scholarly journals Forming Collaborations through the Data Quality Committee to Address Urgent Incidents

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Krystal S. Collier ◽  
Sophia Crossen ◽  
Courtney Fitzgerald ◽  
Kaitlyn Ciampaglio ◽  
Lakshmi Radhakrishnan ◽  
...  

ObjectiveThe National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) works to support syndromic surveillance by providing guidance and assistance to help resolve data issues and foster relationships between jurisdictions, stakeholders, and vendors. During this presentation, we will highlight the value of collaboration through the International Society for Disease Surveillance (ISDS) Data Quality Committee (DQC) between jurisdictional sites conducting syndromic surveillance, the Centers for Disease Control and Prevention’s (CDC) NSSP, and electronic health record (EHR) vendors when vendor-specific errors are identified, using a recent incident to illustrate and discuss how this collaboration can work to address suspected data anomalies.IntroductionOn November 20, 2017, several sites participating in the NSSP reported anomalies in their syndromic data. Upon review, it was found that between November 17-18, an EHR vendor’s syndromic product experienced an outage and errors in processing data. The ISDS DQC, NSSP, a large EHR vendor, and many of the affected sites worked together to identify the core issues, evaluate ramifications, and formulate solutions to provide to the entire NSSP CoP.DescriptionOn November 20, 2017, several sites participating in the NSSP reported anomalies in their syndromic data. Upon review, it was found that between November 17-18, an EHR vendor’s syndromic product experienced an outage and errors in processing data. The ISDS DQC, NSSP, a large EHR vendor, and many of the affected sites worked together to identify the core issues, evaluate ramifications, and formulate solutions to provide to the entire NSSP CoP.How the Moderator Intends to Engage the Audience in Discussions on the TopicFollowing presentation of this information, the presenters will lead a discussion on how to improve the response, provide resolution, communicate expectations, and decrease the time required to resolve issues should a similar event happen in the future. Participants from all three stakeholder groups, sites conducting syndromic surveillance, the NSSP, and vendor representatives, will be invited to share their experiences, successes, and concerns.

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Girum S. Ejigu ◽  
Kakshmi Radhakrishnan ◽  
Paul McMurray ◽  
Roseanne English

ObjectiveReview the impact of applying regular data quality checks to assess completeness of core data elements that support syndromic surveillance.IntroductionThe National Syndromic Surveillance Program (NSSP) is a community focused collaboration among federal, state, and local public health agencies and partners for timely exchange of syndromic data. These data, captured in nearly real time, are intended to improve the nation's situational awareness and responsiveness to hazardous events and disease outbreaks. During CDC’s previous implementation of a syndromic surveillance system (BioSense 2), there was a reported lack of transparency and sharing of information on the data processing applied to data feeds, encumbering the identification and resolution of data quality issues. The BioSense Governance Group Data Quality Workgroup paved the way to rethink surveillance data flow and quality. Their work and collaboration with state and local partners led to NSSP redesigning the program’s data flow. The new data flow provided a ripe opportunity for NSSP analysts to study the data landscape (e.g., capturing of HL7 messages and core data elements), assess end-to-end data flow, and make adjustments to ensure all data being reported were processed, stored, and made accessible to the user community. In addition, NSSP extensively documented the new data flow, providing the transparency the community needed to better understand the disposition of facility data. Even with a new and improved data flow, data quality issues that were issues in the past, but went unreported, remained issues in the new data. However, these issues were now identified. The newly designed data flow provided opportunities to report and act on issues found in the data unlike previous versions. Therefore, an important component of the NSSP data flow was the implementation of regularly scheduled standard data quality checks, and release of standard data quality reports summarizing data quality findings.MethodsNSSP data was assessed for the national-level completeness of chief complaint and discharge diagnosis data. Completeness is the rate of non- null values (Batini et al., 2009). It was defined as the percent of visits (e.g., emergency department, urgent care center) with a non-null value found among the one or more records associated with the visit. National completeness rates for visits in 2016 were compared with completeness rates of visits in 2017 (a partial year including visits through August 2017). In addition, facility-level progress was quantified after scoring each facility based on the percent completeness change between 2016 and 2017. Legacy data processed prior to introducing the new NSSP data flow were not included in this assessment.ResultsNationally, the percent completeness of chief complaint for visits in 2016 was 82.06% (N=58,192,721), and the percent completeness of chief complaint for visits in 2017 was 87.15% (N=80,603,991). Of the 2,646 facilities that sent visits data in 2016 and 2017, 114 (4.31%) facilities showed an increase of at least 10% in chief complaint completeness in 2017 compared with 2016. As for discharge diagnosis, national results showed the percent completeness of discharge diagnosis for 2016 visits was 50.83% (N=36,048,334), and the percent completeness of discharge diagnosis for 2017 was 59.23% (N=54,776,310). Of the 2,646 facilities that sent data for visits in 2016 and 2017, 306 (11.56%) facilities showed more than a 10% increase in percent completeness of discharge diagnosis in 2017 compared with 2016.ConclusionsNationally, the percent completeness of chief complaint for visits in 2016 was 82.06% (N=58,192,721), and the percent completeness of chief complaint for visits in 2017 was 87.15% (N=80,603,991). Of the 2,646 facilities that sent visits data in 2016 and 2017, 114 (4.31%) facilities showed an increase of at least 10% in chief complaint completeness in 2017 compared with 2016. As for discharge diagnosis, national results showed the percent completeness of discharge diagnosis for 2016 visits was 50.83% (N=36,048,334), and the percent completeness of discharge diagnosis for 2017 was 59.23% (N=54,776,310). Of the 2,646 facilities that sent data for visits in 2016 and 2017, 306 (11.56%) facilities showed more than a 10% increase in percent completeness of discharge diagnosis in 2017 compared with 2016.ReferencesBatini, C., Cappiello. C., Francalanci, C. and Maurino, A. (2009) Methodologies for data quality assessment and improvement. ACM Comput. Surv., 41(3). 1-52.


