Center for Surveillance, Epidemiology, and Laboratory Services NNDSS

Center for Surveillance, Epidemiology, and Laboratory Services NNDSS Modernization Initiative (NMI): Overview of Respiratory Invasive Bacterial Diseases (RIBD) HL7 Case Notification Messages Division of Health Informatics and Surveillance December 17, 2019 1

Agenda Welcome and Announcements NMI Updates and Timeline Implementing the Message Mapping Guides Overview of RIBD HL7 Case Notification Messages – Sandy Roush, National Center for Immunization and Respiratory Diseases (NCRID), CDC – Megan Light, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC Questions and Answers 2

Center for Surveillance, Epidemiology, and Laboratory Services NMI Updates and Timeline Sara Imholte Johnston, MPH NNDSS Program Manager Michele Hoover, MS Lead, State Implementation and Technical Assistance 3

Highest MMG Implementation Status 4

Total MMGs in Production 5

Finalized Guides Onboarding Open to All Onboarding For Pilots Only Onboarding On Hold Arboviral v1.3 Babesiosis Mumps Gen v2 CS Pertussis Hepatitis FDD Varicella Lyme/TBRD Malaria STD TB/LTBI Trichinellosis 12/17/2019 6

NMI Implementation Status Oct 15, 2019 7

Arboviral v1.3 MMG Implementation Status 8

Hepatitis v1.0 MMG Implementation Status 9

NNDSS HL7 Message Mapping Guide Estimated Timeline 10

Center for Surveillance, Epidemiology, and Laboratory Services Implementing the Message Mapping Guides Michele Hoover, MS Lead, State Implementation and Technical Assistance

Starting from the Beginning. Engage stakeholders – Engage both informaticians and epidemiologists. – “Engage early and often.” Strongly recommend using Implementation Spreadsheet for documentation of gap analysis and data crosswalk. – This spreadsheet or a similar resource is one requirement of onboarding. 12

Gap Analysis Includes comparing: – data collected in state surveillance system, – data submitted to CDC previously, including how it was sent, – data requested in the MMG. Helps identify – if updates to the surveillance system are needed, – if data needs to be translated to populate the HL7 message correctly, – if additional data needs to be collected for cases. See resources on the Technical Assistance and Training Resource Center webpage Implementing All Other Conditions: Pre-Onboarding. 13

Implementation Maintain or improve on data submitted through previous methods. Ensure all data elements previously submitted to the CDC Programs through any legacy methods can be collected in the state surveillance system and sent in the HL7 message. Request Technical Assistance for additional help by emailing [email protected]. 14

National Center for Immunization & Respiratory Diseases Respiratory Invasive Bacterial Diseases (RIBD) HL7 Case Notification Messages H. influenzae, N. meningitidis, Invasive S. pneumoniae, Legionellosis, Psittacosis, Group A Streptococcus, Group B Streptococcus, Neonatal Sepsis

Respiratory Invasive Bacterial Diseases Message Mapping Guide (RIBD MMG) Overview Guide for all jurisdictions sending data elements via HL7 for five nationally notifiable conditions (NNDSS) – Includes H. influenzae, N. meningitidis, Invasive S. pneumoniae, Legionellosis, Psittacosis – Contains NNDSS data elements – Contains additional subset of data elements sent by EIP sites only to ABCs Guide for Active Bacterial Core Surveillance (ABCs) jurisdictions for both NNDSS and non-NNDSS conditions – Includes GAS, GBS, neonatal expanded infections, and neonatal sepsis Designed to be used in conjunction with Generic v2 MMG 16

RIBD MMG includes Condition/ Surveillance Project NNDSS Data Elements (All states, NYC, DC) ABCs Variables (EIP ABCs sites ONLY) Haemophilus influenzae X X Meningococcal disease (Neisseria meningitidis) X X Invasive pneumococcal disease X X Legionellosis X Psittacosis X Group A Streptococcus X Group B Streptococcus X Neonatal Expanded Infection Surveillance X Neonatal Sepsis Surveillance X 17

RIBD MMG Structure Non-ABCs States Generic V2 MMG RIBD MMG H flu IPD Legionellosi s Psittacosis RIBD message N mening ABCs States ABCs H flu Generic V2 MMG RIBD MMG ABCs IPD ABCs N mening ABCs GAS ABCs GBS Legionellosi s Psittacosis RIBD message 18

Overview and Guidance: RIBD NNDSS Surveillance Office NCIRD Surveillance Data Email Box: Sandy Roush [email protected] H. influenzae, N. meningitidis Amy Blain Invasive Pneumococcal Disease Ryan Gierke Legionellosis Al Barskey Psittacosis Miwako Kobayashi

Context of NNDSS Data Collected for H. influenzae, N. meningitidis, Invasive S. pneumoniae, Legionellosis, Psittacosis NCIRD currently receives all NNDSS data in NETSS format – Core and extended data were developed in mid 1990’s Important changes in epidemiology and laboratory testing since 1990’s: – New vaccines and target populations (e.g., invasive pneumococcal disease) – New lab testing (e.g., PCR) – Changing epidemiology (e.g., herd immunity) Surveillance requirements have changed to support science and program – Investigations, interventions, policies to understand and address changes – Data collection interface(s) to collect relevant required data to support national prevention programs (e.g., legionellosis) 20

