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Frequently Asked Questions (FAQs) about NMI

GENERAL QUESTIONS

What is the CDC Surveillance Strategy?

Launched in February 2014, the CDC Surveillance Strategy (http://www.cdc.gov/surveillance/) is a plan to improve the agency’s activities in public health surveillance. The strategy aims to improve CDC’s overall surveillance capabilities and, by extension, those of the public health system at large. The strategy guides efforts to make essential surveillance systems more adaptable to the rapidly changing technology landscape, more versatile in meeting demands for expanding knowledge about evolving threats to health, and more able to meet the demands for timely and population-specific and geographic-specific surveillance information. The strategy will also facilitate work to consolidate systems, eliminate unnecessary redundancies in reporting, and reduce reporting burden.

The three major goals of the CDC Surveillance Strategy are to

  1. enhance the accountability, resource use, workforce, and innovation for surveillance at CDC and in support of state, tribal, local, and territorial (STLT) agencies;
  2. accelerate the utilization of emerging tools and approaches to improve the availability, quality, and timeliness of surveillance data; and,
  3. through cross-cutting agency initiatives, improve surveillance by addressing data availability, system usability, redundancies, and incorporation of new information technologies in major systems or activities.

The National Notifiable Diseases Surveillance System (NNDSS) Modernization Initiative (NMI) is one of four initiatives to address goal number three.

What is the NNDSS Modernization Initiative?

With the evolution of technology and data and exchange standards, CDC now has the opportunity to strengthen and modernize the infrastructure supporting the National Notifiable Diseases Surveillance System. As part of the CDC Surveillance Strategy, the NNDSS Modernization Initiative is underway to enhance the system’s ability to provide more comprehensive, timely, and higher quality data than ever before for public health decision making. Through this multi-year initiative, CDC seeks to increase the robustness of the NNDSS technological infrastructure so that it is based on interoperable, standardized data and exchange mechanisms.

What is the National Notifiable Diseases Surveillance System?

The National Notifiable Diseases Surveillance System is a nationwide collaboration that enables all levels of public health—local, state, territorial, federal, and international—to share notifiable disease-related health information. Public health uses this information to monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable infectious and noninfectious diseases and conditions.

NNDSS is a multifaceted program that includes the surveillance system for collection, analysis, and sharing of health data. It also includes policies, laws, electronic messaging standards, people, partners, information systems, processes, and resources at the local, state, territorial, and national levels.

Notifiable disease surveillance begins at the level of local, state, and territorial public health departments (also known as jurisdictions). Jurisdictional laws and regulations mandate reporting of cases of specified infectious and noninfectious conditions to health departments. The health departments work with healthcare providers, laboratories, hospitals, and other partners to obtain the information needed to monitor, control, and prevent the occurrence and spread of these health conditions. In addition, health departments notify CDC about the occurrence of certain conditions.

The CDC Division of Health Informatics and Surveillance (DHIS) supports NNDSS by receiving, securing, processing, provisioning, and releasing nationally notifiable infectious diseases data to disease-specific CDC programs. DHIS also supports local, state, and territorial public health departments in collecting, managing, and analyzing their data and in submitting case notification data to CDC for NNDSS. DHIS provides this support through funding, health information exchange standards and frameworks, electronic health information systems, and technical support. Together, DHIS and the CDC programs prepare annual summaries of infectious and noninfectious diseases and conditions, which are published in the Morbidity and Mortality Weekly Report.

CDC programs responsible for national surveillance, prevention, and control of infectious and noninfectious conditions are found in the

  • Center for Global Health (CGH);
  • National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP);
  • National Center for Emerging and Zoonotic Infectious Diseases (NCEZID);
  • National Center for Environmental Health (NCEH);
  • National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP);
  • National Center for Immunization and Respiratory Diseases (NCIRD); and
  • National Institute for Occupational Safety and Health (NIOSH).

These programs collaborate with the Council of State and Territorial Epidemiologists (CSTE) to determine which conditions reported to local, state, and territorial public health departments are nationally notifiable. The CDC programs, in collaboration with subject matter experts in CSTE and in health departments, determine what data elements are included in national notifications. Health departments participating in NNDSS voluntarily submit infectious disease data to DHIS and also submit some data directly to CDC programs.

Who is leading NMI?

