2011 CSTE Conference

Revised Messaging and Data Provisioning Strategy for the

National Notifiable Diseases Surveillance System

Ruth Jajosky, DMD, MPH; CDC/OSELS/PHSPO/DNDHI

June 13, 2011

National Notifiable DiseasesSurveillance System (NNDSS) Messaging Strategy

Reason for Revised Messaging Strategy:Maintaining support for exchange of NNDSS data in three (3) formats led to data management errors and limitations in the ability of CDC Programs to access and use National Notifiable Disease (NND) data.

  1. Background:In fall 2010, CDC performed an internal review of NND processes and identified issues and options for improvement.
  2. Data quality issues and content issues were identified, which were in part related to data translations and different data flows into the Common Data Store(CDS) (CDC’s centralized data repository).
  3. A slow data provisioning process exists, starting from Message Mapping Guide (MMG) developmentto CDC program data access.
  1. Original Messaging Strategy (See Figure 1)
  2. Data are received in 3 formats (sometimes all 3 for one jurisdiction): NETSS, NEDSS Base System (NBS) Master Message, and Health Level 7 (HL7) v2.5.
  3. Uses Generic MMG v1 only for NNDs which do not have a disease-specific MMGbeing planned, in development, or published.
  4. Transitions jurisdictions to HL7 v2.5 as disease-specific guides are implemented.
  1. Revised Messaging Strategy (see Figure 1 and Table 1)
  2. Transition to HL7 v2.5 as soon as possible using the Generic MMG v2, which includes core and NETSS disease-specific data using Public Health Information Network (PHIN) data standards.
  3. Benefits
  4. Simplifies data flow
  5. Improves data quality
  6. Establishes a foundation for future disease-specific MMGs
  1. Shared Governance for NNDs
  2. An OSELS*/OID**Governance Council is in the process of being established to work on NND transition issues.

*OSELS = CDC Office of Surveillance, Epidemiology, and Laboratory Services

**OID= CDC Office of Infectious Disease

  1. Priorities for Disease-specific MMGs
  2. In 2010, the OID Surveillance Work Group established a prioritization of new disease-specific MMGs which were in development or being planned. This list is being revisited and will be communicated to partners when it is available.
  3. A small work group is being planned to identify any changes in priorities for disease-specific guide development and to address Office of Management and Budget (OMB) Paperwork Reduction Act (PRA) issues, which impacts our ability to complete and finalize Guide development.
  1. Technical Assistance and Processes toSupport the Transition to NEDSS
  2. Submit requests for technical assistance via email or call the PHIN help desk at: 800.532.9929 and select option 2.Normal operating hours are between 8 a.m. and 6 p.m. eastern standard time, Monday through Friday.
  3. For a description of the CDC Teams and services that support the transition to NEDSS, see the “CDC Teams” listing on page 6.
  4. Publication of the MMGs and the HL7 v2.5 implementation checklist: see
  5. Training to use the NEDSS Messaging Subscription Services which includes Rhapsody and the Message Subscription Service (MSS): email Arun Srinivasan at for information about training
  6. Regularly scheduled technical support calls:
  7. Bimonthly calls to support the implementation of HL7 NND case notifications: to join the call, email Michelle Mayesat
  8. NBSUser Group (NUG) calls for discussion of NBS-related items, including implementation of HL7 case notifications in the NBS: to join the call, email Arun Srinivasan at or Doug Hamaker at .
  9. Monthly NEDSS MSS User Group (NMUG) calls: to join the call, email Arun Srinivasan at .
  10. Case notification documents on the PHIN web site at “Resources” and then “Guides”).

NND Data Provisioning Strategy for CDC Programs

  1. Original Strategy
  2. Provide access to data in standardized format from 3 data feeds (NETSS, HL7, and NBS Master Message) through data marts as disease-specific MMGs were completed
  3. Provide spin-off SAS file (including data from the 3 data feeds) from legacy (NETSS) processing methods
  1. New Strategy
  2. Provide access to core and NETSS extended disease data for programs
  3. Add-on additional disease-specific data as MMGs are developed and implemented
  4. Incorporate information about processing data so programs can recreate any data set published in the MMWR annual summary
  5. Work with infectious disease Programs to roll-out data access across OID
  1. Immediately Notifiable NND Alerting Strategy
  2. When an electronic case notification for an immediately notifiable NND (e.g., cholera, plague) is received by CDC, an email alert is generated for the NNDSS Team to review and is then sent to the CDC Emergency Operations Center (EOC) to be triaged to the appropriate CDC Subject Matter Expert.This alerting function is fully implemented for cholera and has been partially implemented for other conditions.
  3. After the CDC Programs are trained in how to access the data in data marts, alerts for all immediately notifiable NND will be sent to the EOC directly.
  4. The Generic MMG v2includes a data element to designate whether the case notification is for an immediately notifiable NND.

