Community of Practice Updates

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NSSP CoP Monthly Meeting

The National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) held its monthly meeting on October 26, 2022. On average, 100 to 120 people participate in these meetings. Recordings for the monthly CoP calls are posted in the Knowledge Repository. You can access this month’s recording directly.

NSSP Updates

NSSP Lead Karl Soetebier (CDC NSSP) updated the community on program activities:

• NSSP has been developing a synthetic emergency department (ED) training data set representative of the incoming data seen for chief complaints and diagnoses, correlated with gender and age. The goal of this work is to provide a realistic but synthetic data set that can be used for trainings.
  To that end, we’ve developed a one-time pull of these data from the Chief Complaint Quality and Validation Center (CCQV) that we put through a rigorous scrubbing process to eliminate personally identifiable information (PII). This included both machine methods and a token-by-token human review of chief complaint unigrams, with some additional criteria added to minimize risk. Then we joined the records with additional random components generated from the existing value sets to form a base for the synthetic ED data set. Each day, portions of this base data will be pushed through the existing data flow to a demonstration site set up in the production onboarding environment that simulates a facility’s real-time ED data feed.
  Later stages of this work will explore how to inject and model trends and events. NSSP will email details to site administrators who have opted in to use the CCQV data set. The email will describe the process used and, despite all the effort to remove traceability to person, place, or time, will give site admins another opportunity to opt out.

• CDC and other federal partners are responding to the increase in ED visits for respiratory infections in children. NSSP data are providing support in many ways and are an essential piece of the puzzle. For example, a recent Morbidity and Mortality Weekly Report on the increase in respiratory illness among children featured NSSP data as part of its analysis. NSSP data were also presented as part of the introductory remarks to a briefing of the National Security Council on October 25, 2022. National trends for the broad acute respiratory and respiratory syncytial virus (RSV) definitions (stratified by key age groups) were used to highlight the concerning differences we’re seeing in trends this year. During this discussion, questions around trends in mental health seen in NSSP’s ED data were also raised, indicating a growing awareness of these data and, more broadly, acknowledging the work that NSSP and the community are doing together.

Featured Presentations

(October 2022 NSSP CoP Monthly Call)

• NSSP Mortality Data: Edward Lockhart (CDC NSSP)

  Lockhart explained how the mortality project originated with a 2020 pilot. By the end of 2021, six sites were submitting mortality data to the production environment. Participation has increased, with 12 sites now in production or in the process of joining. Lockhart extended an invitation to attendees interested in joining, offering NSSP’s technical assistance to facilitate onboarding. To learn more about onboarding your site’s mortality data, please contact the NSSP at nssp@cdc.gov. You may also contact Lockhart directly at elockhart@cdc.gov.

  Resources:

• • Mortality Slack Channel: #mortality-data NEW
  • FAQs about Mortality Data
  • Mortality Data Flow Diagram
  • NSSP Mortality Data Source Development Overview
  • National Association of Public Health Statistics and Information Systems (NAPHSIS) and State and Territorial Exchange of Vital Events (STEVE)
  • NSSP + NAPHSIS Mortality Pilot Project Presentation Webinar
  • 2021 National Syndromic Surveillance Program: Mortality Data Source Development Overview
  • NSSP Update Article (February 2022): Data Integration Improves Public Health Surveillance

The Consultant Report on Federal Access Policies for State NSSP Data and the discussion about creating a Syndromic Surveillance Health Equity Focused Toolkit are detailed. You’ll want to listen to these presentations to appreciate the effort put into these topics and to hear the questions and presenter responses.

• Council of State and Territorial Epidemiologists (CSTE) Consultant Report—Federal Access Policies for State NSSP Data (Findings and Implementation Strategies): Cason Schmit, JD (Texas A&M University)
  Schmit, one of four CSTE consultants who worked on the report, served as spokesperson. He described how they assessed federal access policies for state NSSP data. In 2021–2022, the consultants conducted fact-finding activities with CSTE, NSSP, and state, tribal, local, and territorial (STLT) epidemiologists to identify potential implementation strategies for NSSP data access permissions. The goal was to identify specific strategies to revise the current policy pertaining to federal access of NSSP data. In doing so, they drafted a ~100-page report. Schmit’s presentation covered some of the report’s findings and implementation strategies. Current Data Use Agreements (DUAs) do not permit generalized access to STLT data below the U.S. Department of Health and Human Services regional level—and numerous federal efforts have tried to advance (legislate) public health data modernization.
  Schmit explained the information gathering activities and then singled out several implementation strategies that he discussed in greater detail:

• • Strategy 1: Create communication protocols between CDC and STLT governments.
  • Strategy 2: Implement a framework for federal–STLT collaborations.
  • Strategy 4: Permit limited CDC NSSP staff to access state NSSP data to provide supplementary surveillance support subject to reasonable policy guardrails and limitation.
  • Strategy 5: The federal government should minimize additional burdens on STLT governments caused by increased federal access to STLT data and provide additional state and local funding as needed.
  • Strategy 6: Create a STLT NSSP governance group guided by principles of public health ethics.
  • Strategy 7: Create processes for emergency federal NSSP access and use.
  • Strategy 9: Require all federal NSSP users and regular recipients of NSSP data below the state level to sign the NSSP DUA.
  • Strategy 14: Clarify Freedom of Information Act (FOIA) policy for syndromic surveillance data.