NMI is a CDC-wide effort. The NMI team in DHIS, CSELS, is leading the development of the health information infrastructure needed to support NNDSS. Currently, the NMI team is working hand-in-hand with subject matter experts in programs from the CDC Office of Infectious Diseases (OID), who are leading the effort to develop disease-specific data elements for new Message Mapping Guides (MMGs) for Health Level 7 (HL7) –formatted disease case notification.

The NMI team also is working with the Association of Public Health Laboratories (APHL) to implement HL7 case notification messages in jurisdictions and with CSTE to evaluate the NMI effort and to develop and distribute communication messages to jurisdictions.

What are the key components of NMI?

NMI has three key components:

  1. development of prioritized Message Mapping Guides for HL7 case notifications;
  2. development of the Message Validation, Processing, and Provisioning System (MVPS), software that will validate and process nationally notifiable disease data messages sent by jurisdictions and provision the data to CDC programs; and
  3. technical assistance for implementation of HL7 case notification messages in jurisdictions submitting case notifications to NNDSS.

How long will NMI last?

The initiative to modernize NNDSS began in January 2014 and is planned for several years with short-term deliverables in the first phase and long-term activities in the following years.

What is the primary NMI short-term deliverable?

In the first phase of NMI, CDC’s sexually transmitted diseases (STD), hepatitis, mumps, and pertussis programs—as well as programs representing 52 conditions covered by the Generic v2 Message Mapping Guide (for a list of conditions, please see http://wwwn.cdc.gov/nndss/document/Conditions_to_Use_GenV2_Only_2015_Release1_20150529.xlsx)—are expected to receive timely, complete, and high-quality data from certain jurisdictions through the MVPS. As NMI progresses, CDC will increase the number of conditions and jurisdictions using HL7 messages and the MVPS for NNDSS.

What are the longer term activities for NMI?

Longer term NMI activities include the following:

  • Continue development of MMGs and implementation of HL7 case notification messages.
  • Implement and enhance the MVPS, including developing and implementing other services and components of the MVPS.
  • Facilitate the use of standards and promote and encourage data element harmonization for surveillance of nationally notifiable conditions.
  • Retire the National Electronic Telecommunications System for Surveillance (NETSS).
  • Determine future direction of the National Electronic Disease Surveillance System (NEDSS) Base System (NBS).

MESSAGE MAPPING GUIDE QUESTIONS

MMG DEVELOPMENT

Why is CDC developing new HL7 MMGs for NNDSS case notifications?

CDC is developing new HL7 Message Mapping Guides to improve collection, transmission, and analysis of data needed at the national level for public health surveillance. In doing so, CDC is implementing messaging standards and vocabulary standards in case notifications. For some diseases and conditions, the epidemiology of the notifiable disease has changed over time and new data are needed about risk factors or new clinical information is needed, such as laboratory tests and results, vaccination information, and treatment information. For other nationally notifiable diseases, CDC previously received only generic data but also now needs disease-specific data. (Note that NETSS uses a proprietary data and vocabulary format and is not based upon standards.)

What is the difference between a Message Mapping Guide and an HL7 case notification message?

A disease-specific Message Mapping Guide is similar to a data dictionary and indicates the data elements (generic or disease-specific) and the valid values for those data elements included in case notification messages. For example, in referring to the Hepatitis MMG, we are referring only to the disease-specific data elements that are included within the hepatitis message. In contrast, when we refer to a disease-specific HL7 case notification message, we are referring to both the generic data elements that are part of all case notification messages and the data elements specific to that disease. For example, in referring to a hepatitis HL7 case notification message (or hepatitis message), we are referring to both generic and disease-specific data elements that, together, comprise the complete hepatitis HL7 case notification message. For this reason, we talk about implementing HL7 case notification messages and not about implementing MMGs.

What MMGS are being developed currently and why were they selected?

The DHIS NMI team worked with subject matter experts in CDC programs to prioritize six MMGs for development. The first set of guides addressed the generic data elements that will be included in all messages as well as the disease-specific data elements for STD, Hepatitis, Congenital Syphilis, Pertussis, and Mumps.

Work has now begun on guides for Arboviral diseases and Varicella. The next set of conditions will be identified at a later date.

Can jurisdictions use the new HL7 MMGs to send in summary case notifications for specific diseases?

