Syndromic Surveillance-Meaningful Use

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Guidelines for Submitting Syndromic Surveillance in Texas for Meaningful Use

There is no Texas statute requiring the reporting or use of syndromic surveillance data. However, syndromic surveillance tools (sometimes called Early Event Detection systems) are in use in many health care facilities. The Department of State Health Services (DSHS) in Austin does not currently collect statewide data.

As of October 2014, Texas does not currently have any statewide system that is capable of receiving syndromic surveillance data. DSHS is in the process of developing a system that will accept data in the format consistent with the federal Centers for Medicare and Medicaid Services (CMS) Electronic Health Record Incentive Payment Programs (EHR incentive programs).

Information regarding submitting syndromic surveillance data as part of incentive program participation, including information about claiming an exclusion from participating in syndromic surveillance for meaningful use, may be found at

Stage 1:
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/10_Syndromic_Surveillance_Data_Submission.pdf  

Stage 2:
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_HospitalCore_15_SyndromicSurveillanceDataSubmission.pdf

DSHS is working with local health departments across Texas and other partners to develop and implement a syndromic surveillance system that can serve to help identify emerging health threats and inform local decision-making while protecting individuals’ privacy. After completing a data use agreement and supplying data, provider participants will be able to access a set of data analysis tools and make data available to health departments for assisting in community response and health planning. 

The implementation of the new service will prioritize connections to hospitals and hospital systems. At this time DSHS does not expect to be establishing direct connections to non-hospital/urgent care facilities during 2015. 

Hospitals currently submitting data to the City of Houston Public Health Department will be transferred to the DSHS-provided system and should continue to submit data to Houston until the new system is available. The project team will contact participating providers regarding any changes required by providers. No additional hospitals or providers are currently being accepted by Houston.  

No DSHS regional office is conducting syndromic surveillance.

If your facility is in Health Service Region (HSR) 2/3, you may be able to submit syndromic surveillance data that meets EHR incentive program criteria to the Tarrant County Health Department. Follow this link to find a map of the DSHS Health Service Regions: http://www.dshs.state.tx.us/regions/default.shtm

The contact for data submission in HSR 2/3 is Dave Heinbaugh, who may be reached by phone at 817/321-4880 or by email at: wdheinbaugh@TarrantCounty.com

DSHS expects a statewide syndromic surveillance service to be available, including registration of intent to submit data, beginning January 1st, 2015. Registration of intent will be available through this web page.

Interface testing for newly participating hospitals will begin March 1st, 2015.  

Please visit http://www.dshs.state.tx.us/mu/syndromic.aspx regularly for updates to ensure your organization has current information.  

Please retain a copy of this web page as documentation supporting the status of statewide syndromic surveillance by DSHS for any attestation you or your organization may make if you participate in either the Medicare or Medicaid EHR incentive payment programs.  

If you have further questions about syndromic surveillance at DSHS, please contact syndromic.surveillance@dshs.state.tx.us.  

Questions about participating in the Medicaid EHR incentive program should be directed to HealthIT@tmhp.com. If you have other questions about meaningful use and public health, you may contact the DSHS Meaningful Use mailbox at MeaningfulUseTX@dshs.state.tx.us

Questions related to the CMS EHR incentive payment programs registration, attestation, and other meaningful use criteria should be directed to the Health and Human Services Commission, the single state Medicaid agency. Please review the website information thoroughly at www.tmhp.com/pages/healthit/hit_home.aspx before contacting the support desk at HealthIT@tmhp.com

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Syndromic Surveillance in Texas FAQ:

Q: When will DSHS be accepting syndromic surveillance data from new organizations?

A:  DSHS expects the new statewide system will “go live” in the March 2015 timeframe.  The initial system will be limited to existing data and providers in the system currently managed by the Houston Health and Human Services Department.  DSHS expects that it will be accepting new organizations and their data approximately 60 days after the initial “go live” capability. 

Q: Who can submit syndromic surveillance data?

A:  In 2015, DSHS is prioritizing submission from hospitals with emergency departments. Other types of organizations may be included based on resource availability.

Q: What is the impact of Eligible Professionals (EPs) not collecting syndromic surveillance data on participation in the CMS EHR incentive programs?

A: The CMS Final Rule for the EHR incentive program states, ”If an EP does not collect any reportable syndromic information on their patients during the EHR reporting period, then they are excluded from this measure according to the discussion of whether certain EP, eligible hospital or CAH can meet all Stage 1 meaningful use objectives given established scopes of practices.” (75 FR Page 44368) There are also several reasons for claiming exemptions for reporting syndromic under Stage 2. Contact HealthIT@tmhp.com at HHSC with additional questions about documenting this information in your attestation.

