Texas Syndromic Surveillance (TxS2) is the statewide syndromic surveillance system hosted by the Texas Department of State Health Services (DSHS) for use by Local Health Departments (LHDs), DSHS Public Health Regions (PHRs, see map of DSHS PHRs at
http://www.dshs.texas.gov/regions/state.shtm
), DSHS central office, and data providers (hospitals, free standing emergency centers, and urgent care centers, for example) for enhanced surveillance of emerging public health conditions or threats. Syndromic surveillance utilizes trend analysis to establish a baseline and then
uses algorithms to compare the current data to that baseline and issue alerts when aberrations are detected. DSHS has authority to operate TxS2 under Chapter 81 of the Texas Health and Safety Code.
Submitting Data to TxS2
Syndromic Surveillance
History of Syndromic Surveillance in Texas
Goals and Objectives
TxS2 Configuration and Connection
Status and Timeline
Training
Use Cases and Success Stories
Policies and Procedures
Promoting Interoperability
National Syndromic Surveillance Program
Partners
Outreach Material
Submitting Data to TxS2
Hospitals with emergency departments, free standing emergency rooms, and urgent care clinics, as well as medical professionals who work in those facilities are eligible to submit data to TxS2.
To submit data to TxS2, an organization needs to register intent, sign an MOU, test their data stream between their EHR and the TxS2 system, and follow the quality and frequency guidelines once testing is complete and they are moved into production. For a complete explanation of
the onboarding process, please see the
Data Provider and TxS2 User Registration and Onboarding Procedure.
If you are interested in submitting data or learning more, please email
Syndromic.Surveillance@dshs.texas.gov.
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Syndromic Surveillance
The purpose of syndromic surveillance is to protect the health of the community through public health interventions based on enhanced surveillance of emerging public health conditions and consolidation of health-related data statewide. Syndromic surveillance allows
for early detection of abnormal disease patterns that could result in high morbidity and mortality. The basic functions of syndromic surveillance include early event detection, situational awareness, and retrospective analysis.
The basic steps of how syndromic surveillance works are as follows:
- A patient goes to an emergency department.
- The patient’s information is captured in the facility’s electronic health record (EHR).
- Selected elements of the EHR are sent to the syndromic surveillance system.
- The information is analyzed by the system for trends and abnormalities and the system creates alerts for aberrations in the data.
- The information is available for public health authorities to conduct additional analysis.
To learn more about syndromic surveillance and its uses see:
MMWR:
Overview of Syndromic Surveillance: What is Syndromic Surveillance?
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History of Syndromic Surveillance in
Texas
In April 2011, DSHS conducted a survey of existing
syndromic surveillance systems in Texas. At that time, there were at least six
different analysis systems being used in various parts of the state with no
data sharing between them. As of October 2019, there are three syndromic
surveillance systems in Texas: the North Texas Syndromic
Surveillance System (NTXSS) hosted by Tarrant County Public Health
covering PHR 2/3, a system hosted by Houston Health
Department covering PHR 6/5S, and the TxS2 system. NTXSS is
fully incorporated into TxS2, and the Houston Health Department system is
currently working with TxS2 to become fully integrated. The former TALHO system
was fully incorporated into TxS2 and no longer exists. TxS2 is working to
connect other data providers statewide to integrate syndromic data from across
the state into one system.
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Goals and Objectives
- Implement, configure, and test the information technology (IT) infrastructure for TxS2.
- Develop and execute Memorandums of Understanding (MOUs) for data providers to submit data into TxS2 and for LHDs and data providers to access the data in TxS2.
- Conduct user training on TxS2 for data providers, LHDs, DSHS PHRs, and DSHS central office.
- Onboard data providers that have emergency departments and EHRs and achieve ongoing data submission into TxS2.
- Monitor data submission into TxS2 by data providers to ensure stable connectivity and receipt of the TxS2 data set.
- Monitor usage of TxS2 by data providers, LHDs, DSHS PHRs, and DSHS central office to determine if additional training and data feeds are necessary.
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TxS2 Configuration and Connection
The TxS2
configuration consists of data providers using secure protocols to submit
individual level data to DSHS through the Health Services Gateway. Data is also
received from the DSHS EMS and Poison Control registries. Data are stored in a secure database and
accessed by users (LHDs, DSHS PHRs, DSHS central office, and data providers)
through the analysis software known as ESSENCE (Electronic Surveillance System
for the Early Notification of Community-based Epidemics), developed by the
Johns Hopkins University Applied Physics Laboratory.
Data providers located in PHR 2/3 that are
connected to NTXSS
continue to submit data to this system and the data is sent to TxS2. If your
facility is located within PHR 2/3 and you would like to connect to this
system, please contact phinformatics@tarrantcounty.com In addition, if your facility would like
access to view aggregate statewide syndromic surveillance data, please contact
TxS2 at syndromic.surveillance@dshs.texas.gov.
