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BACKGROUND: Tennessee has 13 regional public health jurisdictions currently receiving data from local emergency departments (ER) contributing to Syndromic Surveillance (SS) activities. The Tennessee Department of Health (TDH) historically has not employed a statewide, centralized, and standardized syndromic system. One TN hospital system (HS) had routinely sent ER data directly to BioSense 1.0, accessible by the associated TN jurisdiction. In December 2012, this HS’s feed was interrupted. To re-establish the connection and minimize HS resources expended, TDH engaged in a SS messaging pilot, working with the HS and its vendor to leverage the available electronic health record technology and the existing ELR relationship and infrastructure. The partnership between TDH and the HS was established in February 2013.
METHODS: The existing secure transport connection already established with the HS for ELR utilizes secure file transfer protocol (SFTP) with public-key infrastructure (PKI) certificates, and was used for transmitting the SS files. The syndromic messages arrive at the TDH electronic data interchange (EDI) engine utilizing the same input procedure as ELR, minimizing usage of additional communication points. The existing ELR routes and filters were used to develop SS routing specific for SS message processing and validation. SS and ELR messages are distinguished and directed to their specific rhapsody routes. TDH established a script that uploads the file directly to the BioSense 2.0 cloud server that allows the local jurisdiction view of data.
RESULTS: On December 11, 2013, within 8 months of receipt of initial batch of test messages, TDH developed SS messaging capabilities and move the new interface into production. Based on the feedback TDH provided on the message segments, over 75% of messages were error free and corrected within the first 4 months. BioSense 2.0 was able to consume and validate messages. TDH developed a draft trading partner agreement (TPA), which was then signed by the pilot trading partner and TDH upon production implementation.
CONCLUSIONS: The decision of routing SS messages directly through TDH to the BioSense 2.0 Cloud proved to minimize time and resources to establish secure transport, minimized the number of connections the HS needed to establish, and provided TDH the infrastructure to receive SS data without dependency on any particular consuming application. The existing EDI infrastructure and expertise to support ELR was leveraged to implement the new HL7 interface capabilities. Utilizing existing resources and infrastructure made this project a success and re-established the local public health jurisdiction’s SS activities with the HS.