Hospitals with emergency departments, free-standing emergency centers, and urgent care centers.

Review the Data Provider and TxS2 User Registration and Onboarding procedure for registration steps, or email  syndromic.surveillance@dshs.texas.gov for more information. 

No, we also connect with free-standing emergency care centers and urgent care that have an electronic health record system.

Data providers and Local Health Departments that intend to connect to TxS2 must sign a Memorandum of Understanding (MOU) with DSHS. Individual ESSENCE Users must sign a TxS2 User Access Agreement (UAA) and the Health and Human Services (HHS) Acceptable Use Agreement form to obtain user credentials. 

The administration of the hospital system and the electronic health record system capabilities determine how individual hospitals within a hospital system are connected to TxS2 programmatic data. 

TALHO started a syndromic surveillance system that was intended to be a statewide system. When that organization disbanded, DSHS contracted with Houston Health Department (HHD) to maintain the former TALHO system until a new system could be created. HHD maintained the former TALHO system until August 31, 2016, and DSHS assumed maintenance of this system on September 1, 2016. Data providers that submitted data to the former TALHO system transitioned off this system to the statewide syndromic surveillance program hosted by the TxS2 program. 

The North Texas Syndromic Surveillance System (NTXSS) hosted by Tarrant County Public Health (TCPH) covers syndromic surveillance activities for Public Health Region (PHR) 2/3. Similarly, HHD operates a system that covers syndromic surveillance activities for PHR 6/5S.

The model for the statewide syndromic surveillance system is that data providers located in PHR 2/3 connect to the NTXSS and data providers located in PHR 6/5S connect to the system operated by HHD. These two systems then feed all their data into the statewide system. All other data providers statewide, including those submitting data to the former TALHO system, connect directly to the TxS2 program.

Users in PHR 2/3 and PHR 6/5S can access data for their regions through the NTXSS and HHD systems, respectively. These users can also gain access to aggregate statewide data through the statewide system. Users outside PHR 2/3 and PHR 6/5S can view data for their respective region as well as aggregate statewide data through the statewide system.

DSHS staff (central office and PHRs 2/3 and 6/5S) maintain a collaboration with TCPH and HHD to ensure success for the TxS2 program.  

Requests for technical/IT assistance for the TxS2 programmatic data should be directed to TxS2Support@dshs.texas.gov.  

The statewide syndromic surveillance system is configured to support the Public Health Information Network (PHIN) Messaging Guide for Syndromic Surveillance. The technical specifications can be found in the Data Provider Onboarding and Messaging procedure or contact TxS2 IT staff directly at TxS2Support@dshs.texas.gov for more information. 

Patient data are captured from the electronic health record system (EHR) and sent automatically to the syndromic surveillance system. TxS2 IT staff work directly with the facility’s IT staff to set up the data transfer protocols. Facilities do not have to manually input the data outside the normal entry in their EHR and there is not any change in the clinical process in the patient visit.  

The goal is to have as near real-time data as possible, given the technological constraints of each facility. The frequency of submission is established as the connection to the data provider is made. Data providers are strongly encouraged to submit data at least once every 24 hours. 

The Limited Data Set or TxS2 programmatic data elements are the data elements of interest listed in the Public Health Information Network (PHIN) Messaging Guide for Syndromic Surveillance (Section 4, Document page 95). The system is configured to support these elements.

Users can view all the data elements submitted for an individual record, based on their permissions in the system. Therefore, data provider staff can see all the data elements for records within their facility, while Local Health Departments can see this level of detail for their entire Public Health Record. 

Please find the respective type of data access by DSHS/HHSC Staff, LHDs and Hospitals and Hospital Systems on the ESSENCE page.

Each organization determines who on their staff has access to view data in the system, and DSHS assigns user accounts for those individuals. It is the responsibility of the data provider and LHDs to notify DSHS when users should no longer have access to the system.