Harmonization Results for Disease Specific MMGs by Condition* TOTAL** VACCINE LAB EPI CLINICAL % Harmonized % Harmonized % Harmonized % Harmonized % Harmonized 83 68 75 87 88 58 95 89 95 40 65 100 100 100 88 100 84 100 100 100 N/A N/A 92 92 89 85 100 96 100 93 88 100 85 92 27 67 100 68 28 87 79 100 19 36 29 26 41 81 80 13 100 100 100 N/A 80 AVERAGE 77% 97% 93% 64% 69% RANGE 40%‒95% 84%‒100% 85%‒100% 19%‒100% 13%‒100% CONDITION Mumps Pertussis Varicella Measles Rubella Congenital rubella syndrome H. influenzae N. meningitidis Invasive S. pneumoniae Legionellosis Psittacosis * Data do not include Gen V2 variables. ** ”Total” column also contains variables which do not fit within the four categories on this slide (e.g., system variables) 21

RIBD MMG Components Repeating groups are generally used for: Underlying conditions Antibiotics Vaccine History Lab interpretive diagnostic – Repeats once for each test result – Relatively standardized across the guide, with pathogen-specific exceptions (e.g. Serotype, Serogroup) Industry and occupation Antimicrobial susceptibility testing AIDS Yes Asthma No repeat blocks as needed 22

NCIRD Data Element Priorities - H. influenzae, N. meningitidis, Invasive S. pneumoniae, Legionellosis, Psittacosis “NCIRD Data Element Priorities RIBD v20191114” provides NCIRD priorities including “highest” (1), “high” (2), and “lower”(3) Program considers priorities when assessing implementation spreadsheets For “highest” and “high” priority data element marked “not collected,” jurisdiction provides plan for future collection/transmission of the data element in HL7 case notifications – e.g., “jurisdiction will update systems/transmission by month/year,” “jurisdiction will work with NCIRD to request/identify resources to support the activities that would be required to provide this information” 23

NCIRD Data Element Priority Examples - H. influenzae, N. meningitidis, Invasive S. pneumoniae, Legionellosis, Psittacosis Hospitalized (Generic V2.0) – “Optional” CDC priority in GenV2, however, the priority for NCIRD is “Highest.” – Important for monitoring severity and outcome. Vaccination History Repeating Group – “Highest” and “high” priority data elements for all NCIRD VPDs. – Linkage to IIS encouraged for several high/optional priority elements (e.g., lot number). VPD RC Linkage – 3 data elements: reference laboratory, patient identifier, and specimen identifier. – Can be used to link VPD RC test results with NNDSS cases. 24

NCIRD Materials/Guidance – H. influenzae, N. meningitidis, Invasive S. pneumoniae, Legionellosis, Psittacosis Data Element Priorities Spreadsheet – Available on the NNDSS Message Mapping Guides webpage when the final MMG is posted NCIRD Surveillance Worksheets – Available on Surveillance Manual Appendices webpage and from NCIRD program – Annotations reference MMG data element identifiers 25

NCIRD Materials/Guidance – H. influenzae, N. meningitidis, Invasive S. pneumoniae, Legionellosis, Psittacosis (continued) NCIRD Materials/Guidance NCIRD RIBD Onboarding Welcome Packet – – – – Checklist for onboarding NCIRD MMGs Resources for VPD Surveillance Staff “Notes for Implementation” NCIRD Data Element Priority List Other Resources – Manual for the Surveillance of Vaccine-Preventable Diseases, accessible via CDC webpage – NCIRD Surveillance webpage 26

Overview and Guidance RIBD ABCs ABCs Director EIP IT Melissa Arvay Megan Light ABCs Coordinators and Data Managers Olivia Almendares Amy Blain Yunmi Chung Ryan Gierke Jennifer Onukwube Okaro

Active Bacterial Core Surveillance (ABCs) Component of Emerging Infections Program (EIP) – Network of state health departments and their partners – Used for surveillance, prevention, and control of emerging infectious diseases ABCs sites should use the following tabs in the RIBD MMG: – – – – ABCs GAS ABCs GBS ABCs Hflu ABCs N mening – ABCs IPD – Psittacosis – Legionellosis 28

Active Bacterial Core Surveillance (ABCs) (Continued) Keys for implementation – Data elements are based on current ABCs variables and value sets – Continue to abide by current ABCs protocols and guidance documents – Lab repeating block mimics CRF and is used in case classification algorithm at CDC Reusing value sets – Value sets are designed flexibly to apply across conditions – ABCs valid values are those included on ABCs report forms Supporting documents – Annotated Forms: EIP ABCs Core Case Report Form, GAS Supplemental Form, IPD Form, Neonatal Sepsis Form, Neonatal Infection Expanded Tracking Form – Crosswalk MMG – NeXT and NNS guidance on Introduction tab 29

Thank you Slide Thank you! Questions and Discussion For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Subscribe to monthly NMI Notes news updates at https://www.cdc.gov/nndss/trc/news/ Access the NNDSS Technical Resource Center at https://www.cdc.gov/nndss/trc/ Request NNDSS technical assistance or onboarding at [email protected] Next NNDSS eSHARE is January 21, 2020 – details at https://www.cdc.gov/nndss/trc/onboarding/eshare.html For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.