2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

A Meaningful Journey to Onboard Syndromic Data 
through a Local HIE
Jeffrey Johnson*, Jessica Yen, Brit Colanter and Eric McDonald

County of San Diego Public Health Services, San Diego, CA, USA

Objective
This presentation aims to highlight technical approaches, validation 

activities, outcomes, and lessons learned while onboarding local 
hospitals through a local health information exchange (HIE) for 
Meaningful Use Stage 2 syndromic surveillance.

Introduction
The federal meaningful use initiative is a major driver to the 

establishment of expanded electronic syndromic surveillance 
capacity across the United States. Much has been documented about 
the background and requirements for eligible hospitals to achieve the 
syndromic meaningful use objectives. However, the role and efforts 
by public health agencies in the syndromic onboarding process, which 
varies by jurisdiction, is a significant component of the success of 
meaningful use.

This presentation will highlight the onboarding process developed 
by the County of San Diego, Public Health Services, for working with 
the local hospitals and the local health information exchange. Included 
will be a review of the technical requirements, project management 
tools, resources used, challenges encountered, validation techniques, 
data storage models, the development of performance metrics, and 
the establishment of protocols for hospital follow-up when detected 
events using meaningful use. Lastly, a plan to discover the meaning 
within the syndromic information during the upcoming Stage 2 Year 
2 period and the integration of these data into the existing syndromic 
surveillance system will be described.

Methods
In the process of onboarding, County of San Diego, Public Health 

Services, actively engaged with the hospitals, their electronic health 
record (EHR) vendors, and the local HIE. Public Health Services was 
actively involved with HL7 message structure validation, connectivity, 
HL7 message content validation, use case driven testing, and quality 
assurance. Through these steps, a several lessons have been learned 
that have led to optimized technical approaches to onboarding future 
hospitals, as well as gaining insight into how the data can be used 
in a meaningful way. Going forward, a dedicated meaningful data 
discovery phase process is being planned for the first 180 days of 
Stage 2 - Year 2. This will enable insight into the public health value 
that can be obtained from the meaningful use data. Lastly, the process 
for integrating the meaningful use syndromic data into the existing 
syndromic system will be described.

Results
The local health information exchange in San Diego incorporated 

as a 501c3 nonprofit in 2013. In 2014, hospitals began to pursue 
syndromic meaningful use Stage 2 activities. Many hospitals 
have achieved or are on track to achieve ongoing syndromic data 
submission capacity by the end of 2014. Several tools, resources, 
technical approaches, and data management models have been 
developed as a result of working with the local hospitals. This 
includes adherence to specification documents, use of the NIST 
validation tool, and in collaboration with the local HIE. Preliminary 
outcomes have shown that it is valuable to have public health involved 

in the onboarding process and, more importantly, during validation 
activities. A significant challenge identified is that many hospitals 
have different information workflows that manifest outwardly in the 
submitted data. These include differing classification of inpatient and 
ambulatory related messages, message segment values and how the 
patient’s treating location is coded.

Conclusions
Public health agencies across the United States vary in their 

capacity to onboard meaningful use syndromic data. At the same 
time, various technology approaches are currently in place or are in 
development to collaborate with the hospitals pursuit of Stage 2 - Year 
2 attestation. Following a collaborative onboarding process with the 
public health agency as a key stakeholder is critical to understanding 
and using meaningful use syndromic information.

Keywords
meaningful use; syndromic surveillance; onboarding; health 
information exchange; validation

*Jeffrey Johnson
E-mail: Jeffrey.Johnson@sdcounty.ca.gov    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e193, 201