Streamling Syndromic Surveillance Submission on a Dime: Oregon’s Experience
Authors: Boyd Laurel , Barber Michelle 
Published: May 2017

ObjectiveTo design a low budget process to enroll, track and approvesyndromic submitters for ongoing submission of data to the OregonPublic Health DivisionIntroductionIn 2012, the Oregon Public Health Division (OPHD) tookadvantage of the opportunity created by Meaningful Use, a Centersfor Medicare & Medicaid Services (CMS) Incentive Program, toimplement statewide syndromic surveillance. The Oregon syndromicsurveillance project, or Oregon ESSENCE, began accepting MU-compliant HL7 2.5.1 data in late 2013. Early onboarding effortswere labor-intensive and led to the creation of a testing queue. Asinterest in submitting syndromic data increased, Oregon ESSENCEstreamlined the onboarding process by creating guidance for HL7message construction, message testing and submitter business processdetails (collectively referred to as “onboarding documents”). OregonESSENCE also built a project management database to track MUtesting statuses and data quality variations. With this system, OregonESSENCE collected, tested and approved all 32 eligible healthsystems (56 hospitals) for production-level submission by mid-2015.One health system (with four hospitals) continued to send non-MUcompliant syndromic data for the duration of the project period.MethodsInitially, Oregon ESSENCE began onboarding syndromicsubmitters on a first-come-first-served basis. The lack of a clearprocess for onboarding, a single FTE devoted the endeavor andsubstantial interest in submitting, led to a testing queue. To streamlinethe onboarding process and accommodate the testing timelines of allsubmitters, Oregon ESSENCE created tools to allow for self-pacedtesting followed by short duration, intensive testing with the project.Oregon ESSENCE-branded onboarding documents incorporatedavailable resources such as the CDC’s Public Health InformationNetwork Messaging Guide for Syndromic Surveillance: EmergencyDepartment and Urgent Care Data, Release 1.1 (August 2012) and theNIST 2014 Edition ONC Health IT Certification HL7v2 SyndromicSurveillance Reporting Validation Tool. Submitters began self-pacedtesting by testing their own messages using the NIST tool and sendingsuccessful reports back to Oregon ESSENCE. They then filled outan Oregon ESSENCE Business Process Survey which asked formeta-data and project contact information. Oregon ESSENCE built aproject managment database in FileMaker v14 (FileMaker Inc., SantaClara, CA USA), used to support the statewide communicable diseasedatabase, to store information from the Business Process Survey.After completing self-paced testing, submitters selected a singleweek for intensive testing with Oregon ESSENCE. Each healthsystem’s project staff (registration staff, technical project lead, HL7translator and data exchange lead) met daily with Oregon ESSENCEto test messages. Oregon ESSENCE used Rhapsody IntegrationEngine v6.2.1 (Orion Health, Auckland, NZ), already in use at OPHDfor electronic lab reporting, to parse test data into a test database andthen generated a report for each testing session using SAS v9.4 (SASInstitute Inc., Cary, NC, USA). The report indicated whether or notthe submitter had achieved production-level syndromic messaging bythe end of this week of intensive testing. The project managementdatabase stored notes from each testing session along with MU testingdates.ResultsOregon ESSENCE developed their onboarding documentsbetween November, 2012 and March, 2013 and achieved 100%syndromic submission from eligible health systems in June, 2015.The average duration of onboarding (from initiation of the testingprocess to achieving production submission) of a single healthsystem decreased from 23 months in 2012 to 4 months in 2014 (seeDuration of Onboarding Syndromic Submitters: Oregon 2012-2015).As interest in the project grew (number of submitters contactingOPHD), the amount of time spent onboarding decreased.Oregon ESSENCE uses their project management database forongoing syndromic data quality improvement and to communicateMU dates to submitters (by generating health system-specific emailsdirectly from the database). FileMaker, Rhapsody and SAS are allcurrently used by OPHD and did not require any additional expensefor their use in this testing process. Oregon ESSENCE plans to usethis onboarding process to collect urgent care data for Stage 3 MU.ConclusionsThe onboarding process created by Oregon ESSENCE streamlinedsyndromic data submission without the purchase of additionalprograms or the hiring of additional project staff. Submitting facilitiesbenefited from this process by testing syndromic messages withoutwaiting in a testing queue. The project management database createdfor the testing process will continue to benefit submitters by storingMU testing dates and information for ongoing quality assuranceevaluations. The success of this project took advantage of existinginformatics capabilities at OPHD and speaks to the importance ofthose skills in public health practice. Oregon ESSENCE will usethese methods again in 2017 to collect urgent care data for syndromicsurveillance.Duration of Onboarding Syndromic Submitters: Oregon 2012-2015