1. CSTE 2011 – Pittsburgh Michael A. Coletta, MPH Syndromic Surveillance Requirements and Meaningful Use

2. What You Should Know Who is ISDS and why them? This was a large and difficult task under great time pressure This was a community driven project What worked about the process Challenges and solutions How the document can be used now Next steps

3. Who is ISDS and Why Them? ISDS is made up of public health practitioners and academic leaders who are very interested in practical technological solutions to surveillance related issues. ISDS has its roots in Syndromic Surveillance and is the community of practice to inform any description of the syndromic surveillance process.

4. Workgroup Members ★ Michael A. Coletta, MPH (Workgroup Chair), Virginia Department of Health ★ Ryan Gentry, Indiana State Department of Health ★ Julia E. Gunn, RN, MPH, Boston Public Health Commission ★ Richard S. Hopkins, MD, MSPH, Florida Department of Health ★ Amy Ising, MSIS, University of North Carolina Department of Emergency Medicine at Chapel Hill ★ Geraldine S. Johnson, MS, New York State Department of Health ★ Bryant T. Karras MD, State of Washington, Department of Health ★ Karl Soetebier, Georgia Department of Community Health ★ David Swenson, MEd, State of New Hampshire, Department of Public Health Services ★ Charles Ishikawa, MSPH, International Society for Disease Surveillance ★ David Buckeridge, MD, PhD, McGill University and Montreal Public Health ★ Office of Surveillance, Epidemiology, and Laboratory Science and Career Development, CDC Public Health Surveillance Program Office - Partnerships and Planning Activity: Pamela A. Meyer, PhD, MSPH - Division of Healthcare Information: Samuel Groseclose, DVM, MPH; Taha Kass-Hout, MD, MS Public Health Informatics and Technology Program Office: -Standards and Inoperability: Nikolay Lipskiy, MD, DrPH, MBA -Northrop Grumman: Sergei Li, PMP; Sundak Ganesan, MD; Mark Meadows; Adam Browning;Mary Hamilton

5. Timeline Jan 2010 – ONC Published Interim Final Rule Mar 2010 – ISDS commented on stage 1 Interim Final Rule April 2010 – Distribute CoP ad hoc meeting regarding MU - formed action plan June 2010 – Invite workgroup members Early July 2010 – Workgroup calls began – define scope of syndromic surveillance business process analysis Middle July 2010 – Final Rule published with incorrect specification (based on case reporting instead of syndromic) August 2010 – Meaningful Use Summit – presented to JPHIT that ISDS could describe the requirements for Syndromic Surveillance

6. Timeline Early August 2010 – CDC Partnered with ISDS Mid August 2010 – CDC BioSense leadership worked with ONC to acknowledge the error in the Stage 1 Final Rule Late August 2010 – ISDS partnered with HLN Early September 2010 - In person meetings in Boston End of September - first hard deadline to have a preliminary recommendation for ONC October through December – several face to face meetings to more thoroughly describe business process of syndromic surveillance

7. Timeline Mid December – JPHIT, JPHIT organizations, and community feedback on provisional recommendation Late December 2010 – Final recommendation to CDC March 2011 – Draft PHIN message guide completed open for comment until June 2011

8. What Worked Employing a small, knowledgeable, and engaged community of practice Keeping scope limited to what is known and well understood about syndromic surveillance Compromise In person interactions Having dedicated staff and contractors and not just volunteers from community Adhering to deadlines

9. Challenges and Solutions Challenge: Scope creep – it was difficult to stay limited to contemporary practice of syndromic surveillance and not consider all surveillance or “what you could do” with the meaningful use data feed Solution: Define scope up front – Everyone was empowered to remind us of our scope and when we might be drifting off track

10. Challenges and Solutions Challenge: Considering greater good – Often there was a temptation for workgroup members to just fight for their personal/local interests Solution: Intentionally invite different perspectives from the outset – We spent some time trying to think of who was available, engaged, knowledgeable, and had different implementations from around the country

11. Challenges and Solutions Challenge: Consensus – This was more difficult than initially expected. Many differences were expressed - local legal and practice considerations as well as the tension between contemporary practice and “future possibilities” often caused discord Solution: Compromise – Everyone should be commended for being flexible and understanding during this process. Also, the fast paced deadlines turned out to be an important variable in overcoming an impasse

12. Uses for Recommendation Has already been used to inform the HL7 messaging guide for the 32 element minimum data set Should be used to inform the HL7 messaging guide for the extended data set Should be used as the foundation for the primary care messaging guide Should be used as the foundation to consider syndromic process re-design as new Meaningful Use data feeds come online Should be used by syndromic surveillance practitioners to consider what part of the process described in the recommendation can be adopted to improve their local implementation

13. Next Steps Complete the Extended data set portion of the messaging guide Describe primary care (eligible provider) changes to this document and messaging guide Assure implementation – Identify barriers – Offer technical assistance through community of practice / partner organizations / CDC Work together (ISDS,CSTE, ASTHO, NACCHO, AMIA, and other appropriate partner organizations) to describe integrating syndromic surveillance and “traditional” surveillance processes – Requires an assessment of current business processes with an eye for “re-designed” surveillance processes considering new data and new technologies

14. Final Thoughts ISDS is an engaged community of practice that is ready to pitch in and define requirements This was an important community driven task that was successful because it was well supported by the community and by CDC In order to continue to participate in efforts like Meaningful Use, Public Health is going to have to describe business processes and requirements in this fashion Though we faced challenges, we accomplished something many said couldn’t be done in the time frame we were given and the workgroup members and partners are to be congratulated The recommendation and documents like it are useful not only for message specification, but best practice description

15. Resources ISDS MU Recommendation: http://www.syndromic.org/projects/meaningful-use CDC Messaging Guide: http://www.cdc.gov/phin/library/2011/guides/Syndromic_Surveill ance_Implementation_Guide_Release_1_4.pdf CDC MU Resources: http://www.cdc.gov/EHRmeaningfuluse/resources.html Contact Info: Charlie Ishikawa, MSPH Associate Director of Public Health Programs cishikawa@syndromic.org Michael Coletta, MPH NACCHO Lead Informatics Analyst mcoletta@naccho.org