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Objective
The objective of this project is to enable the ESSENCE system to read in, utilize, and export out meaningful use syndromic surveillance data using the Health Level 7 (HL7) v2.5 standard. This presentation will detail the technical hurdles with reading a meaningful use syndromic surveillance data feed containing multiple sources, deriving a common meaning from the varying uses of the standard and writing data out to a meaningful use HL7 2.5 format that can be exported to other tools, such as BioSense 2.0 (2). The presentation will also describe the technologies employed for facilitating this, such as Mirth, and will discuss how other systems could utilize these tools to also support processing meaningful use syndromic surveillance data.Introduction
In order to utilize the new meaningful use syndromic surveillance data sets (3) that many public health departments are now receiving, modifications to their systems must be made. Typically this involves enabling the storage and processing of the extra fields the new standard contains. Open source software exists, such as Mirth Connect, to help with reading and interpreting the standard. However, issues with reliably reading data from one source to another arise when the standard itself is misunderstood. Systems that process this data must understand that while the data they receive is in the HL7 v2.5 standard format, the meaning of the data fields might be different from provider to provider. Additional work is necessary to sift through the similar yet disjoint fields to achieve a consistent meaning.Methods
This project utilized 3 separate instances of ESSENCE and BioSense 2.0. For both importing and exporting HL7 v2.x standard files, the project used the open source tool Mirth Connect. For importing data the project adapted versions of Tarrant County and Cook County ESSENCE systems in the Amazon GovCloud to receive meaningful use syndromic surveillance data files sent from BioSense 2.0. For exporting data to BioSense 2.0, the project used Mirth Connect to poll the local version of Cook County’s ESSENCE database and export the data into an HL7 v2.5 file. The resultant file was sent over secure file transfer protocol (SFTP) to BioSense 2.0. The team then evaluated the process by comparing the data in the local instances of ESSENCE and the corresponding instances hosted on the Internet cloud.Results
Many issues were encountered during the reading of the HL7. While the standard suggests that hospitals and hospital systems would all send data in the same fields for the same data, the reality was far different. Although HL7 v2.5 is a standard and there is a defined use for each field, it can be interpreted in many ways. A large portion of time was spent communicating with the local health department to determine exactly what each field meant for a particular hospital. Comparing the Internet cloud and local versions did have some difficulties due to local filtration rules that eliminated non-ER related records from the local Tarrant County system. The project was able to utilize new query features in ESSENCE to filter down to only ER related records on the Internet cloud version to support the comparisons. The project was able to re-use much of the configuration that was created when moving from one jurisdiction to the other. This will help when describing how others may use the same technology in their own systems.Conclusions
Reading and interpreting the data consistently from a data feed containing multiple sources can be challenging. Confusion with the HL7 v2.3 or 2.5 standards causes many health organizations to transmit data in inconsistent ways that betrays the notion of a messaging standard. However, with the tools this project have created and the lessons we have learned, the pain of implementing meaningful use syndromic surveillance data into a system can be reduced. 相似文献2.
Rebecca Zwickl Charles Ishikawa Laura C. Streichert 《Online Journal of Public Health Informatics》2013,5(1)
Objective
To document the current evidence base for the use of electronic health record (EHR) data for syndromic surveillance using emergency department, urgent care clinic, hospital inpatient, and ambulatory clinical care data.Introduction
Historically, syndromic surveillance has primarily involved the use of near real-time data sent from hospital emergency department (EDs) and urgent care (UC) clinics to public health agencies. The use of data from inpatient and ambulatory settings is now gaining interest and support throughout the United States, largely as a result of the Stage 2 and 3 Meaningful Use regulations [1]. Questions regarding the feasibility and utility of applying a syndromic approach to these data sources are hampering the development of systems to collect, analyze, and share this potentially valuable information. Solidifying the evidence base and communicating the results to the public health surveillance community may help to initiate and build support for using these data to advance surveillance functions.Methods
