Technical Updates

CAPT Loren Rodgers Named NSSP Lead

Loren Rodgers, PhD
Captain, US Public Health Service

Please join us in congratulating CAPT Loren Rodgers on his appointment as the new National Syndromic Surveillance Program (NSSP) Lead. Rodgers has been acting in this role since July 2020, coordinating NSSP response activities through much of the pandemic.

Already, Rodgers is helping set a clear path for NSSP’s future by working closely with CDC’s Division of Health Informatics and Surveillance (DHIS) management to ensure NSSP can meet the program’s future challenges. During the February 2021 NSSP Community of Practice (CoP) call, Rodgers laid out a vision for NSSP’s road ahead, based on lessons learned during the pandemic. “Emergency department data have been among the most useful metrics for understanding the spread of the pandemic and characterizing more clinically severe cases,” Rodgers said. “This has been insightful in unprecedented ways, but three things have held us back from being more helpful to the response: gaps in coverage, uncertainty about quality and comparability of data across jurisdictions, and data use restrictions that resulted in stakeholders seeking answers from other systems.” Rodgers concluded by stating his commitment to collaborating with the CoP to fully materialize the potential value of NSSP as a flagship system for public health preparedness.

Rodgers will direct the work of DHIS’s cross-functional NSSP teams that coordinate syndromic surveillance activities for the agency. He’ll work within DHIS to direct day-to-day program operations and work across the agency to collaborate with CDC program experts and senior staff. He will collaborate with public health jurisdictions and other external partners and continue to coordinate NSSP support for the COVID-19 response.

Rodgers has 12 years of federal service, primarily in epidemiology and in leading national health information systems. In DHIS, he has served as the Surveillance and Data Science Team Lead, overseeing NSSP surveillance and data quality. His prior positions include overseeing systems and evaluations for immunization information systems, managing regulatory projects at the Food and Drug Administration, and serving as an Epidemic Intelligence Service Officer at the Ohio Department of Health. Rodgers holds a PhD in Biology from the University of California, San Diego, and he has co-authored over 40 manuscripts and industry guidance documents describing best practices for national information systems.

Rodgers is well-suited to balance NSSP’s ongoing achievements with the current demands of the COVID-19 response.

NSSP Releases AMC v1.5.4 Software

On March 18, 2021, NSSP released BioSense Platform Access & Management Center (AMC) v1.5.4 software. New features include:

• time limits for data access rules that will allow users to specify the time and dates they want the data access rules to be active,
• ability to filter users by organization,
• enhanced messaging to provide descriptions of unmet requirements when changing passwords, and
• transaction management to reset failed updates when creating or changing data access rules or user groups.

Also, for users who manage data for the U.S. Department of Veterans Affairs, you’ll be able to further restrict data access by facility state and county.

CELR Data Being Added to ESSENCE

Last month the National Syndromic Surveillance Program (NSSP) asked for your input on a proposal for making coronavirus disease 2019 (COVID-19) electronic laboratory reporting (CELR) summary data available to ESSENCE users on the BioSense Platform. Here’s an update on how NSSP is moving forward:

For background, CDC’s NSSP team at CDC has been working with the Johns Hopkins University Applied Physics Laboratory on fusion models that combine data from multiple sources including laboratory test results and emergency department visits. These fusion models are designed to alert ESSENCE users of spikes in COVID-19 transmission at the county level.

Currently, these models are built on a subset of data from six commercial laboratories that use ESSENCE to report directly to CDC. Going forward, CDC’s CELR team will add ESSENCE CELR data to provide a daily summary table of laboratory tests by county, result, age group (e.g., 0–4, 5–11, 12–17, 18–24, 25–34, 35–44, 45–54, 55–64, 65–74, and 75+), and test type (PCR or antigen). The addition of ESSENCE CELR data will make the fusion models even more comprehensive and representative, allow better tracking of COVID-19 positivity, and improve alerts to state and local authorities.

These tables will be available based on the rhythm of the state submission to CELR (usually daily). CDC’s CELR team will generate the summary table—so no additional work will be needed from you. Keep in mind, however, that the summary tables will not be available to any state or public health jurisdiction that has not yet onboarded to CELR. (Please see the CDC CELR Implementation by State map or email the CELR team at eocevent405@cdc.gov if you have questions about onboarding to CELR.)

