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BACKGROUND: In 2014, CDC Launched the National Notifiable Diseases Surveillance System (NNDSS) Modernization Initiative (NMI) to increase the robustness of the NNDSS technological infrastructure so it is based on interoperable, standardized data and exchange mechanisms. During the first year of NMI, 6 priority Message Mapping Guides (MMG) were developed, using data and messaging standards. Lessons learned from the development of these MMGs have prompted us to propose enhancements to our approach to data element harmonization, the design of the HL7 version 2.5 message specification profile, and work process.
METHODS: During 2014, written and oral feedback from internal and external partners and implementers was solicited by CDC to help improve work products and reduce the implementation burden on reporting jurisdictions and the Message Validation and Processing System (MVPS) for processing incoming HL7 case notifications. The MMG development team considered the feedback received and is proposing enhancements to MMG work products and process. A more robust data harmonization process across all nationally notifiable conditions (NNCs) is also being developed. In addition, recommendations for process improvements from an external assessment of MMG development are expected to be available by March 2015.
RESULTS: The current approach to MMG development and implementation will not allow the retirement of legacy data streams in a reasonable timeframe, due to the extensive resources needed for implementation of the HL7 case notification messages within the MVPS and by reporting jurisdictions. Improvements in the message design are needed to optimize implementation, such as opening segments and fields in the message structure specification which were previously restricted. The changes in message structure for laboratory findings will help to make implementation more efficient by providing for use of primary laboratory data, such as ELR. Over 5,627 surveillance data elements for over 90 NNCs were identified as potential candidates for data harmonization. NNDSS staff have grouped these data elements into thematic categories and have begun to identify options for data element harmonization. In addition, a common messaging structure and vocabulary template for two categories (laboratory and vaccination) was designed.
CONCLUSIONS: Lessons learned from implementation experience from internal and external partners for the first 6 priority MMGs have prompted enhancements in the HL7 case notification message structure design and in our approach to data harmonization across the NNCs. We anticipate these enhancements will help reduce implementation burden, both at CDC and in reporting jurisdictions. Please group this with other NMI updates.