No. The new HL7 MMGs are intended for transmitting individual case notifications. NMI expects to address an HL7-based mechanism for summary notifications in the future, but the current priority is developing guides for individual case notifications.

Any jurisdiction sending summary statistics for specific diseases should continue to do so by using their current process in place. 

What is the process for developing MMGs and implementing case notification messages based upon those MMGs?

The development of any Message Mapping Guide and implementation of the case notification message based upon that MMG is a collaborative process that involves multiple teams, both internal and external to CDC. Internal teams include the NNDSS team, messaging and vocabulary team, MVPS development and testing teams, state implementation technical assistance team, and CDC programs. External groups include health jurisdictions, CSTE, and APHL.

CDC deliverables include the Message Mapping Guide, business rules (BRs) for processing data by the MVPS, test case scenarios, HL7 test messages, and an annotated case report form.

The steps in the process of MMG development and case notification message implementation are as follows:

  1. Initiation.
  2. Requirements analysis.
  3. Message design and development.
  4. Message reconciliation and finalization.
  5. Pilot testing of MMG.
  6. MVPS application development.
  7. MVPS testing and implementation.
  8. Publication of final MMG.

Why is CDC taking an incremental approach to the development of MMGs?

Due to budgetary, personnel, technical, and other resource constraints, CDC is proceeding with NMI—including the development of MMGs—in a phased, incremental manner, with due consideration at each step for how to achieve the most beneficial results in the briefest amount of time.

Are MMGS under development available for review?

MMGs that are under development are posted to the NNDSS Draft Message Mapping Guides Web site at http://wwwn.cdc.gov/nndss/message-mapping-guides.html.

Jurisdiction public health surveillance staff are encouraged to review and comment on each draft MMG when it is open for comment for several weeks on the Draft MMG Web site. MMGs that have been reconciled with the feedback from their open comment periods are also posted to the Draft MMG Web site as pilot test-ready MMGs.

Should jurisdictions use draft message mapping guides to implement surveillance information system changes or submit data to CDC?

No. MMGs in Stages I and II are considered draft and may be revised until the time they are finalized.

Those jurisdictions selected for pilot testing of the test-ready versions (Stage II) of the MMGs should wait until contacted by the NMI TA Team before using the test-ready MMGs, before implementing surveillance information system changes, and before submitting test messages to CDC.

All other jurisdictions should not plan to submit data to CDC or implement MMG-based updates to their surveillance information systems until the final MMGs (Stage III) have been posted.

What diseases will be covered by using the Generic v2 MMG or other HL7 MMGs?

The Notifiable Events and Notification Mechanisms document posted under “Related Documentation” at http://wwwn.cdc.gov/nndss/message-mapping-guides.html should be used by jurisdictions implementing HL7 case notification messages to identify all the diseases or conditions (and their respective event codes) that should be sent to NNDSS by using the Generic v2 MMG and other HL7 MMGs. As new disease-specific MMGs are developed, they will be added to this document.

NOTE: For simplicity in identifying those diseases and conditions that will use the Generic v2 MMG only, we have filtered this information from the Notifiable Events and Notification Mechanisms document and separately posted this information by the Generic v2 MMG on the Draft MMG Web site as “Conditions to Use Generic v2.0 Only.”

The “Event Codes” worksheet in the Notifiable Events and Notification Mechanisms document has a “Preferred Mechanism” column that can be filtered by the type of MMG that jurisdictions are ready to adopt. If the “Preferred Mechanism” column is filtered by the words in the drop-down list specifying “Generic Individual Case Notification v2 (HL7),” then the conditions that use only the Generic v2 MMG will be listed and should be sent by using only the Generic v2 MMG. Alternatively, if the “Preferred Mechanism” column is filtered by the words in the drop-down list specifying “Generic Individual Case Notification v2 with STD Case Notification v1 (HL7),” then STD conditions that use both the STD MMG and the Generic v2 will be listed.

DATA EXCHANGE/SUBMISSION

Are all elements of the Generic v2 MMG required?

Not all the data elements in Generic v2 are required. Information on whether a data element is required, preferred, or optional is indicated in the draft Generic v2 MMG, available on the Draft Message Mapping Guide Web site at http://wwwn.cdc.gov/nndss/message-mapping-guides.html. On the “PHIN Variable IDs” worksheet of the Generic v2 MMG, the column named “CDC Priority” indicates the prioritization of the data element by the CDC surveillance program. Submitters are strongly encouraged to collect and send the preferred data elements because of their importance for analysis and assessment. The column named “HL7 Optionality” indicates whether the listed data element is required for the HL7 message, is required but can be left empty, or is optional for the HL7 message.