• Creating a Syndromic Surveillance Health Equity-Focused Toolkit: Rebecca Rees and Dan Chaput (Kahuina Consulting)
  Rees launched the discussion by explaining that Kahuina Consulting’s goal is to amplify what’s being done well by the NSSP CoP and to explore ways to collaborate and develop solutions for what can be done even better.
  For context, Rees explained that the toolkit project originated during the 2021 Syndromic Surveillance Symposium. In one of the roundtable sessions, the community explored the use of syndromic data for analyses that would focus on health equity. Those conversations highlighted the instrumental role that NSSP could play in examining different health equity topics—like disproportionate healthcare access—and how public health surveillance and response efforts could benefit from using syndromic data.
  Many federal agencies, including CDC, strive to eliminate health disparities. Syndromic surveillance could be a powerful tool to advance this goal by providing timely data, near real-time insights, and a unique look at the populations who do and do not seek care in EDs. “By combining syndromic surveillance data with local knowledge and other data sources,” Rees said, “you can start to build a nice picture to monitor trends and different outcomes to look at health inequities in communities and support even the examination of some of those upstream determinates of health. The toolkit could serve as a starting point to introduce a health equity lens to syndromic surveillance data and analyses…. we are not reinventing the wheel. This work has been going on, and we are trying to formalize all the incredible work that the community of practice is doing already and to broaden the reach of others who can use these tools and implement health equity into their work.”
  After describing the background, purpose, and objectives, Rees focused on the approach used to develop the toolkit. Kahuina Consulting did an environmental scan, conducted interviews, and collected best practices and successful examples to show how public health jurisdictions could learn from one another. The toolkit moves from foundational concepts through use cases into actionable recommendations. Importantly, the toolkit describes strategies for how analysts can look at their data with a health equity lens.
  At the end of the presentation, Rees and Chaput fielded questions. To fully appreciate the discussion, please listen to the presentation.
  Note. The toolkit is a CDC-funded project. The toolkit is ready for CDC review, and the initial draft is tentatively scheduled for release in January 2023. Content will be further refined based on feedback. This NSSP CoP monthly meeting served as a listening session for Kahuina Consulting to assess the community’s initial reaction.

Reminders and Announcements

• The 2022 Syndromic Surveillance Symposium will be held virtually three afternoons from December 6–8, 2022. The event is open to any person or organization interested in advancing syndromic surveillance practice and is FREE of charge. For more information, visit the NSSP CoP website.
• We encourage everyone to make sure your membership information is current. Visit nsspcommunityofpractice.org; click on Quick Links; then click Update NSSP CoP Membership. Update your membership preferences to receive calendar invites.
• The Knowledge Repository (KR) is getting an overhaul. The KR is a popular feature on the NSSP CoP website that contains NSSP CoP call recordings; syndrome library; and resources on data analytics, data sharing, and more. CSTE developers are enhancing the KR search features and user interface with plans to complete the effort this winter.
• Leadership Opportunities:
  
  • Technical Workgroup Co-chair Position: If interested, email Caleb Wiedeman (wiedeman@tn.gov).
• Holiday Rescheduling of Meetings:
  • Rescheduled: NSSP CoP Monthly Call, November 16, 12:00–1:30 PM ET 
  • Cancelled: November 23, 2022, NSSP CoP Monthly Call
  • Cancelled: November 24, 2022, ESSENCE User Group meeting
  • Cancelled: December 7, 2022, Syndrome Definition Subcommittee Call
  • Cancelled: December 28, 2022, NSSP CoP Monthly Call

Syndromic Surveillance Training Series

Learning Objectives

1. Describe the general process to categorize records into syndromes
2. Apply characteristics of SyS data (sources, variables, quality) when describing SyS results
3. Distinguish between which public health issues are and are not well suited for SyS

Expected Outcomes

1. Reliably and confidently define a syndrome using typical syndromic surveillance data elements
2. Reliably and confidently describe representativeness and limitations of SyS results
3. Accurately frame and/or develop hypotheses for SyS applications

Learning Objectives

1. Select appropriate public health actions based on SyS analysis
2. Describe key messages for various target audiences, including data providers, decision makers, and the public

Expected Outcomes

1. Determine appropriate response/public health action based on SyS finding
2. Craft and/or make recommendations for tailored communication per audience profile

Learning Objectives

1. Select and apply the analysis method as appropriate for the context and health condition of interest
2. Identify how to utilize SyS data and methods for multiple public health domains

Expected Outcomes

1. Accurately describe appropriate analytic methods to characterize processed SyS data
2. Expand SyS application to additional health conditions of interest and public health domains