Syndromic Surveillance in WA
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- Dylan Gaines
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2 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
3 BioSense Approval Process 1/18 1/26 4/6 4/13 Official BioSense 2.0 invite received Briefing document requested by DOH Leadership Leadership briefing: Approval to evaluate BioSense Evaluation plan requested Contract processing request filed DUA signed by WA DOH December - April Review of DUA Parties involved: Informatics IT security Contracts Epidemiology Public Health Seattle & King County 5/7 Signed DUA returned by ASTHO
4 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:
5 Alternative 1: No Action Advantages: None Disadvantages: Cost of current system Limited opportunity for expansion Lack of flexibility to adjust to changing landscape
6 Alternative 2: Evaluation Advantages: Determine compatibility with existing infrastructure Assess whether BioSense 2.0 will meet the needs of WA Disadvantages: Staff resources to redirect data feeds
7 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)
8 BioSense Approval Process 1/18 1/26 4/6 4/13 Official BioSense 2.0 invite received Briefing document requested by Leadership Leadership briefing: Approval to evaluate BioSense Evaluation plan requested Contract processing request filed DUA signed by WA DOH December - April Review of DUA Parties involved: Informatics IT security Contracts Epidemiology Public Health Seattle & King County 5/7 Signed DUA returned by ASTHO
9 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* Activity Staff Timeline Involved M J J A S O N D J F M Table 2. Critical Performance Measures Objective 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
10 BioSense Approval Process 1/18 1/26 4/6 4/13 Official BioSense 2.0 invite received Briefing document requested by Leadership Leadership briefing: Approval to evaluate BioSense Evaluation plan requested Contract processing request filed DUA signed by WA DOH December - April Review of DUA Parties involved: Informatics IT security Contracts Epidemiology Public Health Seattle & King County 5/7 Signed DUA returned by ASTHO
11 Data Feed Routing -ms ED, Inpatient, Outpatient, Labs (HL7, Flat-File) WA HIE -ms sftp sftp sftp HL7 v L7 v HL7 v HL7 v Flat-file
12 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
13 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
14 WA State Locker Pilot Project -ms Receiver/ Sender WA Locker (Pilot) stunnel Parser 1. ESSENCE Update File 2. BioSense 2.0 Db File Data Warehouse stunnel WA Locker -ms Receiver BioSense 2.0 Database To ADM HL7 Batch File Meta-Data Longitudinal Data Mart
15 Longitudinal Database Structure Diagnosis Tables Simplifies to 3 view tables linked by Primary Key Core Table Lab Tables Dx Table Lab Table Core Tables 1 core record per visit (ED Visit & Inpatient Admission = 2 records) 1 record per lab result 1 record per diagnosis
16 WA State Locker Pilot Project -ms Receiver/ Sender WA Locker (Pilot) stunnel Parser 1. ESSENCE Update File 2. BioSense 2.0 Db File Data Warehouse stunnel WA Locker -ms Receiver BioSense 2.0 Database To ADM HL7 Batch File Meta-Data Longitudinal Data Mart
17 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)
18 Challenges Knowledge MU Syndromic Surveillance Communication Internal LHJs Hospitals/Clinics Staffing Sustainability
19 The Future Incorporate de-identified notifiable condition data ESSENCE & BioSense expansion to include inpatient & ambulatory data (with labs)
20 Pearls of Wisdom Start early: DUA establishment Informational materials Work with ALL stakeholders as early as possible
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