Similarly, data providers located in PHR 6/5S
that are connected to the Houston Health Department system submit data to this system and the
data is sent to TxS2. If your facility is located within PHR 6/5S and you would
like to connect to this system, please contact Biru Yang at biru.yang@houstontx.gov or (832) 393-4541. In addition, if your
facility would like access to view aggregate statewide syndromic surveillance
data, please contact TxS2 at syndromic.surveillance@dshs.texas.gov.
Data providers outside PHR 2/3 and PHR 6/5S are connected directly to the TxS2
system. Please contact DSHS at syndromic.surveillance@dshs.texas.gov to obtain more information about
registering an intent to submit syndromic surveillance data. Information about obtaining access to view aggregate statewide
data is included in the registration information.
Data providers that submitted data to the former TALHO
system should contact Syndromic.Surveillance@dshs.texas
to set up a connection to the new system. Please note – those connections were
not automatically transferred off the former TALHO system. Facilities in PHR
2/3 should work with Tarrant County Public Health to connect to NTXSS.
Facilities in PHR 6/5S should work with Houston Health Department to connect to
the Houston Health Department system. Facilities located throughout the rest of
Texas will need to work with DSHS to establish new connections to TxS2.
ESSENCE users have access to the data and the ability to
view alerts and run data queries. Hospitals and hospital systems can view data
within the hospital/hospital system and aggregate PHR and statewide data. LHDs
can view data within the PHR and aggregate PHR and statewide data. DSHS
(central office and PHR offices) can view data throughout the state and
aggregate PHR and statewide data.
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Status and Timeline
The Syndromic Surveillance Governance Council (SSGC) was established and met quarterly from October 2014 until April 2020 when it was disbanded.
On May 5, 2016, registration opened for hospitals with
emergency departments, free-standing emergency centers, and urgent care centers
to register their intent to submit data to TxS2. DSHS is currently only
accepting registrations from these Data Providers and will not be connecting
other Data Providers to TxS2 in 2020.
On May 15, 2017, the TxS2 system became operational and
DSHS is onboarding data providers statewide to submit production data into the
TxS2 system. In July 2018, Tarrant County completed onboarding with DSHS. TxS2
now includes data from hospitals that are submitting directly to DSHS and to
Tarrant County. As of May 2019, DSHS is working with the Houston Health
Department to integrate their data feed into TxS2. By Summer 2019, all data
providers with the former TALHO system that contacted DSHS were integrated into
the TxS2 system to complete the statewide view.
In August 2019, data from the DSHS EMS Registry and
Poison
Control registry were added to TxS2 and are available for LHDs and DSHS
staff to review. Data providers may view statewide aggregate data from these
sources.
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Training
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 protocol for monitoring data and responding
to alerts. While it is the responsibility of the local jurisdiction (LHD or PHR
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.
In addition, below are some online training resources for both syndromic surveillance and ESSENCE.
Syndromic Surveillance 101 (4 modules)
ESSENCE Training (3 parts)
Additional Resources
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Use Cases and Success Stories
DSHS is reviewing syndromic surveillance use cases for both day-to-day,
routine surveillance and for unexpected events such as hurricanes or
transmission of Zika virus to provide standard and suggested data queries.
Additional information is posted here when it is available.
If you have questions or recommendations regarding use cases, please contact
DSHS at syndromic.surveillance@dshs.texas.gov.
For the system to be valuable, the data within the system must be viewed and analyzed by experienced public health officials throughout the state. As such, DSHS employees, LHD officials, and hospital infection preventionists have been given access to the system. It is important to share the accomplishments of partners throughout the state and to demonstrate to stakeholders the benefits and usefulness of syndromic surveillance. Syndromic surveillance activities and success stories from partners across the state are posted here. Please share your syndromic surveillance activities and success stories with DSHS by sending them to
syndromic.surveillance@dshs.texas.gov.
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Policies and Procedures
Data in the TxS2 system are shared, accessed, used, and stored in a secure, confidential manner in compliance with all applicable federal and state laws governing the protection of health-related information. Policies and procedures for accessing and using
TxS2 data are posted here as they are available.
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Promoting Interoperability
TxS2 supports federal programs regarding the Promoting
Interoperability (formerly Meaningful Use) of Certified Electronic Health
Record Technology (CEHRT) to improve patient care including the Medicaid
Electronic Health Record (EHR) Incentive Program and the Merit-based Incentive
Payment System (MIPS).
The objectives of Promoting Interoperability include encouraging health care
providers to improve clinical outcomes and population health, increasing the
transparency and efficiency of patient encounters, and developing more robust
research data on health systems.
