TY - JOUR AU - Boyd, Laurel AU - Barber, Michelle PY - 2017/05/02 Y2 - 2024/03/28 TI - Streamling Syndromic Surveillance Submission on a Dime: Oregon’s Experience JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Information system architectures, development and implementation DO - 10.5210/ojphi.v9i1.7646 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7646 SP - AB - <div style="left: 82px; top: 270.987px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.08211);" data-canvas-width="58.10914814814815">Objective</div><div style="left: 95.6667px; top: 284.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00368);" data-canvas-width="347.374474074074">To design a low budget process to enroll, track and approve</div><div style="left: 82px; top: 299.794px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01956);" data-canvas-width="359.2247648148149">syndromic submitters for ongoing submission of data to the Oregon</div><div style="left: 82px; top: 314.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00132);" data-canvas-width="118.3222037037037">Public Health Division</div><div style="left: 82px; top: 343.876px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.11815);" data-canvas-width="75.28890740740741">Introduction</div><div style="left: 95.6667px; top: 357.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0552);" data-canvas-width="348.79687037037024">In 2012, the Oregon Public Health Division (OPHD) took</div><div style="left: 82px; top: 372.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02708);" data-canvas-width="359.2041129629629">advantage of the opportunity created by Meaningful Use, a Centers</div><div style="left: 82px; top: 387.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.986102);" data-canvas-width="360.4367703703704">for Medicare &amp; Medicaid Services (CMS) Incentive Program, to</div><div style="left: 82px; top: 403.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.997316);" data-canvas-width="358.3522240740741">implement statewide syndromic surveillance. The Oregon syndromic</div><div style="left: 82px; top: 418.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.986973);" data-canvas-width="355.3925555555555">surveillance project, or Oregon ESSENCE, began accepting MU-</div><div style="left: 82px; top: 433.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.988102);" data-canvas-width="360.31156851851836">compliant HL7 2.5.1 data in late 2013. Early onboarding efforts</div><div style="left: 82px; top: 448.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.945328);" data-canvas-width="359.60295185185174">were labor-intensive and led to the creation of a testing queue. As</div><div style="left: 82px; top: 463.794px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02366);" data-canvas-width="359.4751685185184">interest in submitting syndromic data increased, Oregon ESSENCE</div><div style="left: 82px; top: 478.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.970761);" data-canvas-width="360.10375925925933">streamlined the onboarding process by creating guidance for HL7</div><div style="left: 82px; top: 494.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.983595);" data-canvas-width="358.0940759259258">message construction, message testing and submitter business process</div><div style="left: 82px; top: 509.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00321);" data-canvas-width="358.6490944444444">details (collectively referred to as “onboarding documents”). Oregon</div><div style="left: 82px; top: 524.535px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.9652);" data-canvas-width="360.1321555555558">ESSENCE also built a project management database to track MU</div><div style="left: 82px; top: 539.72px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00074);" data-canvas-width="358.4980777777777">testing statuses and data quality variations. With this system, Oregon</div><div style="left: 82px; top: 554.905px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01385);" data-canvas-width="361.2008888888889">ESSENCE collected, tested and approved all 32 eligible health</div><div style="left: 82px; top: 570.091px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0004);" data-canvas-width="358.56132407407404">systems (56 hospitals) for production-level submission by mid-2015.</div><div style="left: 82px; top: 585.276px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03095);" data-canvas-width="359.5267981481481">One health system (with four hospitals) continued to send non-MU</div><div style="left: 82px; top: 600.461px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00148);" data-canvas-width="329.08725925925916">compliant syndromic data for the duration of the project period.</div><div style="left: 82px; top: 629.357px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.07341);" data-canvas-width="53.062351851851844">Methods</div><div style="left: 95.6667px; top: 642.979px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.09235);" data-canvas-width="349.878511111111">Initially, Oregon ESSENCE began onboarding syndromic</div><div style="left: 82px; top: 658.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.991853);" data-canvas-width="360.4393518518516">submitters on a first-come-first-served basis. The lack of a clear</div><div style="left: 82px; top: 673.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.997066);" data-canvas-width="360.97113703703695">process for onboarding, a single FTE devoted the endeavor and</div><div style="left: 82px; top: 688.535px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.983941);" data-canvas-width="358.13796111111094">substantial interest in submitting, led to a testing queue. To streamline</div><div style="left: 82px; top: 703.72px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00594);" data-canvas-width="358.7175037037037">the onboarding process and accommodate the testing timelines of all</div><div style="left: 82px; top: 718.905px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02938);" data-canvas-width="359.561648148148">submitters, Oregon ESSENCE created tools to allow for self-paced</div><div style="left: 82px; top: 734.091px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00841);" data-canvas-width="358.8259259259256">testing followed by short duration, intensive testing with the project.