of Practice model1usingparliamentary procedure2.ResultsAcquiring ESSENCE and forming SSCSeT were necessary stepsfor the continuing operation of the SyS. The Consortium includesmembers from local health jurisdictions, health care providers, healthpolicy advocates, academicians, and data aggregators. Created asa democratic society, SSCSeT wrote its constitution and by-laws,voted in officers, formed working groups and has begun developingpolicies. The Consortium is cooperating with the Texas Departmentof State Health Services (DSHS) as well as TCPH. Having ESSENCEwill ensure the HHD-SyS will conform to standards being developedin the state and provide a robust syndromic platform for the partnersof the Consortium.ConclusionsSyndromic systems operated by local health departments canadapt to regulatory changes by growing their networks and engagingregional stakeholders using the Communities of Practice model.

scholarly journals Improving Timeliness of Georgia Emergency Room Data

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Lance Ballester ◽  
Karl Soetebier ◽  
Bill Williamson ◽  
Rene Borroto ◽  
Jessica Grippo ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Room ◽  
Disease Control ◽  
Disease Surveillance ◽  
Syndromic Surveillance ◽  
Kernel Density ◽  
Meaningful Use ◽  
Patient Records ◽  
Data Analyses ◽  
Triage Time

ObjectiveTo explore the timeliness of emergency room surveillance data after the advent of federal Meaningful Use initiatives and determine potential areas for improvement.IntroductionTimeliness 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.MethodsER data were collected from March 2017 through September 2017 from both the Georgia Department of Public Health’s (GDPH) State Electronic Notifiable Disease Surveillance System (SendSS) Syndromic Surveillance Module and the Centers for Disease Control and Prevention (CDC) National Syndromic Surveillance Program’s (NSSP) ESSENCE systems. Patients from hospitals missing 10 or more days of data, as well as patients with missing or invalid triage times, and all visits after August 1st were excluded in order to ensure data were representative of a “typical” time period and that a sufficient amount of time was given for visits to arrive from hospitals.The timeliness of individual records was determined in a number of different ways. All timeliness measurements were determined by subtracting the earlier time event from the later time of the event. The overall measure of timeliness is the time between the patient’s triage time and the data being present in the ESSENCE data system. In between, Georgia’s SendSS system receives and processes the data. This is illustrated in Figure 1. Due to the skewed nature of these measures, they were analyzed using medians and Gaussian kernel density plots.ResultsThe study in total included records from 118 Georgia hospitals, 14,203 data files and 1,897,501 patient records. Overall median timeliness of data from Triage Time to being available in SendSS for analyses was 33.62 hours (IQR=28.5), and in ESSENCE was 45.08 hours (IQR=37.05).The distributions of Triage Time of Day, Time Available in SendSS Staging, and Time Available in ESSENCE Analysis can be seen in Figure 2. Additionally, lines were added for when SendSS makes data available for its own analyses and when it sends data to ESSENCE. These latter lines represent places where the SendSS system itself could improve, and potential improved times were noted based on the kernel densities.Peak triage times for Georgia hospitals were between 10 am to 11 pm, shown in black. This represents the ideal timeliness if Hospitals sent their data immediately. However, data was all batched by Georgia hospitals and sent at different times of the day. The distribution of the time patient records arrived at SendSS staging was indicated in blue.During the period of this study, Georgia processed data into its SendSS system at 6:30am and 11:30am every day and sent data to the ESSENCE system at 1pm each day. These times are highlighted on the plot in green, and red respectively. New potential improved times, based on the kernel density of data being available in SendSS staging, are shown in the lighter shades of these colors at 8:30am and 12pm every day, while being sent to ESSENCE at 9am and 12:30pm to ensure time for data to be properly processed. These were determined to be optimal times for reducing lag in the data, however, may not be optimal for daily analysis.The purple line on the plot represents the times that data were available in ESSENCE’s system for analysis. This was notably delayed by a median 4.15 hours after the data was sent to ESSENCE on a typical day.ConclusionsA data driven approach to choosing processing times could improve timeliness of data analyses in the SendSS and ESSENCE systems. By conducting this type of analysis in an ongoing periodic basis, processing lag times can be kept at a minimum.1. Centers for Disease Control. Progress in improving state and local disease surveillance--United States, 2000-2005. MMWR Morbidity and mortality weekly report. 2005;54(33):822-825.2. Jajosky R, Groseclose S. Evaluation of reporting timeliness of public health surveillance systems for infectious diseases. BMC Public Health. 2004;4(1).3. Travers D, Barnett C, Ising A, Waller A. Timeliness of emergency department diagnoses for syndromic surveillance. AMIA Annual Symposium Proceedings. 2006;Vol. 2006:769.4. Ward M, Brandsema P, van Straten E, Bosman A. Electronic reporting improves timeliness and completeness of infectious disease notification, The Netherlands, 2003. Eurosurveillance. 2005;10(1):7-8.