Can jurisdictions continue to submit information in the Generic v1 MMG?

CDC encourages all jurisdictions to transition to the new guides as soon as possible after they are published in “Final” (Stage III) status because the new data elements are important for notifiable disease surveillance.

Should all diseases be sent by using the Generic v2 MMG? If there are additional supplemental data (such as for varicella, mumps, or pertussis when those MMGs are released), would jurisdictions send cases by using the Generic v2 MMG and a supplemental MMG?

Eventually, the Generic v2 MMG will be used with all nationally notifiable conditions. However, conditions that currently have disease-specific data being sent to CDC through NETSS cannot be sent by using the Generic v2 MMG until there is a disease-specific MMG to complete the case notification.

Jurisdictions should use the Notifiable Events and Notification Mechanisms document posted under “Related Documentation” at http://wwwn.cdc.gov/nndss/message-mapping-guides.html to identify which conditions should be sent by using each of the new HL7 MMGs.

NOTE: For simplicity in identifying those diseases and conditions that will use the Generic v2 MMG only, we have filtered this information from the Notifiable Events and Notification Mechanisms document and separately posted this information by the Generic v2 MMG on the Draft MMG Web site as “Conditions to Use Generic v2.0 Only.”

For TB, STD and Hepatitis, do jurisdictions need to send Generic v2 messages in addition to the disease-specific message? Or will TB, STD, and Hepatitis stand alone and be kept separate from the Generic v2 MMG?

The case notification messages for STD and Hepatitis must use the STD and Hepatitis MMGs, which include the Generic v2 MMG variables. Jurisdictions should not send HL7 TB messages with Generic v2 data elements until the TB MMG is updated to remove the generic variables and CDC is ready for jurisdictions to send the revised TB case notifications, which include the data elements from the Generic v2 MMG.

How will data reconciliation be done with the new HL7 case notifications?

With MVPS, jurisdictions receive an acknowledgement confirming receipt and parsing of messages. A dashboard summarizes data sent by jurisdictions, including the details of messages received and processed by CDC, and it flags any warnings or errors. Jurisdictions will be able to identify problems and submit corrections to reconcile the data as needed throughout the year.

Will CDC program areas adhere to receiving data in this new way or will they still ask for jurisdiction data in Excel or other files?

CDC is working to eliminate the duplication of data requested by CDC in various formats. NMI is one part of the CDC Surveillance Strategy, which is coordinating across the agency to consolidate systems, eliminate unnecessary redundancies in reporting, and reduce reporting burden.

How long will jurisdictions be expected to send duplicate feeds (old way plus new way)?

The period of time where jurisdictions may need to send duplicate feeds will vary by jurisdiction. Jurisdictions will need to develop plans for retiring the old feeds, and CDC can provide technical assistance to help with the development of those plans.

MESSAGE VALIDATION, PROCESSING AND PROVISIONING SYSTEM QUESTIONS

What is the MVPS?

The Message Validation, Processing, and Provisioning System, or MVPS, is software that will validate and process nationally notifiable disease (NND) data messages sent by jurisdictions and will provision the data to CDC programs.

Why is the MVPS needed?

The MVPS addresses a number of data processing and distribution challenges. It will allow CDC to receive NND data from jurisdictions, process them, and provision them to CDC programs more efficiently and effectively than existing systems. The MVPS will provide several benefits to jurisdictions and CDC programs:

  • The MVPS will reduce the number of systems processing data at CDC and allow for streamlined message processing from jurisdictions to CDC.
  • The MVPS will standardize data processed at CDC.
  • The MVPS will allow CDC programs to receive, process, store, access, share, and analyze health-related data, including electronic health record data, to further the agency’s public health goals.
  • Through the MVPS Dashboard, the system will provide submitting jurisdictions the ability to view the data they have submitted and identify data quality issues.

Describe NNDSS, NEDSS, and NBS. How is the MVPS connected to them in NMI?

The National Notifiable Diseases Surveillance System (NNDSS) is a nationwide collaboration that enables all levels of public health—local, state, territorial, federal, and international—to share notifiable disease-related health information. Public health uses this information to monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable infectious and noninfectious diseases and conditions.

