Updates to the Implementation Guide for Syndromic Surveillance

Objective: To describe the process to update the Implementation Guide (IG) for Syndromic Surveillance via community and stakeholder engagement and highlight significant modifications as the IG is vetted through the formal HL7 balloting process.Introduction: In 2011, the CDC released the PHIN Implementation Guide (IG) for Syndromic Surveillance v.1 under the Public Health Information Network. In the intervening years, new technological advancements, EHR capabilities as well as epidemiological and Meaningful Use requirements have led to the periodic update and revision of the IG through informal and semi-structured solicitation and collection of comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the IG v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the IG in a more systematic manner and released further updates via an Erratum and a technical document developed with NIST to clarify validation policies and testing parameters. These documents were consolidated into the Message Guide v.2.1 release and used to inform the development of the NIST Syndromic Surveillance Test Suite (http://hl7v2-ss-r2-testing.nist.gov/ss-r2/#/home), Validation Test Cases, and develop a new rules-based IG built using NIST’s Implementation Guide Authoring and Management Tool (IGAMT).As part of a Cooperative Agreement initiated in 2017, CDC and ISDS built upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the IG with the goal of having the final product to become an “HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance Standard for Trial Use” following a formal HL7 balloting process in 2018.Methods: ISDS coordinated a multi-stakeholder working group to revisit the consolidated IG, v.2.1 and began to collect structured comments via an online portal, which facilitated the documentation, tracking, and prioritization of comments for developing consensus and ultimately reconciliation and resolution when there were errors, conflicts or differing perspectives. 132 comments were received during the initial review period (April – July 2017) with 16 elements captured for each comment which included: Subject, Request Type, Clinical Venue, Name, IG Section, Priority, Working & Final Resolution (Fig. 1). The online portal also allowed for members of the Message Guide Workgroup to provide feedback directly to one another through a ‘conversation tab’, this has b