> **Purpose: The BDSG considered these assumptions when determining
> which Minimum Data Set (MDS) elements would support public health
> preparedness.**

1.  The BDSG will utilize the ASTHO Biosurveillance definition[^1] as a
    working definition for the group.

2.  MDS elements will not meet all current public health data stream
    needs (i.e., our charge is to develop the minimum data set).

3.  The BDSG will focus on readily available electronic data with
    minimal new clinician and/or facility effort from ambulatory care
    settings (i.e., emergency department and outpatient), inpatient
    settings (i.e., hospital, nursing home), and laboratories.

4.  Use and collection of secondary clinical data will help support the
    following functions:

    a.  Early identification and characterization of public health
        events to confirm or refute initial event detection

    b.  Situational awareness of the size, location, spread, control of,
        and response to a public health event

    c.  Notifiable disease case reporting from clinical care

5.  Data will optimally be available in real-time, but will not exceed
    24 hours before reporting. System derived date/time stamps will
    associated with all data messages.

6.  Patient-specific information will only be accessed by registered
    authorized health care professionals and public health officials.\*

7.  Patient-specific information will only be used for biosurveillance
    and other public health purposes.\*

8.  All non-essential Protected Health Information (PHI) will be
    filtered out and retained by the submitting facility before sending
    to public health authorities.\*

9.  A linking process (e.g., randomly-generated, encoded number) will
    assure that patient-level information (i.e., name and address),
    removed prior to submission, is retrievable if required. Only
    authorized public health users will utilize the linking process to
    access facility and patient-level information during a public health
    investigation.\*

10. A multi-jurisdictional approach includes collaborative
    decision-making and coordinated efforts to assure maximal benefits
    to all partners. All jurisdictions (i.e., federal, state and local)
    will simultaneously have access to timely data Data will be shared
    to support initial public health investigations while preserving
    traditional comprehensive public health investigatory roles and
    responsibilities. Biosurveillance systems will add value to public
    health practice. Local health department (LHD) involvement in
    biosurveillance systems development and implementation will be
    critical to leverage and complement existing relationships between
    LHDs and local hospitals/providers.^2^

11. Information from public health agencies will be shared in real-time
    with clinical providers in emergency departments to improve their
    ability to respond to rapidly evolving events.

12. The BDSG will not proscribe the method by which MDS elements will be
    transferred. The architecture for transmission will synergize and be
    based on local and regional health information investments.

13. Specific elements for multi-jurisdictional data sharing will be
    based on the level of accountability and responsibility at each
    level of government. Although simultaneous data sharing is expected,
    the level of MDS elements required within each jurisdiction may
    differ (e.g., PHI) and will require some filtering based on
    legislative rule.

14. Ongoing efforts will be made to evaluate what is available,
    feasible, useful and valuable for multi-jurisdictional data sharing.
    While this MDS is a good first approximation, new elements may be
    added as they are proven to have utility.

\*Added from the Scope of Work Step 1 Preconditions

All of these preconditions will be added to the Scope of Work document
upon consensus of each.

[^1]: ASTHO: Biosurveillance is often referred to as syndromic
    surveillance; however the ability to detect events early requires a
    broader set of information than that of syndromes. While there is no
    single agreed upon definition, there is agreement that such
    "biosurveillance" systems need to take advantage of integrated data
    from multiple sources including public health information as well as
    electronic health information not traditionally monitored by public
    health. Biosurveillance systems must leverage two major surveillance
    methods:

    Well established public health surveillance methods and sources used
    for the tracking, monitoring, and reporting of health-related
    information, such as epidemiologic investigations of infectious
    disease outbreaks or environmental conditions, are needed to ensure
    a broad coverage of data sources, to use as baselines comparisons,
    and to support the accuracy and reliability of the biosurveillance
    findings.

    Early event detection and situational awareness, the use of an
    automated system to evaluate case and suspect case reporting along
    with statistical surveillance and data visualization of
    pre-diagnostic and diagnostic data to support the earliest possible
    detection of events that may signal a public health emergency, is an
    essential component for near real-time detection of natural or
    man-made health events.

    ^2^ National Association of County and City Health Officials,
    Statement of Policy: Biosurveillance. No. 06-02, confirmed July 25,
    2006