scholarly journals A Meaningful Journey to Onboard Syndromic Data through a Local HIE

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Jeffrey Johnson ◽  
Jessica Yen ◽  
Brit Colanter ◽  
Eric McDonald
Keyword(s):  
Public Health ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Agency ◽  
Meaningful Use ◽  
The United States ◽  
Lessons Learned ◽  
Local Health ◽  
Local Public Health ◽  
Public Health Agencies

This presentation aims to highlight key activities, technical approaches, data discoveries, lessons learned and outcomes achieved while onboarding local hospitals for syndromic Meaningful Use Stage 2 through a local health information exchange. The federal meaningful use initiative is currently a major driver to enable greater establishment of syndromic surveillance capacity across the United States. The role and efforts by local and state public health agencies in the syndromic onboarding process varies greatly. We describe efforts from a local public health agency to onboard, validate and integrate meaningful use syndromic information.

scholarly journals Evaluation Activities from the National Syndromic Surveillance Program

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Sebastian Romano ◽  
Cassandra Davis ◽  
Krystal Collier ◽  
Sara Johnston ◽  
Hana Tesfamichael ◽  
...  
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
Lessons Learned ◽  
Surveillance Data ◽  
Acceptance Testing ◽  
Surveillance Program ◽  
Local Health ◽  
State And Local ◽  
Surveillance Practice

ObjectiveThe objective of this session is to discuss syndromic surveillance evaluation activities. Panel participants will describe contexts and importance of selected evaluation and performance measurement activities in NSSP. Discussions will explore ways to strengthen evaluation in syndromic surveillance activities in the future.IntroductionSyndromic surveillance uses near-real-time Emergency Department healthcare and other data to improve situational awareness and inform activities implemented in response to public health concerns. The National Syndromic Surveillance Program (NSSP) is a collaboration among state and local health departments, the Centers for Disease Control and Prevention (CDC), other federal organizations, and other entities, to strengthen the means for and the practice of syndromic surveillance. NSSP thus strives to strengthen syndromic surveillance at the national and the state, and local levels through the coordinated activities of the involved partners and the development and use of advanced technologies, such as the BioSense platform. Evaluation and performance measurement are crucial to ensure that the various strategies and activities implemented to strengthen syndromic surveillance capacity and practice are effective. Evaluation activities will be discussed at this session and feedback from audience will be sought with the goal to further strengthen evaluation activities in the future.DescriptionSyndromic surveillance practice among NSSP grant recipients: findings from a telephone based survey – S. Romano This presentation will highlight the development and implementation of a survey among the NSSP grant recipients about their syndromic surveillance practice. The objectives of the survey was to develop knowledge and understanding about: a) characteristics of syndromic surveillance practice at the state and local level among jurisdictions that are NSSP grant recipients; b) challenges encountered by these jurisdictions in conducting syndromic surveillance; and c) strategies that may help address these challenges. The objectives and methods of the survey will be described in detail. The survey is expected to be implemented before the end of this year. Preliminary findings will be presented if available. Lessons learned and strategies to consider for strengthening syndromic surveillance practice will be discussed.Defining a sustainable approach to syndromic surveillance through the AZ BioSense Workgroup Charter – K. Collier, S. Johnston The Arizona BioSense Workgroup has developed a five year charter outlining the method and measures used for implementation and adoption of syndromic surveillance in Arizona. Membership consists of clinicians, IT and public health. The mission and vision help to establish a foundation for building capacity and quality of the syndromic surveillance data, improved population health and emergency response through timely and effective use of the data. Cross-cutting topics resulted in a process for assessing training needs, establishing protocols and evaluation of use cases, shared plans for situational awareness and making public health decisions. This talk will discuss the collaborative approach and how lessons learned will inform future activities.User Acceptance Testing to inform development and enhancement of the BioSense Platform – C. Davis Between June, 2016 and January, 2017, NSSP operationalized an updated BioSense Platform for conducting syndromic surveillance. The platform included ESSENCE, a software that enables analysis and visualization of syndromic surveillance data and the Access Management Center, a tool that enables jurisdictions to manage access to data. The development of and transition to the updated platform was informed by a User Acceptance Testing (UAT) that examined the functionality and usability of the platform and associated tools After webinar based orientation UAT, participants were requested to carry out specific tasks using the updated platform and tools in development. This presentation will discuss the objectives and methods of implementation of the UAT, findings from the UAT, and how these guided transition activities and the refinement of the platform applications.A quantitative and qualitative assessment of user support provided by the NSSP Service Desk – H. Tesfamichael, S. Romano A principal component of NSSP is the BioSense platform that includes health care visits related information, particularly related to emergency department visits, from across the U.S. BioSense and its associated tools, including ESSENCE, the Access Management Center, and Adminer, enable state and local health departments, and other, as appropriate, to use syndromic surveillance data to implement surveillance and assessment activities. The NSSP Service Desk provides technical support to BioSense users to assist with the use of the BioSense platform and its tools Users submit support request tickets through an online application. An analysis of information related to these tickets, including the context of the requests and their resolution status, was conducted to better understand the support needs of users and how well these were being addressed. This presentation will discuss the assessment, findings, and conclusions.How the Moderator Intends to Engage the Audience in Discussions on the TopicThe moderator will introduce the session and the panelists. The moderator will also invite questions and comments from the audience, and will facilitate the discussions. 