Consistent with federal guidelines regarding Stage 3 Promoting
Interoperability, on June 30, 2016, DSHS declared readiness to receive data
meeting the messaging requirements in the PHIN Messaging Guide for
Syndromic Surveillance: Emergency Department, Urgent Care, Inpatient and
Ambulatory Care Settings, Release 2.0 (April 2015) and the Erratum,
available on the PHIN Messaging Guide web page, as
referenced in the 2015 Edition Health IT Certification Criteria, on and after
January 1, 2017.
With respect to federal Promoting Interoperability
programs, DSHS only accepts registrations from hospitals/hospital systems with
emergency departments, and professionals in urgent care centers or
free-standing emergency centers at this time.
For entities/individuals not participating in federal Promoting
Interoperability programs, DSHS accepts registrations from hospitals/hospital
systems with emergency departments, free-standing emergency centers, and urgent
care centers.
DSHS will not be connecting other data providers to TxS2 in 2020. DSHS did not
operate a statewide syndromic surveillance system in 2013, 2014, or 2015.
More information about TxS2 and the Promoting Interoperability Program can be
found at: http://www.dshs.texas.gov/mu/syndromic.aspx.
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National Syndromic Surveillance Program
In November 2017, DSHS completed onboarding with the National Syndromic Surveillance Program (NSSP) to share data collected in the TxS2 system with NSSP. NSSP collaborates with public health agencies and other partners for the timely exchange of syndromic data to improve the nation’s situational awareness and responsiveness to hazardous events and disease outbreaks.
More information on NSSP can be found at:
http://www.cdc.gov/nssp/.
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Partners
TxS2 is a collaborative
effort and we depend on our public health partners for success of the project.
Therefore, we coordinate with LHDs through the DSHS PHRs and coordinate with
data providers through the LHDs and DSHS PHRs.
Tarrant County Public
Health and Houston Health Department - Tarrant County
Public Health and Houston Health Department host regional syndromic
surveillance systems covering PHR 2/3 and PHR 6/5S, respectively, which then
feed into the statewide syndromic surveillance system, TxS2. DSHS staff in both
the regional offices and at headquarters maintain a collaboration with these
partners for syndromic surveillance activities, including collecting and
sharing data and information, to ensure the success of the statewide system as
a whole.
Public Health (includes LHDs, DSHS PHRs, and DSHS central office) – Public health partners participate in the system by reviewing data for enhanced surveillance, possible earlier detection, and situational awareness of emerging public health conditions or threats. TxS2 data could also help public health partners identify a significant event’s effects on the population post-event, such as large wildfires, chemical facility exposure incidents, or climate extremes (extended heat or cold), and assist in conducting epidemiological investigations. Public health partners respond to alerts generated by the system and conduct epidemiological investigations as needed based on their protocols for response. Additional roles for these individual partners are included below
DSHS Central Office – Management of the TxS2 system is housed within the Division for Regional and Local Health Operations (RLHO), in cooperation with Information Technology support programs. The Community Health Improvement Division and the Laboratory and Infectious Disease Services Division may review data, assist with efforts to standardize data queries, provide support for LHDs and PHRs during investigations of outbreaks or potential outbreaks, and assist RLHO with data and trend analysis, including statewide trends.
DSHS Regional Offices – DSHS PHRs assist in executing MOUs between data providers in their jurisdiction and DSHS. Regional Medical Directors chair the SSRAC for their PHR and regional staff may participate in SSRACs. Regional staff may also attend SSGC meetings as non-voting members. Public Health Regions may review data, assist with efforts to standardize data queries, provide support for LHDs during investigations of outbreaks or potential outbreaks, and assist with data and trend analysis, including statewide trends.
Local Health Departments and Health Districts – LHDs assist, as desired, in executing MOUs between data providers in their jurisdiction and DSHS. LHDs also serve on both the SSGC and the SSRAC. LHDs may review data, assist with efforts to standardize data queries, provide support during investigations of outbreaks or potential outbreaks, and assist with data and trend analysis.
Data providers – Data providers participate in the system by submitting admission, discharge, and transfer (ADT) data. Data provider representatives also serve in both the SSGC and SSRACs. Data providers may review data, assist with efforts to standardize data queries, provide support during investigations of outbreaks or potential outbreaks, and assist with data and trend analysis.
Health Associations – RLHO coordinates with health associations [such as Texas Hospital Association (THA) and Texas Organization of Rural and Community Hospitals (TORCH)] to provide education to and obtain feedback from their memberships regarding TxS2, and promote TxS2 use.
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Outreach Material
ESSENCE FAQ (.pptx, 651 kb)
Texas Syndromic Surveillance (TxS2) Trifold (.pdf, 27 mb)