</div><div style="left: 82px; top: 749.276px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02568);" data-canvas-width="361.2783333333334">Oregon ESSENCE-branded onboarding documents incorporated</div><div style="left: 82px; top: 764.461px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.980051);" data-canvas-width="360.0379314814814">available resources such as the CDC’s Public Health Information</div><div style="left: 82px; top: 779.646px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01789);" data-canvas-width="359.3848166666666">Network Messaging Guide for Syndromic Surveillance: Emergency</div><div style="left: 82px; top: 794.831px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.982669);" data-canvas-width="358.16635740740765">Department and Urgent Care Data, Release 1.1 (August 2012) and the</div><div style="left: 82px; top: 810.017px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01861);" data-canvas-width="359.1615185185185">NIST 2014 Edition ONC Health IT Certification HL7v2 Syndromic</div><div style="left: 82px; top: 825.202px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0013);" data-canvas-width="358.23218518518524">Surveillance Reporting Validation Tool. Submitters began self-paced</div><div style="left: 82px; top: 840.387px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.9784);" data-canvas-width="358.01275925925916">testing by testing their own messages using the NIST tool and sending</div><div style="left: 82px; top: 855.572px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04358);" data-canvas-width="359.70621111111086">successful reports back to Oregon ESSENCE. They then filled out</div><div style="left: 82px; top: 870.757px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.994971);" data-canvas-width="360.4780740740741">an Oregon ESSENCE Business Process Survey which asked for</div><div style="left: 82px; top: 885.943px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.997235);" data-canvas-width="358.3896555555555">meta-data and project contact information. Oregon ESSENCE built a</div><div style="left: 82px; top: 901.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.98948);" data-canvas-width="358.0927851851852">project managment database in FileMaker v14 (FileMaker Inc., Santa</div><div style="left: 82px; top: 916.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.982786);" data-canvas-width="358.15990370370366">Clara, CA USA), used to support the statewide communicable disease</div><div style="left: 82px; top: 931.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0041);" data-canvas-width="335.5538703703703">database, to store information from the Business Process Survey.</div><div style="left: 95.6667px; top: 946.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03859);" data-canvas-width="346.0579185185185">After completing self-paced testing, submitters selected a single</div><div style="left: 82px; top: 961.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0059);" data-canvas-width="361.16862037037026">week for intensive testing with Oregon ESSENCE. Each health</div><div style="left: 82px; top: 977.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0226);" data-canvas-width="359.2570333333333">system’s project staff (registration staff, technical project lead, HL7</div><div style="left: 82px; top: 992.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00193);" data-canvas-width="358.59230185185186">translator and data exchange lead) met daily with Oregon ESSENCE</div><div style="left: 82px; top: 1007.42px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00921);" data-canvas-width="360.9943703703703">to test messages. Oregon ESSENCE used Rhapsody Integration</div><div style="left: 82px; top: 1022.61px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.984899);" data-canvas-width="358.0927851851851">Engine v6.2.1 (Orion Health, Auckland, NZ), already in use at OPHD</div><div style="left: 82px; top: 1037.79px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0039);" data-canvas-width="358.64393148148133">for electronic lab reporting, to parse test data into a test database and</div><div style="left: 82px; top: 1052.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.996414);" data-canvas-width="358.4103074074074">then generated a report for each testing session using SAS v9.4 (SAS</div><div style="left: 82px; top: 1068.16px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02908);" data-canvas-width="359.37319999999994">Institute Inc., Cary, NC, USA). The report indicated whether or not</div><div style="left: 82px; top: 1083.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.990563);" data-canvas-width="358.1547407407406">the submitter had achieved production-level syndromic messaging by</div><div style="left: 82px; top: 1098.54px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.949848);" data-canvas-width="359.53325185185173">the end of this week of intensive testing. The project management</div><div style="left: 464.667px; top: 269.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.979853);" data-canvas-width="358.07084259259244">database stored notes from each testing session along with MU testing</div><div style="left: 464.667px; top: 284.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00174);" data-canvas-width="29.751574074074068">dates.</div><div style="left: 464.667px; top: 313.505px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.08548);" data-canvas-width="46.62155555555556">Results</div><div style="left: 478.333px; top: 327.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.07747);" data-canvas-width="349.54808148148146">Oregon ESSENCE developed their onboarding documents</div><div style="left: 464.667px; top: 342.