Syndromic Surveillance  

Syndromic Surveillance:  Submitting Data

According to the Centers for Disease Control and Prevention, the term, 'syndromic surveillance', applies to surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response.

In general, this refers to the provision of information available at the time of a patient’s first clinical encounter with an outpatient provider or an emergency department to public health authorities.  This information incorporates patient identifiers, triage information including temperature, and the provider’s clinical impression, but is most likely incomplete in terms of laboratory testing.  The benefit to public health agencies is that this information is much more timely and avoids a potentially lengthy delay required for definitive, laboratory-confirmed diagnoses.  As a result, once these syndromic reports exceed a predefined threshold of detection (defined differently for each specific syndrome), disease control and response efforts can be initiated without need for definitive laboratory confirmation.  Furthermore, early recognition of and responses to outbreaks can help get them under control earlier and prevent subsequent illness.

Specific Examples:

While it is the status quo in terms of infectious disease surveillance, delays in identification of potential outbreaks until confirmatory testing is complete are not ideal.  It may help to demonstrate this point with specific examples.  It is well recognized that many laboratory studies (e.g.: bacterial enteric pathogen serologic testing, stool culture, or pulsed field gel electrophoresis i.e.:  fingerprinting) on potential foodborne illnesses can take 2-3 weeks to be completed and reported to the provider.  Further, definitive diagnoses of some vaccine preventable diseases and tick-borne diseases require tests to be repeated roughly a month after the initial tests.   A functional syndromic surveillance system could prompt early recognition of these sort of problems; thereby, helping to prevent the outbreak from worsening.
The following table may help illustrate the distinction between syndromic surveillance and traditional surveillance and highlight the great potential of syndromic data.
Table:  Examples of Clinical Scenarios and the Information Available to Syndromic versus Traditional Surveillance Systems

Situation prompting visit to medical provider Syndromic Surveillance data available at time of visit  Traditional Surveillance data available after clinical workup and epidemiological investigation is complete 
Patient has bout of diarrheal illness associated with fever and bloody stool that causes him to go to the Emergency Department      

Patient Identifiers including: 

  • Name, Age, Race, Gender
  • Date of Onset
  • Initial Temperature (99O)
  • Chief Complaint of Diarrhea
  • Discharge Diagnosis of Bloody Diarrhea 

 Patient Identifiers including: 

  •   Name, Age, Race, Gender
  • All laboratory data including:   Stool Culture results of Shiga toxin producing E. coli and detailed antibiotic susceptibility
  • Complete History and Physical
  • Potential Supplemental Patient and/or Provider Interview to Collect:  Detailed Food History,  Travel History, or other information
  • Definitive Diagnosis of Ecoli O157/H7
Patient has bout of influenza – like illness

Patient Identifiers including:

  • Name, Age, Race, Gender
  • Date of Onset
  • Initial Temperature(102O)
  • Chief Complaint of Cough        
  • Discharge diagnosis of UpperRespiratory Infection

Patient Identifiers including:

  • Name, Age, Race, Gender
  • All laboratory data including: 
    Results of Respiratory Virus PCR Panel, Streptococcal Antigen testing, Chest X ray
  • Complete History and Physical
    Potential Supplemental Patient and/or Provider  
  • Interview to Collect:  Detailed Exposure History, Travel History, or other information
  • Definitive Diagnosis of Influenza
Patient has rash illness 

Patient Identifiers including: 

  • Name, Age, Race, Gender
  • Date of Onset
  • Initial Temperature (103O)
  • Chief Complaints of Rash and Cough
  •  Discharge diagnosis of Viral Exanthem 

Patient Identifiers including:

  • Name, Age, Race, Gender
  • All laboratory data including: Results of acute and convalescent serological tests for measles, mumps, and rubella viruses
  • Complete History and Physical
  • Supplemental Exposure and Travel History
  • Definitive Diagnosis of Measles

Summary: Syndromic surveillance is a relatively new method of disease surveillance that all states are beginning to use to protect their citizens.  Syndromic surveillance data will be accepted by the Arkansas Department of Health and handled in accordance with all laws governing protected health information.  It will be used to provide early identification of events of public health importance, thereby facilitating more rapid, targeted, and effective response.

Reporting of syndromic surveillance data is one way in which facilities and providers can meet ‘Meaningful Use’ requirements.  Please see http://www.healthy.arkansas.gov/programsServices/MeaningfulUse/ for details on other ways to meet the requirements

Submitting Data

The Meaningful Use public health option allows Eligible Professionals (EP) or Eligible Hospitals (EH) to electronically submit data on syndromic surveillance using Health Language Seven (HL7) to send the data.

Downloads
 HL7 2.3.1 and 2.5.1 specifications  - We currently accept HL72.3.1 and  2.5.1 messaging
Arkansas Minimum data set

Steps for testing an HL7 transmission:

  1. Prepare a test file based on the HL7 spec file 
  2. Forward the test file to the Meaningful Use Coordinator for validation on the message structure and content
  3. The EP or EH will receive a validation letter stating the results of the test

**Due to a large amount of requests, please allow a minimum of three weeks for processing your HL7 message**

If the test message does not have the correct structure or format, an e-mail will be sent to the EP or EH with a list of the errors and suggestions (if applicable) on how to correct and resubmit the error.

Due to updates, new HL7 interfaces in production will be temporarily suspended.  The Epidemiology staff will only be validating a test message as defined by Stage I criteria for Meaningful Use only.

Once the upgrades are in place, the Arkansas Department of Health will resume activities to verify that provider interfaces are operational and in production to ADH’s syndromic database.  The syndromic database is a temporary data repository until CDC releases BioSense 2.0.  When BioSense 2.0 is released, ADH will notify and provide EP’s and EH’s with specifications on creating an interface with the new application. 

Contact

Contact Email
Leah Huang

Leah.Huang@arkansas.gov