Thursday, September 23, 2010

MeaningfulUse IG for Public Health Surveillance WILL Change

About a month ago I posted on the topic that the implementation guide chosen to be used with the HL7 2.5.1 standard for public health surveillance was likely to change.  Confirmation came shortly after via the HIT Standards Committee, and has since been acknowledged in an ONC FAQ.

Details on what the plans are to replace this guidance have been relatively limited, and so most implementations are either struggling with the wrong guide still, are hopefully using the advice I gave on how to use the HL7 Version 2.3.1 standard with the HITSP C39 specification.

Here's what's been going on since then.

CDC has been enaged with the International Society of Disease Surveillance (ISDS) on Disease Surveillance topics.  They asked ISDS to engage on this topic.  There was apparently a meeting of ISDS members earlier this month in New York City to discuss the issue, but I don't have many details beyond that.

Sundak Ganasen (Lead CDC Vocabulary Specialist) recently shared some of the outcomes of earlier discussions with ISDS to the HL7 Public Health and Emergency response workgroup through their public mailing list.  You can find that document below:

ISDS subsequently engaged with HLN Consulting to help them develop a consensus-based guide.  I've had some discussion with HLN regarding this work. 

Some of the challenges are that the existing work is in the "Biosurveillance" space which is not necessarily the same space as Syndromic Surveillance, although there are certainly overlaps.  I would argue that the C39 specification is simple enough to get us started while we wait for a larger body of work to be completed. 

The other challenge is having a public health system that is prepared to accept the data, and that is probably a strong argument from the public health perspective.  From the meaningful use perspective, though, trying to ensure that public health gets something they are prepared to use in the timeframes mentioned in the document above will fail for phase 1.  I say that because January 2011 is too late to have a specification that can start being developed upon in time for it to be implemented for phase 1.  That will mean that we wind up with a rather large variation in HL Version 2.3.1 implementations which public health will be equally unready to accept.

This is a difficult challenge.  I almost think that we must step back, and look at surveillance as a phase 2 requirement at this stage, given the time frames.  It is a shame, because it really should fit into phase 1.  The only realistic way to succeed for phase 1 is to get a final specification into the development pipeline by the end of October, and even that will be unlikely to see wide adoption.


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