Figure 1.Original and New Messaging Strategy using Message Mapping Guides

Tiers of Data
Strategy / Original Approach / Simultaneous Development
Generic MMG version 1 – core variables only
Excluded conditions with disease-specific MMGs (planned, in development, or published) / No NETSS disease-specific data included in Generic MMG version 1
Published disease-specific MMGs for varicella & TB
Includes generic content in addition to disease-specific variables
New
Approach / PHASE I – Foundation / PHASE II - Supplement
Generic MMG version 2 / Additional disease-specific MMGs
Information content post-NETSS extended
Core variables / NETSS disease- specific data

Table 1. NNDs to Use with the Generic Case Notification MMG version 2*

Generic Case Notifications with
Core Data Only / Generic Case Notifications with Disease-Specific Data
Anaplasmosis
Anthrax
Babesiosis
Botulism
Brucellosis
Cholera
Coccidioidomycosis
Cryptosporidiosis
Cyclosporiasis
Diphtheria
Ehrlichiosis
E. coli (EHEC, STEC)
Giardiasis
Hansen disease (Leprosy)
Hantavirus pulmonary syndrome
Hemolytic uremic syndrome, post-diarrheal
Legionellosis
Leptospirosis
Malaria
Novel influenza A virus infections, initial detections / Plague
Poliomyelitis, paralytic
Poliovirus infection, nonparalytic
Psittacosis
Q fever
Rabies, animal
Rabies, human
Salmonellosis
SARS
Shigellosis
Smallpox
Spotted fever rickettsiosis
Streptococcal Toxic Shock Syndrome
Streptococcus pneumoniae invasive disease
Toxic shock syndrome (staphylococcal)
Trichinellosis
Tularemia
Typhoid fever
VISA/VRSA
Vibriosis
Viral hemorrhagic fever / Bacterial meningitis
Haemophilus influenzae, invasive disease
Hepatitis
Listeriosis
Lyme disease
Measles
Meningococcal disease
Mumps
Pertussis
Rubella
Rubella, congenital syndrome
Tetanus

*The complete list of conditions that can be reported is included in the document titled “National Condition Reporting: Notifiable Events and Reporting Mechanisms for 2011” on the PHIN web site (

Table 2.NNDs that Do Not Use the Generic MMG version 2.

NNDs which have Published MMGs / NNDs using an Alternative Case Notification Mechanism
Arboviral diseases / STDs
Tuberculosis / Influenza-associated pediatric mortality
Varicella / HIV

Figure 2.New Data Provisioning Strategy for CDC Programs

PHASE I – Foundation: Core/NETSS Extended to All

PHASE II – Supplement: Additional Disease-Specific Guides

Begin work to bring in additional data after completion of Phase I

CDC Teams

Supporting the transition to NEDSS

National Electronic Disease Surveillance System (NEDSS)

NEDSS is an initiative that promotes the use of data and information system standards to advance the development of efficient, integrated, and interoperable surveillance information systems at federal, state and local levels.It is a major component of the PHIN.This broad initiative is designed to:1) monitor the health of the nation, 2) facilitate the electronic transfer of appropriate information from clinical information systems in the health care system to public health departments,3) reduce provider burden in the provision of information, and 4) enhance both the timeliness and quality of information provided.

Messaging and Vocabulary Services

Messaging and Vocabulary services are provided to develop implementation guides based on HL7 for case notification to CDC as part of the NNDSS.Content of the MMGsis based upon CDC Programs’ information needs.Activities include gathering of requirements, development of implementation guides, and serving as technical subject matter experts to state and CDC teams responsible for implementing the guides.

PHIN Vocabulary Access and Distribution System (VADS)

PHIN Vocabulary Standards are a key component in supporting the development and deployment of standards-based public health information systems.For case notification, PHIN VADS contains concepts and data elements which are included in the case notification implementation guides for each disease or group of diseases.

PHIN Messaging Service (PHIN MS)

PHIN MS is a secure and reliable messaging solution provided by CDC to public health partners (state/local, labs & providers) to do secure electronic messaging. The solution utilizes ebXML standards and supports automated send, retries, guaranteed delivery, and chunking for large files.

Data Messaging/Brokering (DMB)

DMB is responsible for receipt, validation, and routing of case notification HL7 messages received by CDC from public health reporting jurisdictions.Messages are received via PHIN MS.Basic structural validation and some limited content validation are performed before the message is routed to the appropriate location.Reports are provided to sending entities to document messaging errors.

