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 (often called Early Event Detection systems in Texas) are in use in many health care facilities. The Department of State Health Services (DSHS) in Austin does not currently collect statewide data.

Syndromic surveillance systems in Texas may exist within local health agencies or organizations and in DSHS regional offices. Coverage areas may overlap, resulting in several options for Eligible Providers (EPs) and Eligible Hospitals (EHs) to use in meeting meaningful use criteria for syndromic surveillance. EPs and EHs should contact appropriate local organizations to determine if they have declared capacity to accept data for meaningful use reporting. Please refer to the map and contact list below for additional information.

Although, the Department of State Health Services is not currently participating in the syndromic surveillance option for meaningful use testing, DSHS is in the process of implementing the national implementation of BioSense 2.0 as an opportunity to integrate, support, and improve the state’s public health informatics and syndromic surveillance infrastructure. This opportunity to move forward has been prompted by the maturity of standards allowing for implementation of a syndromic surveillance capacity in an interoperative environment, as well as improvements in analytics and tools that serve as the foundation of an efficient syndromic surveillance platform.

Each DSHS regional office has a syndromic surveillance contact to learn more about surveillance in their region. Please refer to the map below to identify the appropriate region of the state.

Please contact the regional offices within the appropriate geographical regions to ascertain the best solution (www.dshs.state.tx.us/regions/default.shtm). See the information below to contact the appropriate regional personnel.

Health Service
Region
Region
HQ city
Point of Contact Phone E-mail
1 Lubbock Kevin McClaran 816-744-3577 kevin.mcclaran@dshs.state.tx.us
2/3 Arlington Kay Sanyal 817-264-4500 kay.sanyal@dshs.state.tx.us
4/5N Tyler Horace McCorvey 903-595-3585 horrace.mccorvey@dshs.state.tx.us
6/5S Houston Huai Lin 713-767-3000 huai.lin@dshs.state.tx.us
7 Temple Bonnie Feldt 254-778-6744 bonnie.feldt@dshs.state.tx.us
8 San Antonio Rita Espinoza 210-949-2000 rita.espinoza@dshs.state.tx.us
9/10 El Paso Winston Jackson 915-834-7675 winston.jackson@dshs.state.tx.us
11 Harlingen Herminia Alva 361-888-7837 herminia.alva@dshs.state.tx.us
  Corpus Christi Vivienne Heines 361-878-3510 vivienne.heines@dshs.state.tx.us
Regional Contacts

Follow this link to find a map of the DSHS Health Service Regions: http://www.dshs.state.tx.us/regions/default.shtm

Questions related to the CMS EHR incentive payment program’s 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: Where do I submit the syndromic surveillance data?
A: In Texas, you may submit syndromic surveillance data to the local or regional public health agency, depending on their capabilities. If you already submit syndromic surveillance data to a public health agency, you may continue working with that agency. If you want to start submitting syndromic surveillance data, or have other questions about options in your region, you may contact the health service region point of contact listed above on this web page.

Q: When can I submit the syndromic surveillance data to the public health agency?
A: Many local health departments and health service regions can currently receive data. You need to contact your local health department or the health service region point of contact to identify what options exist in your area.

Q: Can the public health agency receive my data?
A: Many local health departments and health service regions can currently receive data. You need to contact your local health department or the health service region point of contact to identify what options exist in your area.

Q: What is the impact of 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 exemptions for reporting syndromic under Stage 2. Contact HealthIT@tmhp.com at HHSC with additional questions about documenting this information in your attestation.

Q: I have submitted syndromic surveillance through my organization’s Early Event Detection system to the local public health authority for some time, can I use that same transmission to count towards my meaningful use criteria?
A: Any electronic interface intended to satisfy a correlated meaningful use requirement to submit data to a public health agency would need to be a certified EHR product. Eligible providers and eligible hospitals are required to use Certified EHR Technology to qualify for the respective EHR incentive program. As an example, if the interface was intended to provide the capability of electronically recording, modifying, retrieving and submitting immunization information in a standardized format (45 CFR 170.302(k)), it would need to be certified.

Adapted from source: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3163&PageID=20780

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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 30, 2013