NNDSS is a multifaceted program that includes the surveillance system for collection, analysis, and sharing of health data. It also includes policies, laws, electronic messaging standards, people, partners, information systems, processes, and resources at the local, state, territorial, and national levels.  

The National Electronic Disease Surveillance System (NEDSS) is a key component of NNDSS. NEDSS provides data and IT standards, support, and leadership to state, local, and territorial health departments. These health departments provide CDC with data on nationally notifiable diseases and conditions.

The National Electronic Disease Surveillance System (NEDSS) Base System (NBS) provides jurisdictions with a NEDSS-compatible information system to transfer health, laboratory, and clinical data efficiently and securely over the Internet. NBS also provides public health authorities with a tool for processing, analyzing, and sharing data they receive.

Through the NNDSS Modernization Initiative, CDC will replace the existing NNDSS messaging infrastructure, but not the NNDSS program, with a message validation, processing, and provisioning system—the MVPS—that facilitates the receipt and distribution of notifiable disease data. During NMI, jurisdictions will implement HL7 case notification messages and MVPS will support collection of data through new guides and a data exchange system that will result in more comprehensive, timely, and more accurate information than ever before provided to CDC programs.

What is the scope and technology of the MVPS?

The MVPS is a CDC-built and operated message validation, processing, and provisioning system. It will validate and process NND messages sent by jurisdictions, provide a data quality dashboard, and provision NND data to CDC.

The MVPS technology includes 

  • an integration engine that parses and transforms messages/files and performs vocabulary translations and data validations,
  • a business rule management system processing engine, and
  • a database management system that enables provisioning of HL7 and NETSS-formatted data for use by CDC programs.

How will CDC programs receive data once the case notifications are sent to CDC?

The MVPS will provision data to the individual CDC programs, and user access to those data will be determined by the program. Various options will be available over time, but, initially, data will be provided through SQL Server tables and HL7 and NETSS views.

What is data provisioning?

Data provisioning refers to the processes by which surveillance data received through the NNDSS are delivered to the disease-specific programs at CDC. It ensures that the necessary data relationships and data format are preserved to allow accurate and complete use of the data. It also defines the database structures (such as tables and views) that will be used to store the data and make them available to programs for analysis and reporting.

Will the MVPS address NETSS, NBS, and HL7 data streams separately?

No. To reduce redundancy of effort, increase efficiency, and enhance effectiveness of limited resources, MVPS will process NETSS, NBS, and HL7 message formats received from jurisdictions simultaneously for a particular condition. The MVPS team will analyze how the HL7 data stream relates to the NETSS and NBS data streams on a variable-by-variable basis to provision all three message formats in a relational table view and provide both NETSS and HL7 views of the data. NBS data will be translated into both NETSS and HL7 views.

What data provisioning process/structure has the MVPS team defined?

Because the data processing and provisioning needs are different for each condition, the MVPS team identifies and documents the requirements for each condition. The MVPS team then develops processes to extract the data from the HL7 message, perform any needed validations (including content, structural, and business rules) or transformations, and populate the data into tables that are accessible by CDC programs.

What is the CDC Message Evaluation and Testing Service and why is it needed?

The CDC Message Evaluation and Testing Service (METS) will serve as a common message validation service to assist jurisdictions in preparing and sending messages to CDC that adhere to the applicable messaging, vocabulary, and programmatic standards. Specifically, METS allows jurisdictions to evaluate their test messages as they develop their systems to send HL7 messages to CDC, ensuring that their systems are generating messages that conform to the proper message type structure, business rules, and content.

What is the MVPS Dashboard?

The MVPS Dashboard is a component of the MVPS that summarizes data sent by jurisdictions, including the details of messages received and processed by CDC, as well as warnings and errors on messages that were submitted by jurisdictions but do not pass the structural, content, and business rules validation. As a result, jurisdictions and programs will be able to use the dashboard to verify the number of messages received by CDC and to assist with the reconciliation of data throughout the year. In the longer term, MVPS will also provide information on which cases were included in the Morbidity and Mortality Weekly Report (MMWR), allowing jurisdictions to reproduce counts within MMWR tables and track case counts included within MMWR tables.

