Syndromic Surveillance (SS)

Syndromic surveillance uses individual and population health indicators that are available before confirmed diagnoses or laboratory confirmation to identify outbreaks or health events and monitor the health status of a community. By automating public health data collection through Meaningful Use, syndromic surveillance provides public health information in near real time, often sooner than a laboratory test can even be completed. By getting more information more quickly, local, state, and federal public health can detect and respond to more outbreaks and health events more quickly. In addition to the promise of rapid response, the syndromic surveillance data compiled through Meaningful Use provides data streams for longer term, ongoing analysis of chronic conditions such as heart disease and diabetes, injuries, and the use of healthcare services.

Inpatient and Ambulatory Care Data

Public health syndromic surveillance using inpatient and ambulatory clinical care electronic health record (EHR) data is a relatively new practice. As eligible health professionals and hospitals adopt, implement, and upgrade their EHR systems through the CMS EHR Incentive programs (Meaningful Use programs), there is an opportunity for public health authorities to routinely receive health data from settings other than emergency departments and urgent care centers. Given the number of factors and complex relationships that affect EHR data quality, a collaborative approach that includes public health, healthcare, and EHR technology developers is the best way to determine how EHR data can be meaningfully used for surveillance.

The International Society for Disease Surveillance (ISDS) is currently tasked with developing recommendations for syndromic surveillance using inpatient and ambulatory clinical care EHR data. In November 2011, ISDS convened a 10-person Meaningful Use (MU) Workgroup with various stakeholder perspectives and expertise in public health practice and medical informatics to guide the development of the Meaningful Use recommendation to be entitled Recommended Guidelines for Syndromic Surveillance Using Inpatient and Ambulatory Clinical Care EHR Data. With the facilitation of ISDS staff, the Centers of Disease Control and Prevention (CDC), and HLN Consulting, the MU Workgroup has used an iterative development process, soliciting stakeholder feedback at project initiation and while recommendations have been developed. Since its establishment, the MU Workgroup has released Draft Guidelines and Revised Guidelines each for a 30-day public comment period from March 6, 2012 - April 2, 2012 and from June 5, 2012 - July 3, 2012, respectively. The MU Workgroup is currently reviewing the stakeholder feedback from the Revised Guidelines comment period to finalize the Recommended Guidelines by the beginning of September. Once completed, the Recommended Guidelines will be released to the Office of the National Coordinator for Health Information Technology (ONC) as recommendations for Stage 3 of Meaningful Use.

If you would like to learn more about the ISDS MU Workgroup and the development of the ISDS Recommended Guidelines, visit the ISDS MU Inpatient and Ambulatory webpage.

Emergency Department and Urgent Care Data

The “PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data Release 1.0” (HL7 Version 2.5.1 (Version 2.3.1 Compatible)) released on October 18, 2011 includes minimum syndromic surveillance data standards (core and optional). This is a milestone that will help realize the public health objective of the Centers for Medicare & Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs (a.k.a., Meaningful Use Programs) authorized under the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of 2009 American Recovery and Reinvestment Act (Recovery Act) legislation. The final guide translates the recommendations made by the International Society for Disease Surveillance (ISDS) and CDC. The ISDS recommendations were developed using a community consensus-driven process approach, and the final CDC guide addresses the comments received from the Health Information Technology Standards Committee as well as those received when the Guide was posted online for public comment on May 5, 2011. This effort was funded in FY 2010 by the BioSense Program as part of its redesign effort (or BioSense 2.0).

• PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data Release 1.0 (October 2011). FAQs have been documented to assist you.
• PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data Release 1.1 (August 2012).
• New addendum to the PHIN Messaging Guide for Emergency Department and Urgent Care Data Release 1.1 (August 2012)” contains a "Conformance Clarification for EHR Certification of Electronic Syndromic Surveillance"

For further Meaningful Use information refer to the ISDS Meaningful Use Website http://www.syndromic.org/projects/meaningful-use. For BioSense related information refer to the CDC BioSense website http://www.cdc.gov/biosense/.

Check out the Syndromic Surveillance Community of Practice on phConnect.