HL7 balloting process for the Implementation Guide for Syndromic Surveillance
Authors: Hicks Peter , Lamb Emilie , Dearth Shandy , Trepanier Dave 
Published: October 2019

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.