ObjectiveTo describe the latest revisions and modifications to the “HL7 2.5.1 Implementation Guide for Syndromic Surveillance” (formerly the PHIN Message Guide for Syndromic Surveillance) that were made based on community commentary and resolution of feedback from the HL7 balloting process. In addition, the next steps and future activities as the IG becomes an “HL7 Standard for Trial Use” will be highlighted.IntroductionIn 2011, the Centers for Disease Control and Prevention (CDC) released the PHIN Messaging Guide for Syndromic Surveillance v. 1. In the intervening years, new technological advancements including Electronic Health Record capabilities, as well as new epidemiological and Meaningful Use requirements have led to the periodic updating and revision of the Message Guide. These updates occurred through informal and semi-structured solicitation and in response to comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the Message Guide v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the Message Guide in a more systematic manner and released further updates via an Erratum and a technical document developed with the National Institute of Standards and Technology (NIST) to clarify validation policies and certification parameters. This trio of documents were consolidated into the Message Guide v.2.1 release and used to inform the development of the NIST Syndromic Surveillance Test Suite (http://hl7v2-ss-r2-testing.nist.gov/ss-r2/#/home), validate test cases, and develop a new rules-based IG built using NIST’s Implementation Guide Authoring and Management Tool (IGAMT).As part of a Cooperative Agreement (CoAg) initiated in 2017, CDC partnered with ISDS to build upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the Message Guide. The goal of this CoAg is have the final product become an “HL7 Standard for Trial Use” following the second phase of formal HL7 balloting p in Fall 2018.MethodsISDS coordinated a multi-stakeholder working group to revisit the consolidated Message Guide, v.2.1 and collect structured comments via an online portal, which facilitated the documentation, tracking, and prioritization of comments for developing consensus and reconciliation and resolution when there were errors, conflicts, or differing perspectives for select specifications. Over 220 comments were received during the most recent review period via the HL& balloting process (April – June 2018) with sixteen elements captured for each comment, which included: Subject, Request Type, Clinical Venue Application, Submitter Name, IG Section #, Priority, Working and Final Resolution (Figure 1). The online portal was used to communicate with members of the Message Guide Workgroup to provide feedback directly to one another through a ‘conversation tab’. This became an important feature in teasing out underlying concerns and issues with a given comment across different local, state, and private sector partners (Figure 2). Some comments were able to be fully described and resolved using this feature. Following the HL7 balloting period, ISDS continued the weekly webinar-based review process to delve into specific issues in detail. Each week ISDS staff would lead the webinars structured around similar comment types (e.g. values sets, DG1 Segments, IN1 Segments, Conformance Statements, etc.). This leveraged the expertise of individuals and institutions with concerns revolving around a specific domain, messages segment, or specification described within the Message Guide. Comments for which consensus and resolution was achieved were “closed-out’ on the portal inventory and new assignments for review would be disseminated across the Message Guide Workgroup for consideration and discussion during the subsequent webinar.ResultsTo date this review process has identified and updated a wide-range of specification and requirements described within the Message Guide v.2.0. These include: specifications for persistent patient ID across venues of service, inclusion of the ICD-10-CM value set for diagnosis, removal of the ICD-9-CM requirement for testing and messages, modification of values such as pregnancy status, travel history, and medication list from “O” to “RE”, and the update of value sets and PHIN VADS references for FIPS, SNOmed, ICD-10-CM, Acuity, Patient Class, and Discharge Disposition.ConclusionsThe results of this multi-agency comment and review process will be synthesized and compiled by ISDS. The updated version of the Message Guide (re-branded to the HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance) will go through a second round of review and commentary thru HL7 in Fall 2018.This systematic and structured review and documentation process has allowed for the synthetization and reconciliation of a wide range of disparate specifications, historical hold-overs, and requirements via the perspectives of a diverse range of public health partners. As this review process continues it is anticipated that the final HL7 balloted “Standard for Trial Use” IG 2.5 will represent a more refined and extensible product that can support syndromic surveillance activities across a wider and more diverse range of clinical venues, EHR implementations, and public health authorities.ISDS and CDC have recommended that future modifications to the Promoting Interoperability (PI) Programs (formerly Meaningful Use) reference and require the utilization of the revised Implication Guide for Certification. The HL7 2.5.1 Implementation Guide can be found: https://cdn.ymaws.com/www.healthsurveillance.org/resource/resmgr/docs/Group_Files/Message_Guide/IG_SyS_Release_1.pdf
