Technical Updates

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.

New ESSENCE Table Shows Laboratory Data by Individual Results

We have implemented a new way to view and query laboratory data in ESSENCE. For the new data view, laboratory data were reformatted from a “by accession ID” to a “by results” table. The “by results” table can make counting tests of interest and calculating percent positivity for a given test much easier.

When a laboratory receives a specimen, an accession ID is applied that includes all tests run on it (e.g., patient’s blood draw or urine sample). If specimens are sent for testing at the same time, one accession ID might also include data from multiple specimen types. In the current laboratory by accession ID format, all tests for each accession ID are collapsed into one row. This row concatenates multiple test names and results, making it easy to see all tests and results ordered for a given specimen.

In the new Laboratory Data by Results view, each row in the data details section of ESSENCE represents a single laboratory test result. This enables queries and interpretation using individual test counts, which can make counting and categorizing specific tests easier. When you need to query by accession ID, the table is still available. The accession ID table includes tests before the results have been released, while the results table includes tests with a result.

Access to laboratory data, including views by both accession ID and individual laboratory test result, is by state. If either the patient or provider ZIP code is in that state, the site administrator will be able to grant access. If you have questions about access, please contact your site administrator.

As a reminder, one major commercial laboratory transmits test orders and results every 10 minutes. NSSP has labeled this commercial laboratory “Lab A.” Data are sent at time of order, and all result types (including positive and negative results) are included. Data are identified by specimen, and while patient demographics are available, no unique patient identifiers are available in ESSENCE at this time. Lab A data are available from early 2019.

Lab A data include all testing for any reportable disease in the United States. This means if any public health jurisdiction has a disease listed as a mandatory reportable disease, NSSP will receive testing results for that disease from across the nation. NSSP also receives data on specific drugs of abuse from Lab A, including, but not limited to, opioids, fentanyl, cocaine, amphetamines and methamphetamines, benzodiazepines, and cannabinoids.

Further, data for polymerase chain reaction and serology SARS-COVID-2 testing are available from six commercial laboratories, including Lab A. Laboratory data do not update on weekends or federal holidays and might be subject to occasional reporting lags based on events in a public health jurisdiction or surge in testing.

Information about all laboratory fields available in ESSENCE can be found on tab 18 of the Commercial Laboratory Data Dictionary. More questions? Please contact nssp@cdc.gov.

NSSP Job Aid Shows Priority 1, 2, and 3 Data Elements

The National Syndromic Surveillance Program (NSSP) has developed a new job aid, “Syndromic Data Element Prioritization,” that lists data elements essential for conducting syndromic surveillance (priority 1), required within one year of start-up (priority 2), or optional (priority 3). The NSSP team, in collaboration with the syndromic community, set up these priority levels to ensure data quality when onboarding new facilities or re-onboarding facilities that have been out of production. (This is the same list provided in Appendix E of the New Facility and New Site Onboarding Guides but in a format that’s easier to access.)

Data elements are an essential part of syndromic Health Level Seven (HL7) messages. HL7 messaging is the nationally recognized standard for transmitting health-related data electronically. HL7 messaging has common syntax and vocabulary that are independent of the platform. Messages include segments in a defined sequence that contain patient data—or data elements—from the time a patient is admitted for care through the patient’s discharge or transfer. Examples of data elements for syndromic surveillance include Admit_Date_Time, Diagnosis_Code, and Chief_Complaint.

The new job aid is posted in the NSSP Technical Resource Center, Onboarding. For a detailed explanation of syndromic data elements, refer to the PHIN Messaging Guide for Syndromic Surveillance 2.0. For processing details of data elements, see the NSSP Data Dictionary.

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.

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.