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 Diseases Surveillance 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.
a. 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).
b. A slow data provisioning process exists, starting from Message Mapping Guide
(MMG) development to CDC program data access.
2. Original Messaging Strategy (See Figure 1)
a. 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.
b. Uses Generic MMG v1 only for NNDs which do not have a disease-specific MMG
being planned, in development, or published.
c. Transitions jurisdictions to HL7 v2.5 as disease-specific guides are implemented.
3. Revised Messaging Strategy (see Figure 1 and Table 1)
a. 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.
b. Benefits
i. Simplifies data flow
ii. Improves data quality
iii. Establishes a foundation for future disease-specific MMGs
4. Shared Governance for NNDs
a. 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
5. Priorities for Disease-specific MMGs
a. 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.
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i. 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.
6. Technical Assistance and Processes to Support the Transition to NEDSS
a. Submit requests for technical assistance via email to PHINTECH@cdc.gov 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.
b. For a description of the CDC Teams and services that support the transition to
NEDSS, see the “CDC Teams” listing on page 6.
c. Publication of the MMGs and the HL7 v2.5 implementation checklist: see
http://www.cdc.gov/phin/2011/resources2011/mmghomepagecasenotification.ht
ml
d. Training to use the NEDSS Messaging Subscription Services which includes
Rhapsody and the Message Subscription Service (MSS): email Arun Srinivasan
at fos2@cdc.gov for information about training
e. Regularly scheduled technical support calls:
i. Bimonthly calls to support the implementation of HL7 NND case
notifications: to join the call, email Michelle Mayes at MMayes@cdc.gov
ii. NBS User 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 fos2@cdc.gov or Doug Hamaker at
Doug.Hamaker@dshs.state.tx.us.
iii. Monthly NEDSS MSS User Group (NMUG) calls: to join the call, email
Arun Srinivasan at fos2@cdc.gov.
f. Case notification documents on the PHIN web site at http://www.cdc.gov/phin/
(left-click “Resources” and then “Guides”).
NND Data Provisioning Strategy for CDC Programs
1. Original Strategy
a. 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
b. Provide spin-off SAS file (including data from the 3 data feeds) from legacy (NETSS)
processing methods
2. New Strategy
a. Provide access to core and NETSS extended disease data for programs
b. Add-on additional disease-specific data as MMGs are developed and implemented
c. Incorporate information about processing data so programs can recreate any data set
published in the MMWR annual summary
d. Work with infectious disease Programs to roll-out data access across OID
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3. Immediately Notifiable NND Alerting Strategy
a. 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.
b. 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.
c. The Generic MMG v2 includes 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
Original Approach
New
Approach
Strategy
Tiers of Data
Simultaneous Development
Generic MMG version 1 –
core variables only
No NETSS disease-specific data included in
Excluded conditions with
Generic MMG version 1
disease-specific MMGs
(planned, in development,
or published)
Published disease-specific MMGs for varicella & TB
Includes generic content in addition to disease-specific variables
PHASE I – Foundation
PHASE II - Supplement
Generic MMG version 2
Additional diseasespecific MMGs
Core variables
NETSS diseaseInformation content
specific data
post-NETSS extended
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Table 1. NNDs to Use with the Generic Case Notification MMG version 2*
Generic Case Notifications with
Core Data Only
Anaplasmosis
Plague
Anthrax
Poliomyelitis, paralytic
Babesiosis
Poliovirus infection,
Botulism
nonparalytic
Brucellosis
Psittacosis
Cholera
Q fever
Coccidioidomycosis
Rabies, animal
Cryptosporidiosis
Rabies, human
Cyclosporiasis
Salmonellosis
Diphtheria
SARS
Ehrlichiosis
Shigellosis
E. coli (EHEC, STEC)
Smallpox
Giardiasis
Spotted fever rickettsiosis
Hansen disease
Streptococcal Toxic Shock
(Leprosy)
Syndrome
Streptococcus pneumoniae
Hantavirus pulmonary
syndrome
invasive disease
Hemolytic uremic
Toxic shock syndrome
syndrome, post(staphylococcal)
diarrheal
Trichinellosis
Legionellosis
Tularemia
Leptospirosis
Typhoid fever
Malaria
VISA/VRSA
Novel influenza A virus Vibriosis
infections, initial
Viral hemorrhagic fever
detections
Generic Case Notifications with
Disease-Specific Data
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
(http://www.cdc.gov/phin/2011/resources2011/mmghomepagecasenotification.html).
Table 2. NNDs that Do Not Use the Generic MMG version 2.
NNDs which have Published MMGs
Arboviral diseases
Tuberculosis
Varicella
NNDs using an Alternative Case Notification
Mechanism
STDs
Influenza-associated pediatric mortality
HIV
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Figure 2. New Data Provisioning Strategy for CDC Programs
PHASE I – Foundation: Core/NETSS Extended to All
CORE
NETSS
Extended
Lyme SME
NNDSS Data
Warehouse
CORE
Babesiosis SME
CORE
NETSS
Extended
Pertussis SME
PHASE II – Supplement: Additional Disease-Specific Guides
Begin work to bring in additional data after completion of Phase I
CORE
NETSS
Disease
Extended specific
Lyme SME
NNDSS Data
Warehouse
CORE
Disease
specific
Babesiosis SME
CORE
NETSS
Disease
Extended specific
Pertussis SME
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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 MMGs is 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.
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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 CDCdefined 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
(http://www.cdc.gov/phin/library/2011/resources/guides/PHIN%20NotificationMessageSpecificationPr
ofile%20v2%200.pdf )
2. Which MMGs are published and where can I download them?
The published MMGs can be downloaded at: http://www.cdc.gov/phin/resources/guides.html
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 OID Surveillance 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
(www.phconnect.org) 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:
http://www.cdc.gov/phin/resources/guides.html
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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
PHIN MS – PHIN Messaging Service
PHSPO – Public Health Surveillance Program Office (CDC)
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