Author(s):  
Antheny Wilson ◽  
Teresa Hamby ◽  
Wei Hou ◽  
David J Swenson ◽  
Krystal Collier ◽  
...  

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.


2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Amanda D. Morse ◽  
Kevin Wickersham ◽  
Natasha Close ◽  
Elyse Kadocura ◽  
Tom E. Hulse

ObjectiveTo grow and facilitate a community of syndromic surveillance data users in Washington State, improving and expanding local syndromic practice.IntroductionPrior to June 2016, there were 45 registered users of syndromic surveillance data in Washington State, with 29 (64.4%) representing 5 of Washington’s 35 local health jurisdictions and 16 (35.6%) at the state level. Of those registered users, 9 (8.8%) had logged into ESSENCE at least once in the 6 months before October 2016.In June 2016, the Washington State syndromic surveillance program began accepting Meaningful Use data and sought to increase its user base. To accomplish this, the Washington State Department of Health (WA DOH) designated a staff member to oversee outreach efforts to increase the visibility of syndromic data in the state, including the establishment of a Community of Practice.MethodsThe Washington State syndromic surveillance program—the Rapid Health Information NetwOrk (RHINO)—began the process of stakeholder engagement by delivering a needs assessment to 15 current and potential users of the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) platform. The survey assessed interest in participation in a Community of Practice for Washington State syndromic data users, the timing and format for meetings, needs for technical assistance, and topic areas of interest. RHINO then used the survey results to create a bank of topics for Community of Practice calls and develop a strategy for long-term outreach and engagement.In April of 2017, the RHINO team developed a new strategic plan and outlined metrics for evaluating growth and challenges in the program’s outreach efforts, including plans for outreach to novel disciplines like emergency preparedness. These metrics included counts of invitations for speaking engagements, ESSENCE users, onsite ESSENCE trainings and attendees at those trainings, organizations and disciplines represented in the Community of Practice, Community members, and webinars facilitated for the Community. RHINO staff compiled monthly tabulations of these metrics to track progress over the course of the year and aid in adjustments to outreach efforts as necessary.ResultsRHINO received 10 responses to the survey, with 9 respondents from local health jurisdictions and 1 from WA DOH. Respondents indicated particularly strong interest in regular webinars, a database of resources, and live trainings to support syndromic practice in their work. They also expressed concerns about the distance which would be required for in-person meetings.RHINO established that meetings would occur via webinar every other month and held 6 webinars between October 2016 and October 2017 on a broad range of topics including developing syndrome definitions, basic ESSENCE functions, using ESSENCE’s Report Manager tool, monitoring influenza-like-illness in ESSENCE, and using syndromic data for situational surveillance. In addition to the Community of Practice webinars, RHINO staff developed technical guides for both the Washington and National Surveillance Program’s (NSSP) ESSENCE platforms, a handbook for using syndromic surveillance data in Washington State, and a curriculum for onsite ESSENCE training.Between October 2016 and October 2017, RHINO offered 8 onsite ESSENCE trainings for groups of users at the Washington State Department of Health and local health jurisdictions, serving a total of 36 attendees. Over the course of the year, ESSENCE users in Washington State increased to 75, with 40 (53.3%) of them logging into the system at least once over the previous 6 months and 20 (26.7%) listed as “new users” who have not yet activated their accounts. The Community of Practice itself has 86 members representing 16 agencies and 19 disciplines.As RHINO’s profile increased and more potential users became aware of the availability of syndromic data, RHINO began receiving invitations to present for external partners. Between March 2016 and October 2017, RHINO received 8 invitations to present to audiences of potential syndromic data users. These audiences included leadership at the Washington State Department of Health and emergency preparedness and response organizations.In the next year, the program will continue offering data trainings and partner meetings to better serve the needs of both current and potential data users in Washington State. As more jurisdictions begin to have production-quality data, RHINO will continue offering onsite training. RHINO has also built a relationship with the Northwest Tribal Epidemiology Center in Portland, Oregon to begin the process of exploring data sharing with the Tribal Nations and Organizations located within Washington.ConclusionsThrough the development and implementation of a detailed outreach plan, RHINO increased the user base and profile of syndromic surveillance data in Washington State. This work was made possible through the careful construction of strong relationships with new and potential partners and the decision to diversify RHINO’s staff to include members with backgrounds beyond epidemiology.