Objective: To provide a forum to engage key stakeholders to discuss the process for updating and revising the Implementation Guide (IG) for Syndromic Surveillance (formerly the PHIN Message Guide for Syndromic Surveillance) and underscore the critically of community and stakeholder involvement as the Implementation Guide is vetted through the formal Health Level Seven (Hl7) balloting process in 2018.Introduction: Syndromic surveillance seeks to systematically leverage health-related data in near "real-time" to understand the health of communities at the local, state, and federal level. The product of this process provides statistical insight on disease trends and healthcare utilization behaviors at the community level which can be used to support essential surveillance functions in governmental public health authorities (PHAs). Syndromic surveillance is particularly useful in supporting public health situational awareness, emergency response management, and outbreak recognition and characterization. Patient encounter data from healthcare settings are a critical inputs for syndromic surveillance; such clinical data provided by hospitals and urgent care centers to PHAs are authorized applicable local and state laws. The capture, transformation, and messaging of these data in a standardized and systematic manner is critical to this entire enterprise.In August 2015, a collaborative effort was initiated between the CDC, ISDS, the Syndromic Surveillance Community, ONC and NIST to update the national electronic messaging standard which enables disparate healthcare systems to capture, structure, and transmit administrative and clinical data for public health surveillance and response. The PHIN Messaging Guide for Syndromic Surveillance -Release 2.0 (2015) provided an HL7 messaging and content reference standard for national, syndromic surveillance electronic health record technology certification as well as a basis for local and state syndromic surveillance messaging implementation guides. This standard was further amended with the release of the PHIN Messaging Guide for Syndromic Surveillance - Release 2.0, Erratum (2015) and theHL7 Version 2.5.1 PHIN Messaging Guide for Syndromic Surveillance- Release 2.0, NIST Clarifications and Validation Guidelines, Version 1.5(2016). ISDS is now engaged in a process, supported by a CDC Cooperative Agreement, to formally revise the existing guide and generate an HL7 V 2.5.1 Implementation Guide (IG) for Syndromic Surveillance v2.5 for HL7 balloting in 2018.This roundtable will provide a forum to present and discuss the HL7 Balloting process and the outstanding activities in which the Syndromic Surveillance community must participate during the coming months for this activity to be successful. Description: The scope of this project is to provide an updated and consolidated version of the IG v2.5 that includes issues identified in the previously published Erratum and Clarification documents as well as concerns expressed via a community commenting.How the Moderator Intends to Engage the Audience in Discussions on the Topic: Moderator Engagement on Topic:Through this Roundtable moderators will provide an overview of 1.) Recent accomplishments on this project, 2.) Pending deliverables for 2018, 3.) Critical milestones and dates, and 4.) How to participate in the review and balloting process through narrative, handouts, and visual aids.Recent accomplishments: To date this review process has identified and updated a wide-range of specification and requirements described within the IG 2.0. These include: specifications for persistent patient ID across venues of service, inclusion of the ICD-10-CM value set for diagnosis, removal of the ICD-9-CM requirement for testing and messaging, modification of values such as pregnancy status, travel history, and medication lists, and update of value sets and PHIN VADS references for FIPS, SNOmed, ICD-10-CM.Deliverables Include:Completion of the Project Documents as required by Project Insight as described in the 2018 Balloting Calendar (figure 1).Provide a copy of the IG to the Public Health and Emergency Response HL7 Workgroups prior to the ballotSubmit the final version of the IG for ballotingReconcile (with the HL7 Public Health Workgroup and other co-sponsoring workgroups) any comments submitted during the balloting processFinalize the IG for submission as a Standard for Trial Use. This IG v2.5 will replace or supersede all previous guide releases and related documentation and will no longer be a CDC or PHIN artifact.CONCLUSIONS: The results of this multi-agency comment and review process will be synthesized and compiled by ISDS. The updated version of the IG v2.5 will be made available to the Public Health community following the completion of the HL7 Balloting in May 2018. Future revisions of the IG v2.5 will be vettedthrough HL7 Public Health Workgroup.This systematic and structured review and documentation process has allowed for the synthetization and reconciliation of a wide range of disparate specifications, historical hold-overs, and requirements via the perspectives of a diverse range of public health partners. As we continue to move through this review process we believe that the final HL7 balloted “Standard for Trial Use” IG v2.5 will be a stronger more extensible product in supporting syndromic surveillance activities across a wider and more diverse range of clinical venues, EHR implementations, and PHAs.
