The International Society for Disease Surveillance is pleased to present “Electronic Syndromic Surveillance Using Hospital Inpatient and Ambulatory Clinical Care Electronic Health Record Data: Recommendations from the ISDS Meaningful Use Workgroup” (Recommendations). The ISDS Meaningful Use (MUse) Workgroup’s Recommendations provide clarity for Stage 2 Meaningful Use, when on-going syndromic surveillance reporting will be required for eligible hospitals. These Recommendations provide a basis for planning and establishing data use relationships between Public Health Agencies and eligible professionals or hospitals while also building upon prior ISDS work by incorporating both lessons learned and broader stakeholder participation.
The Recommendations were developed in an open, iterative, and consensus-driven manner overseen by a multi-stakeholder workgroup of experts in public health, clinical care, medical informatics, and health information technology. Stakeholder feedback was gathered at the initial stages of development as well after Draft Guidelines and Revised Guidelines were released. In the end, 7 organizations and approximately 100 individuals participated in the development process.
ISDS is grateful to the MUse Workgroup and HLN Consulting, LLC for their shared expertise, talents, and time over the one-year period that the Recommendations were developed. ISDS also thanks the subject matter experts, stakeholders, readers, and ISDS Board of Directors who provided thoughtful help and consideration during this process. Finally, thank you to the Division of Informatics Solutions and Operations, OSELS, CDC for making this work possible. ISDS is grateful for the on-going partnership and support of the CDC in convening the surveillance stakeholder community for expert, consensus recommendations about syndromic surveillance for Meaningful Use.
- Process Summary
- Recommendations Summary
- Findings Summary
- Literature Review
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The ISDS recommendations for Syndromic Surveillance Meaningful Use are an expert consensus among public health officials, healthcare professionals, and health information technology developers. Without thoughtful dedication and support from many professionals the recommendations would not have been possible.
ISDS Meaningful Use Workgroup: ISDS Meaningful Use Workgroup (MUse Workgroup) oversaw and advised recommendation development, including the review and use of stakeholder input. Thank you MUse Workgroup members for sharing your expertise, talents and time over the one-year period that the recommendations were developed.
Subject Matter Experts: Many subject matter experts were consulted to provide information and perspective on a range of topics during recommendation development. Thank you to all the experts who voluntarily spoke with the MUse Workgroup, project staff, and held webinar presentations for helping us to understand that current of public health surveillance practice with syndromic surveillance methods using these clinical data sources.
Stakeholders: Stakeholder input on draft guidelines was integral to understanding current the current public health science and community sentiment regarding syndromic surveillance using hospital inpatient and ambulatory clinical data. Thank you for your thoughtful and constructive feedback throughout the recommendation development process.
Readers: The Recommendation report was reviewed and edited by two professionals with technical and policy perspectives on Meaningful Use but was uninvolved in development. Thank you Mr. John Page and Dr. Sanjeev Tandon for your careful review and perspective on the report.
HLN Consulting, LLC: ISDS is grateful for the diligent consulting efforts of Noam Arzt, PhD, and Maiko Minami throughout the development of the Recommendations.
Centers for Disease Control and Prevention (CDC): The Division of Informatics Solutions and Operations, OSELS, CDC supported this work. ISDS is grateful for the on-going partnership and support of the CDC in convening the surveillance stakeholder community for expert, consensus recommendations about syndromic surveillance Meaningful Use.
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Process Summary: The recommendations were developed in an open, iterative and consensus-driven manner overseen by a multi-stakeholder committee of experts in public health, clinical care, medical informatics, ad health information technology. Stakeholder input gathered in November 2011 served as a basis for the ISDS Meaningful Use Workgroup’s initial or draft guidelines that were released in February 2012. Stakeholder comments on the draft guidelines then informed a revision to better align the guidelines with community needs and expectations for syndromic surveillance using these clinical data. In June 2012, stakeholders had an opportunity to review the Revised Guidelines and once again provide feedback. The MUse Workgroup then prepared the guidelines for recommendation with a final revision based on stakeholder feedback received in June. In the end, 7 organizations and approximately 100 individual professionals in public health, academia, and health IT participated in the development process.
Recommendations Summary: The Workgroup’s recommendations meet a need for guidance across the Meaningful Use stakeholder spectrum. The Workgroup sought to balance current feasibility and resource concerns with community enthusiasm for surveillance innovation with these clinical data. In addition, to general recommendations for policy, practice, and research, the recommendations provide:
- A snapshot of current PHA use of inpatient and ambulatory clinical data using a syndromic surveillance approach to inform the decision-making by all Meaningful Use stakeholders;
- An assessment of feasible public health uses of these data for syndromic surveillance that addresses priority issues in public health system planning (Summary Table A);
- Basic parameters or business rules that inform how these data should be provided by eligible hospitals and professionals (Summary Table B);
- Core clinical data elements to inform what certified EHR technology must support (Summary Table C); and
- Clinical data elements that support data uses that extend beyond current capabilities or may in the future inform practice, technology and policy planning (Appendix 1-2).
Findings Summary: Among United States public health agencies and healthcare providers, surveillance using electronic syndromic surveillance data from hospital inpatient and ambulatory clinical care settings is gaining traction as a complement to syndromic surveillance using ED and UC data. The few existing hospital inpatient and ambulatory syndromic surveillance systems tend to vary in system design, population coverage, and data use. To begin inpatient syndromic surveillance, much of the necessary infrastructure and analytic tools are already in place, whereas for ambulatory syndromic surveillance most public health localities will be starting with minimal capacity and analytic experience.
Literature Review: ISDS conducted a literature review to explore the evidence base for the use of Electronic Health Record (EHR) data to perform syndromic surveillance using inpatient, emergency department (ED) and ambulatory clinical data. We found that among U.S. public health agencies (PHAs) and healthcare providers, surveillance using electronic syndromic surveillance data from hospital inpatient and ambulatory clinical care settings is gaining traction as a complement to syndromic surveillance using emergency department (ED) and urgent care (UC) data.
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- ISDS is working with the Division of Informatics Solutions and Operations, OSELS, CDC to revise the PHIN Messaging Guide for Syndromic Surveillance (release 1.1) by incorporating the recommendations for inpatient syndromic surveillance. This complete hospital-based syndromic surveillance guide is planned for completion by March 2013.
- Within the public health surveillance community, enthusiasm for using clinical data for non-infectious disease surveillance purposes is high. Since, however, there are significant technological and methodological advances needed for this purpose, the ISDS MUse Workgroup recommends that a workgroup form around this topic. Such a group could serve as a forum for exchanging lessons learned, problem solving, disseminating advances, evaluating innovations, identifying gaps, and advocate for funds that will support demonstration projects, research and evaluation.
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