2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Mark Bova ◽  
Roas Ergas

ObjectiveTo develop a detailed data validation strategy for facilitiessending emergency department data to the Massachusetts SyndromicSurveillance program and to evaluate the validation strategy bycomparing data quality metrics before and after implementation ofthe strategy.IntroductionAs a participant in the National Syndromic Surveillance Program(NSSP), the Massachusetts Department of Public Health (MDPH)has worked closely with our statewide Health Information Exchange(HIE) and National Syndromic Surveillance Program (NSSP)technical staff to collect and transmit emergency department (ED)data from eligible hospitals (EHs) to the NSSP. Our goal is to ensurecomplete and accurate data using a multi-step process beginning withpre-production data and continuing after EHs are sending live datato production.MethodsWe used an iterative process to establish a framework formonitoring data quality during onboarding of EHs into our syndromicsurveillance system and kept notes of the process.To evaluate the framework, we compared data received duringthe month of January 2016 to the most recent full month of data(June 2016) to describe the following primary data quality metricsand their change over time: total and daily average of message andvisit volume; percent of visits with a chief complaint or diagnosiscode received in the NSSP dataset; and percentage of visits with achief complaint/diagnosis code received within a specified time ofadmission to the ED.ResultsThe strategies for validation we found effective includedexamination of pre-production test HL7 messages and the executionof R scripts for validation of live data in the staging and productionenvironments. Both the staging and production validations areperformed at the individual message level as well as the aggregatedvisit level, and included measures of completeness for requiredfields (Chief Complaint, Diagnosis Codes, Discharge Dispositions),timeliness, examples of text fields (Chief Complaint and TriageNotes), and demographic information. We required EHs to passvalidation in the staging environment before granting access to senddata to the production environment.From January to June 2016, the number of EHs sending data tothe production environment increased from 44 to 48, and the numberof messages and visits captured in the production environmentincreased substantially (see Table 1). The percentage of visits witha chief complaint remained consistently high (>99%); howeverthe percentage of visits with a chief complaint within three hoursof admission decreased during the study period. Both the overallpercentage of visits with a diagnosis code and the percentage of visitswith a diagnosis code within 24 hours of admission increased.ConclusionsFrom January to June 2016, Massachusetts syndromic surveillancedata improved in the percentage of visits with diagnosis codes and thetime from admission to first diagnosis code. This was achieved whilethe volume of data coming into the system increased. The timelinessof chief complaints decreased slightly during the study period, whichmay be due to the inclusion of several new facilities that are unable tosend real-time data. Even with the improvements in the timeliness ofthe diagnosis code field, and the subsequent decrease in the timelinessof the chief complaint field, chief complaints remained a more timelyoption for syndromic surveillance. Pre-production and ongoing dataquality assurance activities are crucial to ensure meaningful dataare acquired for secondary analyses. We found that reviewing testHL7 messages and staging data, daily monitoring of productiondata for key factors such as message volume and percent of visitswith a diagnosis code, and monthly full validation in the productionenvironment were and will continue to be essential to ensure ongoingdata integrity.Table 1: ED Data in the Production Environment


2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Stacey Hoferka ◽  
Marcus Rennick ◽  
Erin E. Austin ◽  
Anne Burke ◽  
Rosa Ergas ◽  
...  