As with other ESSENCE data, the NSSP site administrator in each state or county will determine state and local access to CELR data. The default view will allow state users to only access data and alerts from their own state. Federal users will have access to CELR data in ESSENCE using the same access rules applied to other systems—such as AIMS and HHS Protect.

NSSP Updates Query for ED Visits with Diagnosed COVID-19

Additional ICD-10-CM codes related to COVID-19 became effective January 1, 2021. These codes will capture more information about COVID-19 in emergency department (ED) surveillance data.

Based on these new codes, NSSP added “J12.82: Pneumonia due to coronavirus disease 2019” to the chief complaint discharge diagnosis (CCDD) category CDC Coronavirus-DD v1. This was an update to v1—not a new version. Due to other CCDD categories referencing CDC Coronavirus-DD v1, the following categories will now reference and include this update:

• ILI Syndrome Neg Coronavirus DD v1
• ILI CCDD Neg Coronavirus DD v1
• CLI CC with CLI DD and Coronavirus DD v2
• CLI CC with CLI DD and Coronavirus DD v1

NSSP has also added a new CCDD category titled CDC COVID-Specific DD v1. This category will narrow the ICD-10-CM and SNOMED codes to those specific to COVID-19 and will capture the following codes:

• U07.1 – COVID-19
• J12.82 – Pneumonia due to coronavirus disease 2019
• 840539006 – COVID-19
• 840544004 – Suspected disease caused by 2019 novel coronavirus
• 840533007 – 2019-nCoV (organism)

What does this mean for you? Any methods using CDC Coronavirus-DD v1 or associated categories in NSSP–ESSENCE should automatically reflect the addition of J12.82, including myESSENCE dashboards, alerts, and references to application programming interfaces, or APIs. Some facilities are updating older ED visits to include the new J12.82 code, so those visit counts could change.

The new COVID-specific category is ready for use in NSSP–ESSENCE now. Anecdotally, we understand that certain facilities use diagnosis codes outside this narrow set. For this reason, data pulled by this category could vary by public health jurisdiction.

Although these changes will likely affect the classification of some ED visits, we anticipate that the trends will stay generally the same. Shown below is a comparison of CDC Coronavirus-DD with CDC COVID-Specific DD.

No action is needed on your part. The changes are being made within NSSP–ESSENCE. If you have questions, please contact nssp@cdc.gov.

New Syndrome Definitions and Updates

The syndrome definition for CDC Benzodiazepine Overdose v1 is live on ESSENCE. A fact sheet will be added to the NSSP Community of Practice Knowledge Repository.

Adding New Information, Data Fields, or Message Types to an Existing Feed

Several site administrators have recently notified NSSP’s onboarding team of work they’re doing to receive additional data fields and message types into production data—an activity that we fully encourage and support.

Here’s a best practice to keep in mind: When adding data fields to existing production feeds or making other changes, always add the new facility fields to production-level data being sent to the staging environment. Do this while continuing the active feed to the production environment. This practice allows both the sites and NSSP onboarding team an opportunity to confirm that data already being received have not been negatively affected by the additional fields or message types.

NSSP Sites Begin Using Mortality Data

As of January 2021, two public health jurisdictions that participate in NSSP have mortality data in production NSSP–ESSENCE.

This is an exciting step after conducting a successful pilot of mortality data in 2020. During the pilot, public heath jurisdictions in Kansas, Oregon, and Washington State helped to refine data receipt, ingestion, and processing mechanisms; define data governance; and test the user interface.

So, how are mortality data processed? Mortality data are received in the standard Inter-Jurisdictional Exchange (IJE) electronic file format defined by the National Association for Public Health Statistics and Information Systems (NAPHSIS) IJE Committee. Jurisdictions can query Cause of Death codes. They can also query the Literal Cause of Death, a text field that provides the first indication of cause of death, which is like querying a chief complaint field in emergency department data. The Literal Cause of Death field is often received before the final ICD-10 codes, providing early insight and opportunity for timely analysis and response. Practitioners whose jurisdictions include mortality data in NSSP–ESSENCE will be able to integrate these data with illness, injury, and other health-related data in their response to public health threats and events.

If your public health jurisdiction is interested in onboarding mortality data and would more details, please contact nssp@cdc.gov.