informatics

by Melanie Kourbage, PhD, MA, APHL consultant; Gretl Glick, MPH, APHL consultant; and Laura Carlton, MPH, senior specialist, Informatics

The ability to send case notifications from their integrated surveillance system reduces duplicate data entry, allowing those resources to be used for surveillance and response.

Working Together on the Ground …

Data collection and analysis of potential Zika cases began as soon as the first case was discovered in Puerto Rico in late December 2015, concurrently with the more well-publicized public health outbreak response. Subject matter experts( SMEs) from all three agencies worked together to develop and test a message mapping guide( MMG) for arboviral diseases, with teams including experts in system integration, vocabulary and messaging, epidemiology and project management, as well as stakeholders from state and local PHAs. Further development updates were made to the Message Quality Framework( MQF), the system used to validate messages prepared by PHAs, and to prepare CDC systems to receive, process, and provision the arboviral messages. Select PHAs piloted the Arboviral v1.3 MMG, participated in end-to-end testing and completed onboarding activities to move into production by the end of

2016. The ability to send case notifications from their integrated surveillance system reduces duplicate data entry, allowing those resources to be used for surveillance and response.

… And In the Cloud

APHL SMEs and the CDC NEDSS Base System team provided expertise through every development stage of the updated Arboviral v1.3 MMG, and extensive technical assistance( TA) to help PHAs implement HL7 messaging. The APHL TA team worked with New York and Florida as pilot states— both remotely and on site— to expedite the implementation process. APHL terminologists helped PHAs accurately map the Arboviral v1.3 MMG to state surveillance system data and update their systems to generate a valid arboviral HL7 message.

Additionally, APHL technical architects helped guide PHAs through transport set up, validation, user acceptance testing and onboarding activities. For PHAs with limited resources that were trying to simultaneously coordinate an outbreak response and execute a highly complex implementation project, this extra support was essential to implementing the updated Arboviral v1.3 MMG in an expedited and timely fashion. The CDC NEDSS Base System team provided similar support to states using NEDSS Base Systems, including Tennessee and Texas. As of December 2016, four PHAs( New York, Florida, Tennessee and Texas) are in production and submitting Arboviral v1.3 HL7 case notifications, with all state PHAs to be sending case notifications by summer 2017.

The aggressive timeline is only possible because APHL, CDC and CSTE have been actively working to modernize the National Notifiable Diseases Surveillance System( NNDSS) as part of the NNDSS Modernization Initiative( NMI). The ultimate goal of NMI is to replace the National Electronic Telecommunications Surveillance System and associated reporting systems with a single data feed of HL7 2.5.1 case notification messages from PHAs to CDC. These messages will provide meaningful, more timely information to CDC to support critical decisions about threats to the nation’ s public health.

Arboviral MMG Development in 2016

Despite the redirection of NMI resources to arboviral messaging, the NMI team is implementing HL7 case notification messages for other diseases and was able to onboard the first two pilot agencies, Michigan and Oregon, with Generic v2.0 and Hepatitis case notifications by January 2017. Moreover, CDC opened onboarding for Generic v2.0 and Hepatitis to all PHAs beginning in mid-January 2017. The finalized MMGs, as well as the NMI Implementation and Technical Assistance Guidebook are available through the NMI Technical Assistance and Training Resource Center at https:// www. cdc. gov / nmi / ta-trc / index. html. Interested PHAs can also request technical assistance by emailing edx @ cdc. gov.