NSSP Closes Out CoAg

Recipients of CDC NSSP funding for syndromic surveillance convened to share their experiences, challenges, problem-solving, and best practices. Community collaboration is strengthening public health and positioning surveillance activities to thrive in the years ahead.

On August 19–20, 2019, recipients of NSSP funding convened in Atlanta, Georgia, to close out the current (CDC-RFA-OE15-1502) 4-year cooperative agreement (CoAg) that ended August 31. The meeting title—Maintaining and Advancing in Epidemiology and Laboratory Capacity (ELC) for Prevention and Control of Emerging Infectious Diseases—conveyed the major administrative change of integrating future NSSP CoAg activities with the ELC’s Health Information Systems Capacity CoAg. By merging with the ELC CoAg, the NSSP team will spend less time administering the CoAg, leaving more time for technical support and program planning. NSSP also gains a strong, well-established infrastructure with the flexibility to fund more health jurisdictions and special projects.

The merger with the ELC CoAg should elevate the visibility of syndromic surveillance. Already, NSSP has increased its collaboration across other surveillance areas and encouraged integration of syndromic data with other systems.

Syndromic Surveillance in Action

A highlight of the close-out meeting, aside from sharing surveillance experiences with colleagues, was hearing presentations about ways in which NSSP funding had expanded state capacity. Some state health departments expanded capacity by hiring much needed epidemiological experts, whereas others created dashboards to support strategic alliances, enhanced their systems, or expanded their facility coverage and data quality. In future issues of NSSP Update, we plan to share some of these inspiring stories.

Across most health jurisdictions, the onboarding numbers reflected a significant increase in coverage (currently, 68% of the nation’s emergency departments [EDs] transmit data to NSSP). Connecticut, for example, has 100% of its EDs onboard. Nebraska experienced a 48% increase in the proportion of targeted EDs that submit production data, which translates into 88% of the population being represented. New York State (excluding New York City) has 88% of its EDs onboard. Massachusetts—an “NSSP Only” syndromic surveillance health jurisdiction—has onboarded 100% of its EDs and is now focusing on onboarding urgent care facilities.

Practitioners in all states aimed high with their performance goals. The list of state successes is long and impressive—too long to adequately cover here. Still, here’s a glimpse into how state commitment to syndromic surveillance translates into public health action:

• Connecticut implemented automated alerts and identified a mass overdose of K2. Connecticut monitors weather-related emergencies, hoarding-related disorders, chronic disease, and STDs—all the while looking at risk factors and geographic hot spots.
• Kansas is fast becoming a model for data sharing. About 20 local health departments in Kansas have data use agreements in place, with another 8 about to start. The Kansas team has also launched discussion with state hospital associations about data sharing.
• Missouri uses ESSENCE daily and has enhanced how it monitors special events (e.g., World Series, Presidential Debate in St. Louis, New Year’s holiday, and St. Louis Fair).
• Nevada uses ESSENCE to evaluate the impact of the legalization of marijuana.
• New Hampshire expanded its partnerships with state agencies to better support the State Drug Monitoring Initiative.
• New Jersey moved beyond using syndromic data for communicable disease into monitoring environmental and occupational exposures, opioid classifications, tick-related illness, and waterborne illness (new).
• New Mexico links syndromic data with other data sources, including weather data, and is exploring machine learning techniques to improve national biosurveillance.
• New York State added three drug-related syndromes to its surveillance system, initiated a Chief Complaint/Discharge Diagnosis (CC/DD) algorithm, and began using SaTScan supplemental surveillance methods to look at drug-related syndromes and communicable disease.
• North Dakota reviewed its data security policies and overcame some data confidentiality concerns to improve its data quality.
• Utah strengthened syndromic surveillance by selecting measures to improve onboarding, data quality, data flow, and representativeness. Utah is also helping staff at healthcare organizations communicate the impact of Promoting Interoperability programs to health information exchanges.

For more state successes, we encourage you to read NSSP Update and postings in the Knowledge Repository.

NSSP’s Future

NSSP Program Manager Michael Coletta took the meeting attendees on a whirlwind journey of the program’s transformation, priming them for what’s ahead. He emphasized that step one is to maintain what we’ve built. The NSSP team will continue to enhance the data flow, BioSense Platform architecture, AMC controls, and, in partnership with community members, explore word embedding, machine learning, and new analytic methods. We also plan to pilot the new HL7 balloted Implementation Guide early in 2020. NSSP analysts will continue to look for opportunities to integrate new data sources. CDC will continue to support the NSSP CoP, and NSSP will work closely with the new CoAg partner to promote activities and identify opportunities to advance syndromic practice and science.

Capstone Meeting

Given so many community members were in Atlanta for the close-out meeting, NSSP used this opportunity to host a capstone meeting Wednesday, August 21, 2019, to share results from a recent series of regional data-sharing workshops. The workshops, conducted in partnership with the Council of State and Territorial Epidemiologists (CSTE), were designed for funding recipients in each of the U.S. Department of Health and Human Services’ 10 regions. The workshops were customized to meet participants’ surveillance objectives, maximizing the practical value of data sharing and, more importantly, setting a foundation for subsequent collaborative work.

Workshop facilitator Charlie Ishikawa of Kahuina Consulting shared his workshop take-aways by reminding everyone of the larger picture: How does SyS data sharing improve situational awareness? What are our common barriers? What is CDC’s vision for data sharing?

Ishikawa acknowledged the community members’ readiness to share syndromic data because the value added was clear and compelling. Ishikawa applauded the rigor with which community members tackle associated challenges, noting that motivation is NOT a barrier. In fact, the community is highly motivated. Most barriers being experienced are inherent to systems of jurisdictional policy and public health governance. He also acknowledged that competency using the BioSense Platform tools has increased, and, although it could be stronger, competency is not a barrier to data sharing.

Ishikawa concluded by identifying the need to formulate the strategic next steps for an action plan to reinforce SyS data-sharing collaborations. Look for more on data sharing in upcoming issues of NSSP Update.