scholarly journals Syndromic Surveillance – Reports of Successes from the Field

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Antheny Wilson ◽  
Teresa Hamby ◽  
Wei Hou ◽  
David J Swenson ◽  
Krystal Collier ◽  
...  
Keyword(s):  
Public Health ◽  
Data Quality ◽  
Syndromic Surveillance ◽  
Surveillance Program ◽  
Local Health ◽  
Health Departments ◽  
Local Health Departments ◽  
Success Stories ◽  
Department Of Health ◽  
State And Local

Objective: This panel will:● Discuss the importance of identifying and developing success stories● Highlight successes from state and local health departments to show how syndromic surveillance activities enhance situational awareness and address public health concerns● Encourage discussion on how to further efforts for developing and disseminating success storiesIntroduction: Syndromic surveillance uses near-real-time emergency department and other health care data for enhancing public health situational awareness and informing public health activities. In recent years, continued progress has been made in developing and strengthening syndromic surveillance activities. At the national level, syndromic surveillance activities are facilitated by the National Syndromic Surveillance Program (NSSP), a collaboration among state and local health departments, the CDC, other federal organizations, and other organizations that enabled collection of syndromic surveillance data in a timely manner, application of advanced data monitoring and analysis techniques, and sharing of best practices. This panel will highlight the importance of success stories. Examples of successes from state and local health departments will be presented and the audience will be encouraged to provide feedback.Description: ●Success stories – acknowledging and informing syndromic surveillance practiceThis presentation will discuss the importance of success stories for NSSP focused on increasing syndromic surveillance representativeness, improving data quality, and strengthening syndromic surveillance practices among grant recipients and partners. From the beginning of the program, the identification of success stories has been an important part of the efforts to develop knowledge base that better guide syndromic surveillance program activities.●NJ and BioSense – Making The Connection The New Jersey Department of Health (NJDOH) uses Health Monitoring’s EpiCenter as its primary ED data for syndromic surveillance. This data is also submitted to CDC’s NSSP BioSense Platform. In April 2017, a spike in ED Visits of Interest was identified by a CDC NSSP subject matter expert and brought to the attention of NJDOH’s data analyst. Data showed an increase in “Exposure” and “School Exposure” chief complaints in two contiguous counties. News reports showed the visits resulted from a dormitory fire at a university in the area. The NSSP and NJDOH staff collaboration integrated data from both NJDOH’s EpiCenter and CDC’s BioSense Platform for further investigation. This activity shows BioSense Platform’s potential as an additional syndromic surveillance tool because of its different classifications and keyword groupings.●Evaluation and Performance Measures at the Utah Department of HealthSyndromic surveillance related evaluation activities at the Utah Department of Health requires collaboration between subject matter experts and system users from the UT-NSSP workgroup. The progress is examined quarterly and outcomes compared with the short-, mid-, and long-term outcomes listed in the NSSP logic model to ensure activities are in sync with the program’s overall goals. Throughout the budget year, a variety of tools were used to keep track of the progress. During this session, challenges and successes, lessons learned, and effective strategies will be discussed.●NSSP R tool Data Download Useful in NHThe New Hampshire Department of Health and Human Services (NH DHHS) uses the state-wide Automated Hospital Emergency Department Data (AHEDD) system as its primary syndromic surveillance system. A copy of this data is submitted to CDC’s NSSP BioSense Platform. In July of 2017, NH worked with the NSSP vendor, CDC staff, a jurisdictional expert, NH Division of Information Technology staff, and an external vendor to create an “R” software download in CSV format and home-based NSSP Cognos report. This allowed NH DHHS staff to compare these data to the home-based data and ultimately, it proved to be an important step in the NSSP data quality assessment process.●Achieving success to improve data quality through collaborative Community of Practice partnerships The Data Quality Committee is a forum to identify, discuss, and attempt to address syndromic surveillance data quality issues. Maintaining data quality for the chief complaint field is a priority as it can impact the creation and refinement in the successful application of a syndrome definition for one of the fundamental data elements. An issue was observed in the Arizona data in the BioSense Platform, where chief complaint was being truncated at 200 characters. Through efforts to build relationships from the committee in the Community of Practice, Arizona was able to discover the root causes for the issue, assess if it affected other jurisdictions, and work with the partners to find a feasible resolution. This talk will discuss how this collaborative approach helped improve data quality.How the Moderator Intends to Engage the Audience in Discussions on the Topic: The moderator will introduce the session and the panelists, and will invite questions and comments from the audience.