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00316);" data-canvas-width="360.8885296296293">between November, 2012 and March, 2013 and achieved 100%</div><div style="left: 464.667px; top: 357.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.966072);" data-canvas-width="359.8456111111113">syndromic submission from eligible health systems in June, 2015.</div><div style="left: 464.667px; top: 372.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.96216);" data-canvas-width="359.7036296296297">The average duration of onboarding (from initiation of the testing</div><div style="left: 464.667px; top: 387.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0212);" data-canvas-width="361.3170555555556">process to achieving production submission) of a single health</div><div style="left: 464.667px; top: 403.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02196);" data-canvas-width="359.084074074074">system decreased from 23 months in 2012 to 4 months in 2014 (see</div><div style="left: 464.667px; top: 418.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.999336);" data-canvas-width="358.46193703703705">Duration of Onboarding Syndromic Submitters: Oregon 2012-2015).</div><div style="left: 464.667px; top: 433.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.985301);" data-canvas-width="360.62005555555544">As interest in the project grew (number of submitters contacting</div><div style="left: 464.667px; top: 448.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00145);" data-canvas-width="293.5918888888888">OPHD), the amount of time spent onboarding decreased.</div><div style="left: 478.333px; top: 463.794px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.981192);" data-canvas-width="346.34446296296284">Oregon ESSENCE uses their project management database for</div><div style="left: 464.667px; top: 478.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.965488);" data-canvas-width="359.61198703703695">ongoing syndromic data quality improvement and to communicate</div><div style="left: 464.667px; top: 494.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00695);" data-canvas-width="358.72653888888885">MU dates to submitters (by generating health system-specific emails</div><div style="left: 464.667px; top: 509.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.957274);" data-canvas-width="359.4403185185185">directly from the database). FileMaker, Rhapsody and SAS are all</div><div style="left: 464.667px; top: 524.535px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01614);" data-canvas-width="359.0518055555555">currently used by OPHD and did not require any additional expense</div><div style="left: 464.667px; top: 539.72px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03168);" data-canvas-width="359.3848166666666">for their use in this testing process. Oregon ESSENCE plans to use</div><div style="left: 464.667px; top: 554.905px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00202);" data-canvas-width="346.2799259259258">this onboarding process to collect urgent care data for Stage 3 MU.</div><div style="left: 464.667px; top: 583.802px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.10391);" data-canvas-width="77.45735185185185">Conclusions</div><div style="left: 478.333px; top: 597.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.99026);" data-canvas-width="344.5116111111111">The onboarding process created by Oregon ESSENCE streamlined</div><div style="left: 464.667px; top: 612.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03754);" data-canvas-width="361.89530740740724">syndromic data submission without the purchase of additional</div><div style="left: 464.667px; top: 627.794px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.983742);" data-canvas-width="357.95080370370357">programs or the hiring of additional project staff. Submitting facilities</div><div style="left: 464.667px; top: 642.979px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03171);" data-canvas-width="359.3783629629628">benefited from this process by testing syndromic messages without</div><div style="left: 464.667px; top: 658.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00079);" data-canvas-width="358.5329277777777">waiting in a testing queue. The project management database created</div><div style="left: 464.667px; top: 673.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02256);" data-canvas-width="359.1899148148148">for the testing process will continue to benefit submitters by storing</div><div style="left: 464.667px; top: 688.535px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.995178);" data-canvas-width="360.66910370370374">MU testing dates and information for ongoing quality assurance</div><div style="left: 464.667px; top: 703.72px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04327);" data-canvas-width="359.70362962962946">evaluations. The success of this project took advantage of existing</div><div style="left: 464.667px; top: 718.905px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.962065);" data-canvas-width="359.65200000000016">informatics capabilities at OPHD and speaks to the importance of</div><div style="left: 464.667px; top: 734.091px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.97817);" data-canvas-width="360.48839999999996">those skills in public health practice. Oregon ESSENCE will use</div><div style="left: 464.667px; top: 749.276px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.989394);" data-canvas-width="358.2102425925926">these methods again in 2017 to collect urgent care data for syndromic</div><div style="left: 464.667px; top: 764.461px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00197);" data-canvas-width="65.59544444444442">surveillance.</div><div style="left: 464.667px; top: 790.11px; font-size: 11.3889px; font-family: serif; transform: scaleX(1.00194);" data-canvas-width="307.4772222222221">Duration of Onboarding Syndromic Submitters: Oregon 2012-2015</div> ER -