Syndromic Surveillance in WA

Syndromic Surveillance in WA Established in 2003

Voluntary participation

16/39 counties with ≥1 facility

Establishment: Recruited by LHJ with assistance from

the Department of Health (DOH) (n=28)

RHIO contract with CDC (n=17)

Data formats:

Flat-file (1 message/24 hours)

HL7 v.2.5 (Batched every 15 min.)

Systems:

WA-hosted ESSENCE

○ ED data only

Longitudinal Database (HL7 data only)

○ ED, Inpatient, Outpatient (with labs)

Not a BioSense 1.0 participant

BioSense Approval Process

1/18 • “Official” BioSense 2.0 invite received

1/26

• Briefing document requested by DOH Leadership

4/6

• Leadership briefing:

• Approval to evaluate BioSense

• Evaluation plan requested

• Contract processing request filed

4/13 • DUA signed by WA DOH

5/7 • Signed DUA returned by ASTHO

December - April

Review of DUA

Parties involved:

• Informatics

• IT security

• Contracts

• Epidemiology

• Public Health –

Seattle & King

County

BioSense 2.0 Implementation

Briefing Paper Outline

Contact:

Purpose: Provide background and recommendations about DOH

signing a Data Use Agreement (DUA) with ASTHO, which will allow

DOH to evaluate BioSense 2.0.

Background:

Key Stakeholders & Interests:

Analysis of Alternative Actions:

ALTERNATIVE 1 – NO ACTION

ALTERNATIVE 2 – EVALUATION OF BIOSENSE

ALTERNATIVE 3 – FULL PARTICIPATION IN BIOSENSE

Recommendation:

Alternative 1: No Action

Advantages:

None

Disadvantages:

Cost of current system

Limited opportunity for

expansion

Lack of flexibility to adjust

to changing landscape

Alternative 2: Evaluation

Advantages:

Determine

compatibility with

existing infrastructure

Assess whether

BioSense 2.0 will

meet the needs of

WA

Disadvantages:

Staff resources to re-

direct data feeds

Alternative 3: Full Participation Advantages:

PHEP & ELC grant

alignment

Expansion capability

Participation in a

national model

Servers maintained

by BioSense

Access to technical

resources for set-up

BioSense meets WA

IT security standards

Web-browser

accessible

Disadvantages:

Unknown long-term

funding

TBD (based on

evaluation)



1/26

• Briefing document requested by Leadership

4/6







December - April

Review of DUA

Parties involved:

• Informatics

• IT security

• Contracts

• Epidemiology


Seattle & King

County

BioSense 2.0 Transition and Evaluation Plan

1. Project cost and resources required (Epi, Infomatics, PHEP)

2. Project plan. Timeframe, steps and outcomes. Table 1. Transition Plan*

Table 2. Critical Performance Measures

3. What are other states doing?

4. Impact on PHEP specifically during evaluation period.

5. ESSENCE in the cloud

6. Data security

7. Costs of long term use should the evaluation be successful

Activity Staff

Involved

Timeline

2012 2013

M J J A S O N D J F M

Objective Performance Measures



1/26

• Briefing document requested by Leadership

4/6







December - April

Review of DUA

Parties involved:

• Informatics

• IT security

• Contracts

• Epidemiology


Seattle & King

County

Data Feed Routing

WA

HIE sFTP sFTP

Flat-file HL7 v.2.5.1

HL7 v.2.5.1 HL7 v.2.5.1

HL7 v.2.5.1

sFTP

-ms

-ms

ED, Inpatient,

Outpatient, Labs

(HL7, Flat-File)

Active Hospital Recruitment

King County BioSense Challenge Grant

Late June:

Letter

○ Encourage submission of Meaningful Use (MU) compliant

syndromic surveillance data

○ Route through WA HIE to DOH

BioSense Fact Sheet

○ Details of ASTHO DUA

WA MU Syndromic Surveillance Implementation Guide

Summer/Early Fall:

In-person meetings

Passive Hospital Recruitment

DOH MU Website (coming soon)

Outline of MU test message certification process

○ Enrollment form

○ MQF Validation of A01, A03, A04, and A08

○ Submission of MQF reports & test messages

○ Establish transport mechanism (sFTP, PHINMS, HIE)

○ Submission of Meta-data Questionnaire (in process)

WA MU Implementation Guide (in process)

Syndromic Surveillance Fact Sheet

WA State Locker – Pilot Project

WA Locker (Pilot)

-ms Receiver/

Sender

Parser

Longitudinal

Data Mart HL7 Batch File

Meta-Data

Data

Warehouse

WA Locker

BioSense 2.0

Database

-ms Receiver

stunnel

stunnel

1. ESSENCE

Update File

2. BioSense 2.0

Db File

To

ADM

Longitudinal Database Structure

Core Table

Dx Table Lab Table

Simplifies to

3 view tables

linked by

Primary Key

Diagnosis Tables

Lab Tables

Core Tables

• 1 core record per visit (ED Visit &

Inpatient Admission = 2 records)

• 1 record per lab result

• 1 record per diagnosis

WA State Locker – Pilot Project

WA Locker (Pilot)

-ms Receiver/

Sender

Parser

Longitudinal

Data Mart HL7 Batch File

Meta-Data

Data

Warehouse

WA Locker

BioSense 2.0

Database

-ms Receiver

stunnel

stunnel

1. ESSENCE

Update File

2. BioSense 2.0

Db File

To

ADM

Staffing and Users WA DOH:

Epidemiologists ○ Project Manager/BioSense Admin/Message validation

○ Communicable disease & Non-infectious disease program

Informaticians ○ Transport specialist—PHINMS, sFTP, HIE

○ Testing Coordinator

○ National expert & visionary

Contracted Software Developer ○ Builds infrastructure

○ Will modify system for new data feeds

LHJs: Epidemiologists/Public Health Nurses

○ ESSENCE

○ BioSense 2.0 web interface

○ Locker access (super-users)

Challenges…

Knowledge MU

Syndromic Surveillance

Communication Internal

LHJs

Hospitals/Clinics

Staffing Sustainability

The Future

Incorporate de-identified

notifiable condition data

ESSENCE & BioSense

expansion to include inpatient

& ambulatory data (with labs)

Pearls of Wisdom…

Start early:

DUA establishment

Informational materials

Work with ALL stakeholders as early as

possible

Syndromic Surveillance in WA

Documents