scholarly journals Updates to the HL7 2.5.1 Implementation Guide for Syndromic Surveillance

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Emilie Lamb ◽  
Dave Trepanier ◽  
Shandy Dearth
Keyword(s):  
Public Health ◽  
Syndromic Surveillance ◽  
Review Process ◽  
Meaningful Use ◽  
Management Tool ◽  
Second Phase ◽  
Diverse Range ◽  
Online Portal ◽  
Wide Range ◽  
Icd 10

ObjectiveTo describe the latest revisions and modifications to the “HL7 2.5.1 Implementation Guide for Syndromic Surveillance” (formerly the PHIN Message Guide for Syndromic Surveillance) that were made based on community commentary and resolution of feedback from the HL7 balloting process. In addition, the next steps and future activities as the IG becomes an “HL7 Standard for Trial Use” will be highlighted.IntroductionIn 2011, the Centers for Disease Control and Prevention (CDC) released the PHIN Messaging Guide for Syndromic Surveillance v. 1. In the intervening years, new technological advancements including Electronic Health Record capabilities, as well as new epidemiological and Meaningful Use requirements have led to the periodic updating and revision of the Message Guide. These updates occurred through informal and semi-structured solicitation and in response to comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the Message Guide v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the Message Guide in a more systematic manner and released further updates via an Erratum and a technical document developed with the National Institute of Standards and Technology (NIST) to clarify validation policies and certification parameters. This trio of documents were consolidated into the Message Guide v.2.1 release and used to inform the development of the NIST Syndromic Surveillance Test Suite (http://hl7v2-ss-r2-testing.nist.gov/ss-r2/#/home), validate test cases, and develop a new rules-based IG built using NIST’s Implementation Guide Authoring and Management Tool (IGAMT).As part of a Cooperative Agreement (CoAg) initiated in 2017, CDC partnered with ISDS to build upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the Message Guide. The goal of this CoAg is have the final product become an “HL7 Standard for Trial Use” following the second phase of formal HL7 balloting p in Fall 2018.MethodsISDS coordinated a multi-stakeholder working group to revisit the consolidated Message Guide, v.2.1 and collect structured comments via an online portal, which facilitated the documentation, tracking, and prioritization of comments for developing consensus and reconciliation and resolution when there were errors, conflicts, or differing perspectives for select specifications. Over 220 comments were received during the most recent review period via the HL& balloting process (April – June 2018) with sixteen elements captured for each comment, which included: Subject, Request Type, Clinical Venue Application, Submitter Name, IG Section #, Priority, Working and Final Resolution (Figure 1). The online portal was used to communicate with members of the Message Guide Workgroup to provide feedback directly to one another through a ‘conversation tab’. This became an important feature in teasing out underlying concerns and issues with a given comment across different local, state, and private sector partners (Figure 2). Some comments were able to be fully described and resolved using this feature. Following the HL7 balloting period, ISDS continued the weekly webinar-based review process to delve into specific issues in detail. Each week ISDS staff would lead the webinars structured around similar comment types (e.g. values sets, DG1 Segments, IN1 Segments, Conformance Statements, etc.). This leveraged the expertise of individuals and institutions with concerns revolving around a specific domain, messages segment, or specification described within the Message Guide. Comments for which consensus and resolution was achieved were “closed-out’ on the portal inventory and new assignments