This roundtable will provide a forum for the syndromic surveillance Community of Practice (CoP) to learn about activities of the BioSense 2.0 User Group (BUG) workgroups that address priority issues in syndromic surveillance. The goals of the workgroups are to coordinate efforts nationwide, better inform development of BioSense 2.0 to the Governance Group and CDC, and achieve high-quality outcomes for the practice of syndromic surveillance. Representatives from each workgroup will describe their efforts to date so participants can discuss key challenges and best practices in the areas of data quality, data sharing, onboarding, and developing syndrome definitions.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fatma Saleh ◽  
Jovin Kitau ◽  
Flemming Konradsen ◽  
Leonard E. G. Mboera ◽  
Karin L. Schiøler

Abstract Background Disease surveillance is a cornerstone of outbreak detection and control. Evaluation of a disease surveillance system is important to ensure its performance over time. The aim of this study was to assess the performance of the core and support functions of the Zanzibar integrated disease surveillance and response (IDSR) system to determine its capacity for early detection of and response to infectious disease outbreaks. Methods This cross-sectional descriptive study involved 10 districts of Zanzibar and 45 public and private health facilities. A mixed-methods approach was used to collect data. This included document review, observations and interviews with surveillance personnel using a modified World Health Organization generic questionnaire for assessing national disease surveillance systems. Results The performance of the IDSR system in Zanzibar was suboptimal particularly with respect to early detection of epidemics. Weak laboratory capacity at all levels greatly hampered detection and confirmation of cases and outbreaks. None of the health facilities or laboratories could confirm all priority infectious diseases outlined in the Zanzibar IDSR guidelines. Data reporting was weakest at facility level, while data analysis was inadequate at all levels (facility, district and national). The performance of epidemic preparedness and response was generally unsatisfactory despite availability of rapid response teams and budget lines for epidemics in each district. The support functions (supervision, training, laboratory, communication and coordination, human resources, logistic support) were inadequate particularly at the facility level. Conclusions The IDSR system in Zanzibar is weak and inadequate for early detection and response to infectious disease epidemics. The performance of both core and support functions are hampered by several factors including inadequate human and material resources as well as lack of motivation for IDSR implementation within the healthcare delivery system. In the face of emerging epidemics, strengthening of the IDSR system, including allocation of adequate resources, should be a priority in order to safeguard human health and economic stability across the archipelago of Zanzibar.


Author(s):  
Sakiko Fukuda-Parr ◽  
Thea Smaavik Hegstad

Abstract One of the most important elements of the 2030 Agenda and the SDGs is the strong commitment to inclusive development, and “leaving no one behind” has emerged as a central theme of the agenda. How did this consensus come about? And what does this term mean and how is it being interpreted? This matters because SDGs shift international norms. Global goals exert influence on policy and action of governments and stakeholders in development operates through discourse. So the language used in formulating the UN Agenda is a terrain of active contestation. This paper aims to explain the politics that led to this term as a core theme. It argues that LNOB was promoted to frame the SDG inequality agenda as inclusive development, focusing on the exclusion of marginalized and vulnerable groups from social opportunities, deflecting attention from the core issues of distribution of income and wealth, and the challenge of “extreme inequality.” The term is adequately vague so as to accommodate wide ranging interpretations. Through a content analysis of LNOB in 43 VNRs, the paper finds that the majority of country strategies identify LNOB as priority to the very poor, and identify it with a strategy for social protection. This narrow interpretation does not respond to the ambition of the 2030 Agenda for transformative change, and the principles of human rights approaches laid out.


2021 ◽  
pp. 1-22
Author(s):  
Qiang Zha

Abstract This paper examines several research questions relating to equality and equity in Chinese higher education via an extended literature review, which in turn sheds light on evolving scholarly explorations into this theme. First, in the post-massification era, has the Chinese situation of equality and equity in higher education improved or deteriorated since the late 1990s? Second, what are the core issues with respect to equality and equity in Chinese higher education? Third, how have those core issues evolved or changed over time and what does the evolution indicate and entail? Methodologically, this paper uses a bibliometric analysis to detect the topical hotspots in scholarly literature and their changes over time. The study then investigates each of those topical terrains against their temporal contexts in order to gain insights into the core issues.


2009 ◽  
Vol 51 (3) ◽  
pp. 563-589 ◽  
Author(s):  
Raf Gelders

In the aftermath of Edward Said's Orientalism (1978), European representations of Eastern cultures have returned to preoccupy the Western academy. Much of this work reiterates the point that nineteenth-century Orientalist scholarship was a corpus of knowledge that was implicated in and reinforced colonial state formation in India. The pivotal role of native informants in the production of colonial discourse and its subsequent use in servicing the material adjuncts of the colonial state notwithstanding, there has been some recognition in South Asian scholarship of the moot point that the colonial constructs themselves built upon an existing, precolonial European discourse on India and its indigenous culture. However, there is as yet little scholarly consensus or indeed literature on the core issues of how and when these edifices came to be formed, or the intellectual and cultural axes they drew from. This genealogy of colonial discourse is the subject of this essay. Its principal concerns are the formalization of a conceptual unit in the sixteenth and seventeenth centuries, called “Hinduism” today, and the larger reality of European culture and religion that shaped the contours of representation.


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