Public Health Data Exchange FAQ

DOH has the capability to electronically receive the following data for public health data exchange:

• Electronic lab reporting
• Immunization reporting
• Syndromic surveillance
• Electronic Case Reporting
• Cancer Reporting
• Prescription Monitoring
• Clinical Data Registry

You need to register your intent at least once for each public health objective. Once you register, you do not need to register again in future years, unless you were:

• Qualified for an exclusion in the year of your initial registration
• Exited the onboarding process, OR
• Failed to participate in the onboarding processes (e.g., failed to respond within 30 days to the department's written requests for action on two occasions).

No. A clinic may complete a single registration on behalf of all providers that primarily practice at the clinic. The clinic or healthcare organization is responsible for tracking the list of individual providers for whom the registration applies.

Only register for the physical location where you work the majority of the time, using the DOH Public Health Data Exchange registration form. You may list other sites where you practice in the “comments” field of the registration form but this is not required.

There are circumstances where you may qualify for an exemption from one or more Public Health objectives. These may include the following circumstances:

• You do not administer immunizations.
• Public health is not accepting syndromic surveillance data from your practice. Please refer to the Public Health Promoting Interoperability Eligibility Criteria for details on what data public health accepts for syndromic surveillance.
• You do not diagnose or treat cancer.

You, the data submitter, are responsible for providing documentation to prove that you meet any exclusion criterion. Public Health does not issue exclusions or provide documentation confirming you qualify for an exclusion. For further assistance please go to Centers for Medicare and Medicaid Services (CMS) Promoting Interoperability Programs.

Yes. The onboarding process must be completed by (or on behalf of) each legal entity attesting for Promoting Interoperability.

If all data for your organization is centralized AND messages will be generated centrally for all entities in your organization, you only need to complete the onboarding process once. If this is not the case, each facility will have to complete the entire onboarding process independently.

No. A clinic may complete the onboarding process on behalf of all providers that primarily practice at the clinic.

This effort is in line with the Office of National Coordinator (ONC) for Health IT mandating all data exchange between providers and with public health to be done through RESTful API based transactions.

Health Information Exchange :: Washington State Department of Health

Please refer to the CMS pages for audit related information below:

Audits and Appeals Overview | CMS

2022 Program Audit Process Overview (cms.gov)

DOH supports submission of syndromic surveillance data from eligible hospitals and eligible professionals in alignment with activities related to Promoting Interoperability. Some eligible professionals may qualify for an exclusion from syndromic surveillance reporting. Please refer to the Meaningful Use Eligibility Criteria to determine if Washington State is accepting syndromic surveillance data from your facility.

Please view the Washington State Messaging Guide for Syndromic Surveillance (PDF) for guidance on formatting syndromic surveillance messages.

Unlike reportable conditions where you would send information to public health for a select number of conditions, syndromic surveillance requires sending limited data on every visit to your facility. The goal of syndromic surveillance is to provide a flexible, all-hazards system that can be used to monitor different aspects of population health as the need arises. This cannot be accomplished using traditional disease reporting. For additional guidance on what data should be included in a syndromic surveillance message, please view the Washington State Messaging Guide for Syndromic Surveillance (PDF).

Upon request, DOH will review sample messages for basic adherence to structural requirements and expected value sets. Contact syndromic.surveillance@doh.wa.gov to coordinate a review of some sample messages.

The National Institute of Standards and Technology (NIST) has created a syndromic surveillance validation tool. This tool allows for both context-free validation (i.e., only message structure is verified) and context-based validation (i.e., structure and limited content are verified).

Please keep in mind that the NIST tools do not check messages for compliance with Washington-specific guidance.

NIST HL7v2 Syndromic Surveillance Test Suite

DOH recognizes that promotion of a system to production prior to testing goes against traditional IT methodology; however, DOH has found that validation of test messages generated by a test system is insufficient and a secondary validation process must be completed once the data feed is promoted to production.

Validation is a time intensive process. In order to most efficiently use the department's limited resources, the department is asking that facilities promote syndromic surveillance reporting to production prior to validation. This allows for the department to identify all issues and implement solutions in a single validation process.

DOH is unable to provide estimates on the length of time required to complete the validation process. The length of time will largely be dependent on how quickly a facility is able to resolve the issues identified by DOH. DOH encourages facilities to begin investigation of issues as quickly as possible as there is often a delay if vendor assistance is required to address one or more issues.

DOH cannot promise you will be able to complete the onboarding process during your reporting period, but you will improve chances of success if you start the process as early as possible (i.e. before the reporting period begins) and quickly respond to any requests from DOH.

DOH hopes to maintain a long-term, collaborative relationship with facilities submitting syndromic surveillance data to the department. In order to maintain a productive partnership and a robust syndromic surveillance system, the department requests that facilities adhere to Expectations for Facilities Participating in Washington State's Syndromic Surveillance System (PDF).

DOH will provide the following documentation of your facility's engagement:

• Acknowledgement of registration
• Invitation to onboard or qualification for exclusion (if not accepting data from your facility)
• Acknowledgement of production status

Due to limited resources for onboarding, DOH will not be providing additional documentation of engagement. Please gather evidence such as email exchanges, meeting invites, message acknowledgements, and transport logs to show your facility is actively engaged with public health. In the event of an audit, additional documentation may be provided by DOH. Please contact syndromic.surveillance@doh.wa.gov with these requests.

While the department appreciates our early adopters who began providing data to public health prior to Promoting Interoperability, this does not meet Promoting Interoperability requirements.

In order to satisfy these criteria, an expanded set of data must be sent from an Office of the National Coordinator (ONC) certified Electronic Health Record system to the Washington State Department of Health using an HL7 2.5.1 message format.

DOH is the only public health authority accepting syndromic surveillance data for EHR incentive programs in Washington State. The department will grant local health department staff access to data collected from their jurisdiction.

Yes, you should continue to report syndromic surveillance data to your local health jurisdiction without making any changes to data elements, file format, or mode of transmission. This will ensure that local health jurisdictions do not lose local surveillance capacity during the transition period. The local health jurisdiction will notify your facility when this reporting is no longer required.

Syndromic surveillance is defined as public health surveillance using healthcare data and statistical tools to detect and characterize events requiring public health investigation.

The goal of syndromic surveillance reporting is to provide public health with timely information that allows local, state, and federal public health authorities to detect and respond to outbreaks and health events more quickly.

Collection of syndromic surveillance data will enable public health to monitor healthcare utilization for infectious diseases (e.g. influenza), non-infectious conditions (e.g. heart disease, diabetes, and injuries), natural disasters or environmental exposures.

The department anticipates that the expanded set of data elements will improve public health capability to detect, characterize, and track events of public health significance.

The National Syndromic Surveillance Program (NSSP) is a collaboration among individuals and organizations at local, state, and federal levels aimed at promoting and advancing a syndromic surveillance system for the timely exchange of syndromic data. Please visit the CDC's NSSP Overview page for more information, or direct any questions to syndromic.surveillance@doh.wa.gov.

Eligible professionals practicing at clinics that do not meet the above criteria for syndromic surveillance may qualify for an exclusion for syndromic surveillance reporting. If you are unsure about whether your clinic qualifies for an exclusion, you are encouraged to email syndromic.surveillance@doh.wa.gov and complete the Public Health Data Exchange Registration Form to receive an individualized review of your clinic.