Syndromic Surveillance Using Electronic Health Records | International Society for Disease Surveillance


Public Health Syndromic Surveillance (PHSS) is a widely adopted and rapidly evolving approach for monitoring and assessing public health.

The approach leverages information technology to systematically collect large volumes of electronic health-related data from clinical and non-clinical service providers in near “real-time” (e.g., hospital and school administrations), often on a daily or weekly basis. Epidemiologists then analyze PHSS data to monitor, assess or identify population health trends including infectious disease outbreaks, exacerbations of chronic disease conditions, and injuries.

In conjunction with other surveillance and situational information, PHSS is used by public health authorities (PHA) to guide or evaluate response measures and public health interventions.

Emergency Department EHR Data for Syndromic Surveillance

The majority of PHSS systems currently use de-identified patient encounter data from hospital emergency departments (ED). Epidemiologists find these data valuable because ED data are widely captured using EHR technology, and are available in a timely manner. Moreover, as access points for people in urgent need of medical care, EDs are more likely to care for vulnerable populations during public health emergencies.      PHSS using inpatient or ambulatory care health data is a novel and developing practice. Currently, few PHA routinely receive and analyze those data for PHSS.     

Based on recommendations made by ISDS in January 2011, the CDC developed an implementation guide for HL7 2.5.1 for EHR data that are core and commonly used in PHSS practice.

This PHIN Messaging Guide for Syndromic Surveillance describes how an ADT (Admission, Discharge, and Transfer) message from an EHR system can carry ED patient encounter data for PHSS. The guide does not cover data from other clinical sources (e.g., inpatient or ambulatory care).

Inpatient and Ambulatory Care EHR Data for Syndromic Surveillance

Public health syndromic surveillance using inpatient or ambulatory clinical care data is a relatively new practice. As eligible professionals and hospitals adopt, implement, and upgrade their EHR systems through the CMS EHR Incentive programs (a.k.a., 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. Public health surveillance, and other key stakeholders, can play an important role in determining how to advance syndromic surveillance practice through Meaningful Use policy.

Making the Most of Meaningful Use

As the accessibility of standardized EHR data increases due to Meaningful Use and rules promulgated by the HITECH Act, public health authorities have an opportunity to enhance their ability to assess and monitor population health. Making the most of this opportunity, however, requires material and technical resources, as well as procedures that preserve existing surveillance capabilities and data quality. As eligible hospitals and health professionals, EHR vendors, and PHA implement the PHSS messaging for Meaningful Use, leveraging the following resources and practices will help:

BioSense 2.0: Governed by the Association of State and Territorial Health Officials (ASTHO) and supported by the US Centers for Disease Control and Prevention (CDC), BioSense 2.0 provides surveillance data storage, management, and analytic services to public health authorities in the U.S. Using cloud computing technology, BioSense 2.0 can save PHA’s the expense of receiving and warehousing Meaningful Use PHSS data. What’s more, once within the BioSense 2.0 environment, PHA can share data at aggregate or other levels with collaborating agencies in real-time (e.g., PHA from neighboring communities, or jurisdictional levels).

BioSense Redesign Collaboration Site
CDC BioSense Site
BioSense Redesign FAQs

ISDS Recommendation: Core Processes and EHR Requirements for Public Health Syndromic Surveillance. This document describes the core business processes of public health syndromic surveillance in detail. Rendered as a generalized model, the critical tasks and decision points that consecutively produce PHSS information are drawn and explained from the perspective of a PHSS analyst. Referencing the process diagrams and task descriptions will be useful during Meaningful Use implementation.

Public Health Information Network (PHIN) Messaging Guide for Syndromic Surveillance:  The PHIN Syndromic Surveillance Messaging Guide meets a national need for health data exchange standards among healthcare providers and U.S. public health authorities. The Guide provides the HL7 technical specifications necessary for exchanging health data elements that are core to public health Syndromic Surveillance practice in accordance with the ISDS Final Recommendations: Core Processes and EHR Requirements for Public Health Syndromic Surveillance. The Guide was originally released in October of 2011 and was updated and released again in August 2012. Please find the links to the different versions below.