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ISDS 2012 Conference Abstracts

Recommendations for Syndromic Surveillance Using
Inpatient and Ambulatory EHR Data
Geraldine Johnson1, Charles Ishikawa2, Rebecca Zwickl2, Maiko Minami4, Taha Kass-Hout3
and Laura Streichert*2

1NY State Health Dept., Albany, NY, USA; 2ISDS, Brighton, MA, USA; 3Division of Informatics Solutions and Operations, CDC, Atlanta,
GA, USA; 4HLN Consulting, San Diego, CA, USA

Objective
To develop national Stage 2 Meaningful Use (MUse) recommen-

dations for syndromic surveillance using hospital inpatient and am-
bulatory clinical care electronic health record (EHR) data.

Introduction
MUse will make EHR data increasingly available for public health

surveillance. For Stage 2, the Centers for Medicare & Medicaid Serv-
ices (CMS) regulations will require hospitals and offer an option for
eligible professionals to provide electronic syndromic surveillance
data to public health. Together, these data can strengthen public health
surveillance capabilities and population health outcomes (Figure 1).

To facilitate the adoption and effective use of these data to advance
population health, public health priorities and system capabilities
must shape standards for data exchange. Input from all stakeholders
is critical to ensure the feasibility, practicality, and, hence, adoption
of any recommendations and data use guidelines.

Methods
ISDS, in collaboration with the Division of Informatics Solutions

and Operations at the Centers for Disease Control and Prevention
(CDC), and HLN Consulting, convened a multi-stakeholder Work-
group of clinicians, technologists, epidemiologists, and public health
officials with expertise in syndromic surveillance. Recommended
MUse guidelines were developed by performing an environmental
scan of current practice and by using an iterative, expert and com-
munity input-driven process. The Workgroup developed initial guide-
lines and then solicited and received feedback from the stakeholder
community via interview, e-mail, and structured surveys. Stakeholder
feedback was analyzed using quantitative and qualitative methods
and used to revise the recommendations.

Results
The MUse Workgroup defined electronic syndromic surveillance

(ESS) characteristics. Specifically, data are characterized by their
timeliness, sensitivity rather than specificity, population focus, lim-
ited personally identifiable information, and inclusion of all patient
encounters within a specific healthcare setting (e.g., emergency de-
partment, inpatient, outpatient). Based on stakeholder input (n=125)
and Workgroup expertise, the guidelines identify priority syndromic
surveillance uses that can assist with:

1. Monitoring population health;
2. Informing public health services; and
3. Informing interventions, health education, and policy by char-

acterizing the burden of chronic disease and health disparities.
Similarly, the Workgroup identified data elements to support these

uses in the hospital inpatient setting and possibly in the ambulatory
care setting. They were aligned to previously identified emergency
department and urgent care center data elements and Stage 1-2 clin-
ical MUse objectives. Core data elements (required for certification)
cover treating facility; patient demographics; subjective and objective

clinical findings, including chief complaint, body mass index, smok-
ing history, diagnoses; and outcomes. Other data elements were des-
ignated as extended (not required for certification) or future (for
future consideration). The data elements and their specifications are
subject to change based on applicable state and local laws and prac-
tices. 

Based on their findings and recommended guidelines detailed in
the report, the Workgroup also identified community activities and
additional investments that would best support public health agen-
cies in using EHR technology with syndromic surveillance method-
ologies.

Conclusions
The widespread adoption of EHRs, catalyzed by MUse, has the

potential to improve population health. By identifying and describing
potential ESS uses of new sources of EHR data and associated data
elements with the greatest utility for public health, the recommenda-
tions set forth by the ISDS MUse Workgroup will serve to facilitate
the adoption of MUse policy by both healthcare and public health
agencies.

Figure 1: Syndromic surveillance data can inform public health functions.

Keywords
EHR; syndromic surveillance; Meaningful Use; inpatient; ambula-
tory

Acknowledgments

We thank the ISDS MUse Workgroup. This work supported by CDC con-
tract #200-2011-41831.

*Laura Streichert
E-mail: lstreichert@syndromic.org

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e53, 2013