TxS2 programmatic data is protected health information (PHI). All TxS2 data is stored in a secure database and accessed only by authorized users. 

In the event of an alert that results in an investigation and follow-up with potential cases, the users in the appropriate jurisdiction can work with the data provider(s) to re-identify patients during the investigation. 

The patient’s chief complaints are grouped into broad syndrome categories. The analysis software is customizable regarding syndromes and ad hoc queries. The system uses a set of 13 syndromes, which are the typical sets used in other states. These syndromes include botulism-like, exposure, fever, gastrointestinal illness, hemorrhagic illness, influenza-like illness, injury, neurological, rash, reportable diseases/records of interest, respiratory, shock/coma, and other. 

ESSENCE hosts emergency room, Poison Control registry, Death Record, Air, and Weather Event observation data. Poison Control data are provided by the Poison Control Registry. Death Record Data are provided from the Texas Center for Vital Statistics. Air Quality Observation data are provided by AirNow, and Weather Event observation data are provided by the National Weather Service.

Historic data from data providers are incorporated into the statewide syndromic surveillance system, as available, to help establish the baseline. The system generates alerts based on deviations from the baseline. Users can see the expected number of cases for a particular syndrome versus the observed number of cases on a given day, as well as the geographic distribution of those cases. These alerts can be further analyzed for any of the following - to determine if there is a potential outbreak; to identify any rapid or unusual increase in a syndrome; to identify rare conditions of interest.

More information about using the system as well as a protocol for responding to alerts can be found on User Trainings page, as well as on the Use Cases and Success Stories page. While it is the responsibility of the local jurisdiction (Local Health Department (LHD) or Public Health Region (PHR) acting as the LHD) to determine the appropriate response to an alert in their jurisdiction, this guide provides general tips for analyzing syndromic surveillance data. 

DSHS developed a user’s guide to help users access and navigate the system’s main features through the ESSENCE platform. There is also a guidance for monitoring data and responding to alerts. While it is the responsibility of the local jurisdiction (Local Health Department (LHD) or Public Health Region acting as the LHD) to determine the appropriate response to an alert in their jurisdiction, this guide provides some general tips for analyzing syndromic surveillance data. Both of these documents, as well as online training resources for both syndromic surveillance and ESSENCE, can be found under User Trainings.

In addition, DSHS works with partners to provide training. If you are interested in receiving or providing training, please email syndromic.surveillance@dshs.texas.gov or additionally inquire about our Syndromic Surveillance in Texas User Forum. 

Data providers can use the system for:

• Integration into existing emergency room tracking or infection control procedures
• Forewarning about health trends affecting neighboring regions
• Analysis of data
• Collaboration with public health entities while protecting hospital/patient confidentiality
• Population health monitoring of catchment area
• Tracking post-surgical infections
• Participation in the Promoting Interoperability Program 

Public health officials can use the system for:

• Querying data for symptoms or syndromes of concern
• Providing situational awareness, especially with rapidly spreading gastrointestinal or respiratory illness
• Mapping clusters
• Detecting early events 
• Identifying outbreak cases
• Assessing the impact of natural/man-made disaster or severe weather 
• Identifying exposure contacts 
• Investigating exposure sources 
• Tracking healthcare-acquired infections
• Monitoring national disease trends

Providers participating in either the Medicaid Electronic Health Record (EHR) incentive program or MIPS can utilize their participation in syndromic surveillance to meet certain federal requirements. MIPS is part of the Quality Payment Program (QPP) under The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  

Eligible Professionals in urgent care centers or free-standing emergency centers can register their intent to submit data to the TxS2 program. Information on registering an intent to submit data can be found in the Data Provider and TxS2 User Registration and Onboarding procedure or contact the TxS2 program directly at syndromic.surveillance@dshs.texas.gov for more information. 

Requests for Promoting Interoperability public health reporting documentation for syndromic surveillance should be sent to syndromic.surveillance@dshs.texas.gov. The facility’s name and attestation period should be included in the request.