RETIREMENT OF THE LEGACY NNDSS PORTFOLIO

Will the MVPS supersede NNDSS?

No, the MVPS will not supersede NNDSS. NNDSS is a multifaceted program that includes the surveillance system for collection, analysis, and sharing of health data. It also includes policies, laws, electronic messaging standards, people, partners, information systems, processes, and resources at the local, state, territorial, and national levels. The MVPS is a data exchange system that will replace and modernize the current technical infrastructure that supports NNDSS.

Can certain disease-specific reporting still use NETSS?

NETSS will be used until all the notifiable conditions have been transitioned to new HL7 message mapping guides and NETSS can be retired. NETSS retirement is an NMI priority, so, although there is not a defined time table, all conditions and jurisdictions will be required to transition to the new HL7 case notifications.

What is the strategy for transitioning from legacy data streams to the MVPS?

As MMGs are finalized, jurisdictions are encouraged to implement MMG-based case notification messages in their surveillance systems and work with CDC for onboarding.

Does CDC have a final cut-off date when it will no longer accept NETSS files?

NETSS retirement is an NMI priority. The final date when NETSS files will no longer be accepted has not been determined at this time. However, jurisdictions are encouraged to begin implementing the new MMGs when they reach “Final” (Stage III) status. The Health Information Systems component of the Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement requires demonstrated progress toward the implementation of the new MMGs.

What are the plans for the CDC Data and Message Brokering (DMB) system and the Common Data Store (CDS)?

The DMB and CDS systems will be replaced by the MVPS information system. Upon successful transition from DMB and CDS to MVPS, the legacy systems will be retired.

USER ACCEPTANCE TESTING

Who will perform user acceptance testing (UAT) and when will it take place?

CDC will ask NMI pilot jurisdictions to assist with testing MVPS releases before they are implemented. User acceptance testing will be coordinated between CDC and the pilot jurisdictions. This effort will include participation from the MVPS development and testing teams, CDC programs, and the NMI technical assistance team. 

Six MMGs (Generic v2, STD, Congenital Syphilis, Hepatitis, Mumps, and Pertussis) have been prioritized, and each will have an associated UAT timeframe for testing MVPS. The MVPS teams will work with CDC programs and the NMI technical assistance team to define time frames and support actual testing.

Selected jurisdictions will be asked to participate in two aspects of UAT: 1) formal user acceptance testing of the software, and 2) end-to-end testing, which includes provisioning data to CDC programs.

TECHNICAL ASSISTANCE QUESTIONS

What is the role of technical assistance in NMI?

CDC is partnering with CSTE and APHL to provide and evaluate technical assistance to state and local jurisdictions to implement the initial six HL7 case notification messages. Through this NMI Technical Assistance Coordination Team, CDC and its partners will help jurisdictions adopt the MMGs and use them to send test case notification messages to the MVPS to ensure that these messages will be properly received, processed, and stored for analysis through this new system. CDC, in collaboration with CSTE and APHL, will provide direct technical assistance and training in the form of webinars, online technical guides, and other training materials to support implementation for all jurisdictions.

PILOT JURISDICTION SELECTION

What jurisdictions are serving as pilot sites for NMI?

To help ensure a smooth and translatable technical assistance approach with all jurisdictions, the NMI Technical Assistance Coordination Team is piloting both the MMGs and the NMI technical assistance approach. 

A single jurisdiction, Michigan, served as the beta pilot site for the NMI TA in Pilot Phase I, which occurred from September 2014 to April 2015.

NMI TA Pilot Phase II, wave 1, occurred from April to June 2015, and California, Florida, Michigan, Minnesota, and Oregon were the pilot jurisdictions participating in this wave. In addition, New York served as an independent pilot site during wave 1. They participated in the NMI evaluation process, working with draft NMI TA tools and resources to implement the priority MMGs.

Arizona, Colorado, and up to three additional states will be included in wave 2 of the NMI TA Pilot Phase II, which started on 7/1/15.

How were jurisdictions selected for the pilot phase of NMI?

In a collaborative effort, the CDC NMI team worked with CDC programs, CSTE, and APHL to identify the jurisdictions to pilot the MMGs and technical assistance process. These jurisdictions were selected by using several criteria, including a jurisdiction’s technical experience and capacity, readiness to participate, scalability of their implementation experience, ability to provide feedback on NMI TA tools and resources, and ability to participate in NMI evaluation activities.