Objective: To describe the process to update the Implementation Guide (IG) for Syndromic Surveillance via community and stakeholder engagement and highlight significant modifications as the IG is vetted through the formal HL7 balloting process.Introduction: In 2011, the CDC released the PHIN Implementation Guide (IG) for Syndromic Surveillance v.1 under the Public Health Information Network. In the intervening years, new technological advancements, EHR capabilities as well as epidemiological and Meaningful Use requirements have led to the periodic update and revision of the IG through informal and semi-structured solicitation and collection of comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the IG v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the IG in a more systematic manner and released further updates via an Erratum and a technical document developed with NIST to clarify validation policies and testing parameters. These documents were consolidated into the Message Guide v.2.1 release and used to inform the development of the NIST Syndromic Surveillance Test Suite (http://hl7v2-ss-r2-testing.nist.gov/ss-r2/#/home), Validation Test Cases, and develop a new rules-based IG built using NIST’s Implementation Guide Authoring and Management Tool (IGAMT).As part of a Cooperative Agreement initiated in 2017, CDC and ISDS built upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the IG with the goal of having the final product to become an “HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance Standard for Trial Use” following a formal HL7 balloting process in 2018.Methods: ISDS coordinated a multi-stakeholder working group to revisit the consolidated IG, v.2.1 and began to collect structured comments via an online portal, which facilitated the documentation, tracking, and prioritization of comments for developing consensus and ultimately reconciliation and resolution when there were errors, conflicts or differing perspectives. 132 comments were received during the initial review period (April – July 2017) with 16 elements captured for each comment which included: Subject, Request Type, Clinical Venue, Name, IG Section, Priority, Working & Final Resolution (Fig. 1). The online portal also allowed for members of the Message Guide Workgroup to provide feedback directly to one another through a ‘conversation tab’, this has been an important feature in teasing out the underlying concerns and issues with a given comment across different local, state, and private sector partners which many have differing institutional perspectives and state or locally derived requirements (Fig. 2). Some comments were able to be fully described and resolved using this feature. Following the initial comment period, ISDS initiated a weekly webinar-based review process to delve into specific issues in an in-depth manner. In general, approximately 12 comments were addressed on a given call. Each week ISDS staff would lead the webinars structured around similar comment types (e.g. values sets, DG1 Segments, IN1 Segments, Conformance Statements, etc.). This efficiently leveraged the expertise of individuals and institutions with concerns revolving around a specific domain, messages segment, or specification described within the IG. Comments for which consensus and resolution was achieved would be “closed-out’ on the portal inventory and new assignments for review would be disseminated across the Message Guide Workgroup for consideration and discussion during the subsequent review calls.Results: To date this review process has identified and updated a wide-range of specification and requirements described within the IG v.2.0. These include: specifications for persistent patient ID across venues of service, inclusion of the ICD-10-CM value set for diagnosis, removal of the ICD-9-CM requirement for testing and messages, modification of values such as pregnancy status, travel history, and medication list from “O” to “RE”, and the update of PHIN VADS value sets.Conclusions: The results of this multi-agency comment and review process will be synthesized and compiled by ISDS. The updated version of the Message Guide (re-branded to the HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance) will be made available to the Public Health community by November 2017, when a second round of review and commentary will be initiated.This systematic and structured review and documentation process has allowed for the synthetization and reconciliation of a wide range of disparate specifications, historical hold-overs, and requirements via the perspectives of a diverse range of public health partners. As we continue to move through this review process we believe that the final HL7 balloted “Standard for Trial Use” IG 2.5 will be a stronger more extensible product in supporting syndromic surveillance activities across a wider and more diverse range of clinical venues, EHR implementations, and public health authorities.
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