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CMS EHR Incentive Payment Program Criteria: Syndromic Surveillance

Stage 1 Menu Set Objective for Eligible Providers, Eligible Hospitals or Critical Access Hospitals (CAHs) for Syndromic Surveillance

Meaningful Use Requirements – Objectives and Measures

Eligible providers may choose at least one of two public health objectives and measures from a menu set to meet the meaningful use requirements in Stage 1. These objectives include submitting electronic immunization information to immunization registries or immunization information systems, and/or submitting electronic syndromic surveillance data to public health agencies. Eligible hospitals must also choose at least one public health objective from the menu set which includes the two objectives previously listed and/or submitting electronic laboratory results to public health agencies.

Objective: Capability to submit electronic syndromic surveillance data to public health agencies and actual submission according to applicable law and practice.

Measure: Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful (unless none of the public health agencies to which an EP [eligible hospital or CAH] submits such information has the capacity to receive the information electronically).

Exclusion for Eligible Providers: Exclusion in accordance with paragraph (a)(2) of this section. An EP who does not collect any reportable syndromic information on their patients during the EHR reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically.

Exclusion for Eligible Hospitals and CAHs: Exclusion in accordance with paragraph (a)(2) of this section. No public health agency to which the eligible hospital or CAH submits information has the capacity to receive the information electronically.

Source: CMS Final Rules EHR Incentive Program Section 495.6(e)(10), Paragraph Citation 75 FR 44568 and 495.6(g)(10), Paragraph Citation 75 FR Page 44570 (Also see CMS Final Rules for the EHR Incentive Program).

Stage 2 Menu Set Objective for Eligible Providers, Eligible Hospitals or CAHs for Syndromic Surveillance

Meaningful Use Requirements – Objectives and Measures

Eligible Providers

Syndromic surveillance is one of the six (6) menu objectives Eligible Providers may select in meeting the menu set requirements for Stage 2 Meaningful Use. Please refer to CMS for appropriate updates.

Objective: Capability to submit electronic syndromic surveillance data to public health agencies and actual submission except where prohibited and in accordance with applicable law and practice

Measure: Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period

Exclusions:  Any EP that meets one or more of the following criteria may be excluded from this objective:

  1. the EP is not in a category of providers that collect ambulatory syndromic surveillance information on their patients during the EHR reporting period;
  2. the EP operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by CEHRT at the start of their EHR reporting period;
  3. the EP operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or
  4. the EP operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by CEHRT at the start of their EHR reporting period can enroll additional EPs.

Reference: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPMenu_1_SyndromicSurveillanceDataSub.pdf, accessed 9/28//2013

Eligible Hospitals and CAHs

Syndromic surveillance is a core objective in Stage 2 Meaningful Use. Please refer to CMS for appropriate updates.

Objective: Capability to submit electronic syndromic surveillance data to public health agencies and actual submission except where prohibited and in accordance with applicable law and practice.

Measure: Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period.

Exclusions: Any eligible hospital or CAH that meets one or more of the following criteria may be excluded from this objective:

  1. Does not have an emergency or urgent care department;
  2. Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data in the specific standards required by Certified EHR Technology at the start of their EHR reporting period;
  3. Operates in a jurisdiction where no public health agency provides information timely on capability to receive syndromic surveillance data; or
  4. Operates in a jurisdiction for which no public health agency that is capable of accepting the specific standards required by Certified EHR Technology at the start of their EHR reporting period can enroll additional eligible hospitals or CAHs.

Source: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_HospitalCore_15_SyndromicSurveillanceDataSubmission.pdf, accessed 9/28/2013

Summary of Syndromic Surveillance Standards, Implementation Specifications and Certification Criteria

Certification Criterion Electronic Health Record (EHR)Technology:
Content Exchange Standards and
Implementation Specifications
Message Vocabulary
Final Rule Text: § 170.302(l). Public health surveillance. Electronically record, modify, retrieve, and submit syndrome-based public health surveillance information in accordance with the standard (and applicable implementation specifications) specified in § 170.205(d)(1) or § 170.205(d)(2). HL7 2.3.1 No implementation
specifications cited.
None cited.
HL7 2.5.1 No implementation
specifications cited.
Summary of Syndromic Standards

Source: ONC Final Rules Health Information Technology Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology (75 FR 44590)

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Other Federal and National Resources and FAQ

Office of the National Coordinator (ONC) for HIT FAQ:

All ONC Regulation FAQ

ASTHO Meaningful Use FAQ

CDC’s Meaningful Use web page

International Society for Disease Surveillance Recommendations for Syndromic Surveillance reporting

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Last updated October 20, 2014