What activities are NMI pilot sites engaged in?

NMI pilot sites are engaged in several activities:

  • adopting and testing pilot-test ready MMGs;
  • testing and providing feedback on the CDC MVPS;
  • providing feedback on TA tools and resources; and
  • participating in the evaluation of the overall NMI pilot.

GENERAL TECHNICAL ASSISTANCE

What technical assistance will be available?

CDC has partnered with CSTE and APHL to provide technical assistance for the following activities:

  • extracting data from surveillance information systems,
  •  mapping codes in the data extract to vocabulary specified in the MMGs,
  •  creating HL7 messages based on the MMGs by using an integration engine (e.g., Rhapsody) or other tools,
  • facilitating secure transport of HL7 messages, and
  • transferring knowledge to enhance in-house capability on the use of integration engines and infrastructure management for case notifications to CDC based upon MMGs; and
  • providing education and training to build capacity to use current and future MMGs to implement case notification messages.

Can all jurisdictions participate in NMI Technical Assistance?

Yes, all jurisdictions will have the opportunity to participate. The requirement to implement HL7 case notification messages, starting with the priority guides, and the availability to request technical assistance are both in the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement. Jurisdictions may choose to implement available HL7 case notification messages on their own as well. Either way, CDC will work with jurisdictions to monitor progress through the quarterly ELC Health Information Systems calls.

Is technical assistance system dependent?

No. For HL7 case notification message implementation, jurisdictions using NBS will receive most of their technical assistance from the NBS team. Selected NBS jurisdictions will participate in the NMI pilot phases by using the Generic v2, Hepatitis, and STD MMG page builder templates. In addition, jurisdictions that use NBS will be able to pilot Congenital Syphilis, Pertussis, and Mumps MMGs by using the NBS Generic v2 template as the basis and creating the disease-specific pages that map to each MMG with support from the NBS vendor and through technical assistance.

Jurisdictions that do not use NBS will receive technical assistance from APHL.

Will there be a cost associated with technical assistance? Will funding be provided to help with this process?

No, there is no cost for technical assistance. All jurisdictions can request funding to support the implementation of HL7 case notification messages as part of the ELC Cooperative Agreement, Section C. When technical assistance is requested, jurisdictions will be prioritized based on their readiness and ability to conduct HL7 case notification message implementation activities.

When will all jurisdictions be able to adopt the new MMGs?

Once an MMG is finalized (Stage III), all jurisdictions will be invited to adopt the finalized MMG, go through onboarding, and send case notification messages to CDC through the MVPS.

Should jurisdictions use draft message mapping guides to implement surveillance information system changes or submit data to CDC?

No. MMGs in Stages I and II are considered draft and may be revised until the time they are finalized.

Jurisdictions selected for pilot testing of the test-ready versions (Stage II) of the MMGs should wait until contacted by the NMI TA Team before using the test-ready MMGs, before implementing surveillance information system changes, and before submitting test messages to CDC.

All other jurisdictions should not plan to submit data to CDC or implement MMG-based updates to their surveillance information systems until the final MMGs (Stage III) have been posted.

How do I submit a technical assistance request?

A jurisdiction may request onsite technical assistance by sending an e-mail to EDX@cdc.gov and including the following information:

  • type(s) of assistance needed,
  • identification of the guide (Generic v2, STD, Congenital Syphilis, Hepatitis, Mumps, and Pertussis, etc.), and
  • primary point of contact and contact information.

FUNDING/COOPERATIVE AGREEMENT

Are NMI and ELC Cooperative Agreement activities two separate projects?

No. The state implementation part of NMI, which includes technical assistance, is a required activity in the health information systems section of the ELC Cooperative Agreement.

What activities are ELC grantees expected to conduct during the current funding cycle (August 1, 2014, to July 31, 2018)?

Implementation of HL7 case notification messages developed through the NMI process is a requirement for jurisdictions who are receiving health information systems funding through the ELC Cooperative Agreement that covers 2014–2018. (Note that implementing the old HL7 guides does not meet this requirement, and jurisdictions should not invest effort in implementing those guides.)

How will grantees report on these activities (monthly, quarterly)? Who will monitor these activities?

