Introduction

Syndromic Surveillance is “the systematic process of data collection and analysis for the purposes of detecting and characterizing outbreaks of disease in humans and animals in a timely manner” (RODS). Rather than relying strictly on confirmed reports of disease or condition occurrence, syndromic surveillance attempts to bring together a variety of data – largely from the clinical setting, but from other sources in the community as well – to support decision making in the event of a disaster or emergency.

A fundamental building block of syndromic surveillance is the use of data to identify and predict trends as they are occurring, which often takes the form of analyzing patient chief complaints as they present for care in hospital emergency rooms and other acute care settings. Critical to the long-term success of this surveillance is the quick and efficient transmission of critical data from clinical systems to the appropriate local, state, and Federal public health agencies. The exact path of this data differs from state to state, as do the specific data sets that are collected. Consult with your state public health agency for specific requirements.

Meaningful Use

Funded by CDC, the International Society for Disease Surveillance (ISDS), with assistance from HLN, convened aWorkgroup of public health experts to document current syndromic surveillance business processes and data requirements in support of meaningful use of EHR systems in emergency department and urgent care settings. Final Recommendations were released in January, 2011. In October, 2011, ISDS and HLN kicked off a projected (funded by CDC) to continue this work by developing business and infrastructure requirements for syndromic surveillance using inpatient and ambulatory clinical care EHR data. In November, 2012 ISDS released final recommendations.

For both the Mod Period and Stage 3 Meaningful Use, there is now one public health reporting objective with multiple measures, including syndromic surveillance reporting. However, for Stage 3, only EPs who practice in urgent care settings are eligible to claim this measure. The Medicare and Medicaid Programs Electronic Health Record Incentive Program Final Rule for Stage 3 (October 2015), contains the following objective and measure relative to syndromic surveillance:

EP/EH/CAH Objective: The EP, eligible hospital or CAH is in active engagement with a public health agency to submit electronic public health data from CEHRT except where prohibited and in accordance with applicable law and practice.
EP/EH/CAH Measure: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit syndromic surveillance data from an urgent care setting (urgent care ambulatory for EP, emergency or urgent care department for eligible hospitals and CAHs).

An EP can be excluded from this measure if s/he does not practice in an urgent care setting. An eligible hospital can be excluded if it does not have an emergecy/urgent care department. Either can be excluded if the public health agency cannot accept data in the specified standard and no other entity has been designated to do so on its behalf (like an HIE), if the public health agency does not indicate its capability to collect data, or if the public health agency is not capable of enrolling the EP/hospital in a timely way and has not declared its readiness by the proscribed deadline.

Though the infrastructure to support HIEs is still developing, there is an expectation that as the program proceeds expectations for submission of syndromic surveillance information to public health agencies via HIE will increase.

Technical Standards

The ONC 2014 Edition Health Information Technology (Health IT) Certification Criteria (September, 2014) identified the following standards for immunization data exchange for Stage 2 which can continue to apply for the Mod Period (2015-2017):

§ 170.205 Content exchange standards and implementation specifications for exchanging electronic health information
(d)(3):Standard. HL7 2.5.1 (incorporated by reference in § 170.299). Implementation specifications. PHIN Messaging Guide for Syndromic Surveillance (incorporated by reference in § 170.299) and Conformance Clarification for EHR Certification of Electronic Syndromic Surveillance, Addendum to PHIN Messaging Guide for Syndromic Surveillance (incorporated by reference in § 170.299).

For Stage 3 (in 2018, and also if begun early in 2017, or if desired during the Mod Period), the ONC 2015 Edition Health Information Technology (Health IT) Certification Criteria (October, 2015) identified the following standards for immunization data exchange

§ 170.205 Content exchange standards and implementation specifications for exchanging electronic health information
(d)(4):Standard. HL7 2.5.1 (incorporated by reference in §170.299). Implementation specifications. PHIN Messaging Guide for Syndromic Surveillance: Emergency Department, Urgent Care, Inpatient and Ambulatory Care Settings, Release 2.0, April 21, 2015 (incorporated by reference in § 170.299) and Erratum to the CDC PHIN 2.0 Implementation Guide, August 2015; Erratum to the CDC PHIN 2.0 Messaging Guide, April 2015 Release for Syndromic Surveillance: Emergency Department, Urgent Care, Inpatient and Ambulatory Care Settings (incorporated by reference in § 170.299).

Testing Procedures

The National Institute of Standards and Technology (NIST) has provided a guidance document and testing tools (see right panel) for ensuring that certified EHR systems can properly send syndromic surveillance data.