for review would be disseminated across the Message Guide Workgroup for consideration and discussion during the subsequent webinar.ResultsTo date this review process has identified and updated a wide-range of specification and requirements described within the Message Guide v.2.0. These include: specifications for persistent patient ID across venues of service, inclusion of the ICD-10-CM value set for diagnosis, removal of the ICD-9-CM requirement for testing and messages, modification of values such as pregnancy status, travel history, and medication list from “O” to “RE”, and the update of value sets and PHIN VADS references for FIPS, SNOmed, ICD-10-CM, Acuity, Patient Class, and Discharge Disposition.ConclusionsThe results of this multi-agency comment and review process will be synthesized and compiled by ISDS. The updated version of the Message Guide (re-branded to the HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance) will go through a second round of review and commentary thru HL7 in Fall 2018.This systematic and structured review and documentation process has allowed for the synthetization and reconciliation of a wide range of disparate specifications, historical hold-overs, and requirements via the perspectives of a diverse range of public health partners. As this review process continues it is anticipated that the final HL7 balloted “Standard for Trial Use” IG 2.5 will represent a more refined and extensible product that can support syndromic surveillance activities across a wider and more diverse range of clinical venues, EHR implementations, and public health authorities.ISDS and CDC have recommended that future modifications to the Promoting Interoperability (PI) Programs (formerly Meaningful Use) reference and require the utilization of the revised Implication Guide for Certification. The HL7 2.5.1 Implementation Guide can be found: https://cdn.ymaws.com/www.healthsurveillance.org/resource/resmgr/docs/Group_Files/Message_Guide/IG_SyS_Release_1.pdf

scholarly journals Engaging Local Health Departments in Disaster Research: A Washington State Survey

2019 ◽  
Vol 14 (2) ◽  
pp. 163-167
Author(s):  
Ali Everhart ◽  
Resham Patel ◽  
Nicole A. Errett
Keyword(s):  
Public Health ◽  
Emergency Preparedness ◽  
Disaster Response ◽  
Online Survey ◽  
Washington State ◽  
Local Health ◽  
Health Departments ◽  
Local Health Departments ◽  
Disaster Research ◽  
Research Activities

AbstractObjective:Disaster research can inform effective, efficient, and evidence-based public health practices and decision making; identify and address knowledge gaps in current disaster preparedness and response efforts; and evaluate disaster response strategies. This study aimed to identify challenges and opportunities experienced by Washington State local health departments (LHDs) regarding engagement in disaster research activities.Methods:An online survey was disseminated to the emergency preparedness representative for the 35 LHDs in Washington State. Survey questions sought to assess familiarity and experience with disaster research, as well as identify facilitators and barriers to their involvement. The survey was first piloted with 7 local and state public health emergency preparedness practitioners.Results:A total of 82.9% of Washington’s 35 LHDs responded to our survey. Only 17.2% of respondents had previous experience with disaster research. Frequently reported barriers to engaging in disaster research included funding availability, competing everyday priorities, staff capacity, and competing priorities during disaster response.Conclusions:These findings can inform efforts to support disaster research partnerships with Washington State LHDs and facilitate future collaboration. Researchers and public health practitioners should develop relationships and work to incorporate disaster research into LHD planning, training, and exercises to foster practice-based disaster research capacity.

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