The quarterly ELC Health Information Systems Implementation Support and Monitoring calls with CDC will include updates on HL7 case notification message implementation. The NMI team also is working with CSTE to evaluate the NMI effort. Additional details regarding monitoring and lessons learned activities will be provided at a later date.

How will CDC success in the NMI effort be measured?

Per the NMI performance objective in the CDC Surveillance Strategy, by 2016, 90% of data reported through NNDSS will be by standard HL7 messages. 

How will grantee success in the NMI effort be measured?

Grantees will identify a realistic number of priority HL7 case notification messages that they will implement in 2014–2018 and, by using these messages, successfully transmit associated notifiable diseases data to CDC.

What happens if jurisdictions do not participate in NMI?

Implementation of available HL7 case notification messages developed through the NMI process is a requirement for jurisdictions who are receiving Health Information Systems funding through the ELC Cooperative Agreement that covers 2014–2018.

CDC understands that jurisdictions not participating in the ELC Cooperative Agreement may face circumstances that affect their ability to implement the new HL7 case notification messages. It is nevertheless imperative that CDC and the public health community move forward with NMI so that NNDSS can provide more comprehensive, timely, and higher quality data to all users as soon as possible.

NNDSS ONBOARDING QUESTIONS

Is CDC still “certifying” NNDSS messages through PHIN Certification?

No. To foster a more collaborative relationship with jurisdictions submitting NNDSS messages, CDC is transitioning to focus on onboarding messages into production and away from certification of NNDSS messages through PHIN Certification.

What is the NNDSS onboarding process?

The onboarding process will ensure that jurisdictions transmit data in compliance with the NNDSS message mapping guide requirements and that CDC programs are confident in the quality of the data that they are receiving. 

The NMI team anticipates beginning onboarding for the Generic V2, Hepatitis, and STD MMGs in fall 2015. Specific instructions will be published on the NNDSS web page and disseminated to ELC recipients. 

GLOSSARY OF TERMS

National Notifiable Diseases Surveillance System (NNDSS): The National Notifiable Diseases Surveillance System (NNDSS) is a nationwide collaboration that enables all levels of public health—local, state, territorial, federal, and international—to share notifiable disease-related health information. Public health uses this information to monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable infectious and noninfectious diseases and conditions.

NNDSS is a multifaceted program that includes the surveillance system for collection, analysis, and sharing of health data. It also includes policies, laws, electronic messaging standards, people, partners, information systems, processes, and resources at the local, state, territorial, and national levels.

National Electronic Disease Surveillance System (NEDSS): A key component of NNDSS is the National Electronic Disease Surveillance System. NEDSS provides data and information technology standards, support, and leadership to state, local, and territorial health departments. These health departments provide CDC with data on nationally notifiable diseases and conditions.

NEDSS Base System (NBS): The National Electronic Disease Surveillance System Base System is a CDC-built application that provides jurisdictions with a NEDSS-compatible information system to transfer health, laboratory, and clinical data efficiently and securely over the Internet. NBS also provides public health authorities with a tool for processing, analyzing, and sharing data they receive.

National Electronic Telecommunications System for Surveillance (NETSS): Before implementing NEDSS, CDC developed and used the National Electronic Telecommunications System for Surveillance. The term NETSS refers to a 1) computerized public health surveillance information system that provides CDC with weekly data regarding nationally notifiable diseases and 2) data file content format for submitting case notifications to CDC. NETSS surveillance information systems continue to be used by selected jurisdictions that are transitioning to the more robust NEDSS. A bare-bones approach for providing basic data and information, the NETSS file content format has not been changed or updated substantially since NETSS launched in 1990.

Message Validation, Processing, and Provisioning System (MVPS): The MVPS is software that will validate and process nationally notifiable disease data messages sent by jurisdictions and provision the data to the CDC programs.

The MVPS will provide several benefits to jurisdictions and CDC programs:

  • The MVPS will reduce the number of systems processing data at CDC and allow for streamlined message processing from jurisdictions to CDC.
  • The MVPS will standardize data processed at CDC.
  • The MVPS will allow CDC programs to receive, process, store, access, share, and analyze health-related data, including electronic health record data, to further the agency’s public health goals.
  • Through the MVPS Dashboard, the system will provide submitting jurisdictions the ability to view the data they have submitted and identify data quality issues.

Have a question about the NNDSS Modernization Initiative that is not answered here? Please send your question to edx@cdc.gov for consideration.

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