We conducted a literature search in the published and grey literature that scanned for relevant articles in the Google Scholar, Pub Med, and EBSCO Information Services databases. Search terms included: “inpatient/ambulatory electronic health record”; “ambulatory/inpatient/hospital/outpatient/chronic disease syndromic surveillance”; and “EHR syndromic surveillance”. Information gleaned from each article included data use, data elements extracted, and data quality indicators. In addition, several stakeholders who provided input on the September 2012 ISDS Recommendations [2] also provided articles that were incorporated into the literature review.ISDS also invited speakers from existing inpatient and ambulatory syndromic surveillance systems to give webinar presentations on how they are using data from these novel sources.Results
The number of public health agencies (PHAs) routinely receiving ambulatory and inpatient syndromic surveillance data is substantially smaller than the number receiving ED and UC data. Some health departments, private medical organizations (including HMOs), and researchers are conducting syndromic surveillance and related research with health data captured in these clinical settings [2].In inpatient settings, many of the necessary infrastructure and analytic tools are already in place. Syndromic surveillance with inpatient data has been used for a range of innovative uses, from monitoring trends in myocardial infarction in association with risk factors for cardiovascular disease [3] to tracking changes in incident-related hospitalizations following the 2011 Joplin, Missouri tornado [3].In contrast, ambulatory systems face a need for new infrastructure, as well as pose a data volume challenge. The existing systems vary in how they address data volume and what types of encounters they capture. Ambulatory data has been used for a variety of uses, from monitoring gastrointestinal infectious disease [3], to monitoring behavioral health trends in a population, while protecting personal identities [4].Conclusions
The existing syndromic surveillance systems and substantial research in the area indicate an interest in the public health community in using hospital inpatient and ambulatory clinical care data in new and innovative ways. However, before inpatient and ambulatory syndromic surveillance systems can be effectively utilized on a large scale, the gaps in knowledge and the barriers to system development must be addressed. Though the potential use cases are well documented, the generalizability to other settings requires additional research, workforce development, and investment. 相似文献3.
Megan Patel Enyinnaya Adighibe Joseph Lombardo Wayne Loschen Miles Stewart Michael O. Vernon 《Online Journal of Public Health Informatics》2013,5(1)
Objective
In May 2012, thousands of protesters, descended on Chicago during the NATO Summit to voice their concern about social and economic inequality. Given the increased numbers of international and domestic visitors to the Windy City and the tension surrounding protesting during the summit, increased monitoring for health events within the city and Chicago metropolitan region was advised. This project represents the first use of cloud technology to support monitoring for a high profile event.Introduction
Hospital emergency departments in Cook and surrounding counties currently send data to the Cook County Department of Public Health (CCDPH) instance of ESSENCE on CCDPH servers. The cloud instance of ESSENCE has been enhanced to receive and export all meaningful use data elements in the meaningful use format. The NATO summit provided the opportunity for a demonstration project to assess the ability of an Amazon GovCloud instance of ESSENCE to ingest and process meaningful use data, and to export meaningful use surveillance data to the Cook County Locker in BioSense 2.0.Methods
In the three weeks leading up to the NATO Summit, HL7 data extracts were sent to BioSense 2.0 and a data feed was established to the Amazon GovCloud instance of ESSENCE. Queries specific to anticipated health events associated with the summit such as injuries, tear gas exposure, and general exposure, were developed. Several features of the cloud instance of ESSENCE enhanced the ability of CCDPH staff epidemiologists to conduct analyses, including the sharing capabilities of queries and the myESSENCE dashboard feature. The sharing capabilities within the cloud instance of ESSENCE allowed queries to be easily shared with multiple staff epidemiologists and across health jurisdictions. The myESSENCE dashboard feature was used to create dashboards of surveillance results, including time series graphs, maps, and records of interest for relevant queries, that were shared with public health staff monitoring population health during the summit. This information was used to provide situational awareness on a daily basis in the Chicago Metropolitan region.Results
Data feeds to BioSense 2.0 and the Amazon GovCloud instance of ESSENCE were successful. The NATO Summit did not produce any remarkable public health concerns in suburban Cook County. The use of the cloud instance of ESSENCE enhanced the timeliness of generating situational awareness reports for distribution to public health partners in the Chicago Metropolitan region.Conclusions
While further evaluation of cloud resources to conduct syndromic surveillance is warranted, use of the cloud instance of ESSENCE during the NATO Summit demonstrated the ability of the cloud to support surveillance for both routine and high profile events. 相似文献4.
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Brian E. Dixon Jason A. Siegel Tanya V. Oemig Shaun J. Grannis 《Online Journal of Public Health Informatics》2013,5(1)