Message Quality Framework (MQF)

The MQF is a flexible framework of services and utilities designed to assist public health partners with preparing and communicating quality, standard electronic messages as defined by the applicable messaging, vocabulary, and programmatic standards.

PHIN Certification

PHIN Certification certifies the ability of an application (or multiple applications, components, or systems) to perform specific functions in compliance with the PHIN Requirements and Certification Criteria.

Each PHIN Certification is based on one or more of the PHIN Requirements. For example, the PHIN Certification for sending varicella case notification messages from a partner to the CDC is "PHIN Varicella Case Notification Message - Send". The required functionalities are: (1) the ability to compose functional varicella case notification messages; (2) the ability securely send the messages to the CDC; and (3) the application(s) used must be secure and available.

Common Data Store (CDS)

The CDS receives case notification data from reporting jurisdictions in multiple formats.Using CDC-defined requirements, CDS standardizes the data for structure and content and implements processes to create/update/delete case notifications are they are received.CDS provides data marts for access to the data by responsible CDC programs.CDS also serves as a message repository for data in its original form as sent in by the reporting entity.

Frequently Asked Questions

1. What is a Case Notification MMG?

A Case Notification MMG describes the content and message mapping specifications for a set of data elements used to communicate information for a condition or group of conditions for case notifications sent to CDC.

The MMG is used with the “National Condition Reporting Case Notification ORU^R01 Message Structure Specification Profile” to contruct an HL7 message to send to CDC ( )

2. Which MMGs are published and where can I download them?

The published MMGs can be downloaded at:

3. When can CDC receive messages for the published MMGs?

CDC can usually receive messages once the MMG is posted to the PHIN web site.

4. When will CDC stop receiving NETSS data?

CDC will work with CSTE and the OIDSurveillance Working Group to determine reasonable timeframes for requesting state partners to transition to HL7 messaging.Once a timeframe/deadline is determined and announced, state partners will be expected to transition by that date.After the deadline, CDC will not support NETSS messaging for that condition or group of conditions.

5. Which disease-specific MMGs are coming after Generic MMG v2?

The OSELS and OID will work to prioritize implementation of disease-specific MMGs based on a variety of factors.More information will be shared as it becomes available.PH Connect ( and existing workgroup calls and mechanisms will be used to disseminate information.

6. How can my state get started with HL7 messaging for case notification to CDC?

To get started with HL7 messaging for case notification PHIN web site at:

7. Should I implement the Generic MMG v2 for conditions with extended data, such as pertussis, or should I wait until the pertussis disease-specific MMG is released?

The disease-specific data elements covered in the Generic MMG v2 contain the data elements currently collected through the NETSS extended record layout.Generic MMG v2 is intended as a starting point for future disease-specific MMGs that contain more data elements than what is currently collected through the NETSS extended record layout.Although all current NETSS data elements may not carry forward into a disease-specific MMG in the future, a large proportion of those data elements would.Thus, work done implementing the Generic MMG v2 would be re-used, all or in part, in future MMGs.

8. If I am an NBS state, should I adopt the Generic MMG v2?

By transitioning to the new NBS Pages, the new functionality available in pages built with PageBuilder will be available (business rules, decision support, etc.).However, there are additional data elements for some conditions collected in NBS which a jurisdiction would lose if the Generic MMG v2 were followed exactly.Those additional data elements could be added as state-specific questions and later be transitioned to standardized questions when a disease-specific MMG is available.There would be additional work required to do this.For any given condition, a jurisdiction will have to weigh their need for the new functionality with the potential for rework and make a decision for each of the conditions in the Generic MMG v2.For those conditions without disease-specific data in NBS in addition to Generic MMG v2, this would not be a concern.

Abbreviations

CDC – Centers for Disease Control and Prevention

CSTE – Council of State and Territorial Epidemiologists

DMB – Data and Message Brokering

ELR – Electronic Lab Report

EOC – Emergency Operations Center

HL7 – Health Level 7

MMG – Message Mapping Guides

MSS – Message Subscription Service

MMWR – Morbidity and Mortality Weekly Report

NBS – NEDSS Base System

NEDSS – National Electronic Disease Surveillance System

NND – Nationally Notifiable Disease

NNDSS – National Notifiable Diseases Surveillance System

OSELS– Office of Surveillance, Epidemiology and Laboratory Services

OID – Office of Infectious Disease

PHIN – Public Health Information Network

PHIN MQF – PHIN Message Quality Framework

PHIN VADS – Public Health Information Network Vocabulary Access Distribution Service

PHINMS – PHIN Messaging Service

PHSPO – Public Health Surveillance Program Office (CDC)

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