Hospital Alerting for Syndromic Surveillance: COVID-19/SAR-CoV-2 - Minnesota Dept. of Health

Hospital Alerting for Syndromic Surveillance: COVID-19/SAR-CoV-2

MDH has the authority to conduct this surveillance under Minnesota Statutes, section 144.05, subdivision 1.

UPDATED & ADDED 2/2021

  • Drug overdose
    • T36-T50
    • F11 (added 2/2)

UPDATED & ADDED 1/2021
New ICD-10-CM code for COVID-19, effective January 1, 2021 (PDF)

  • Encounter for screening for COVID-19 - Z11.52
  • Personal history of COVID-19 - Z86-16

UPDATED 1/2021

  • Influenza Like Illness - J09-J11
  • Pneumonia - J12-J18
  • Specific pneumonia - J12, J16-J18
  • COVID (virus identified) - U07.1
  • COVID (virus not identified) - U07.2
  • Coronavirus - B34.2, B97.21, B97.29
  • COVID exposure - Z03.818, Z20.828, Z20.822 - New ICD-10-CM code for COVID-19, effective January 1, 2021 (PDF)
  • Cough - R05
  • SOB – R06.00, R06.01, R06.02, R06.03, R06.09
  • Fever - R50.9, R50, R50.8, R50.81
  • Sore throat - J02.9
  • Muscle ache - M79.1
  • Headache - R51
  • Diarrhea - R19.7
  • Loss of smell & taste - R43.0, R43.1, R43.2, R43.8, R43.9
  • Fatigue/malaise - R53.81, R53.82, R53.83

UPDATED & ADDED 12/2020

UPDATED 11/2020

  • Influenza Like Illness - J09-J11
  • Pneumonia - J12-J18
  • Specific pneumonia - J12, J16-J18
  • COVID (virus identified) - U07.1
  • COVID - B97.29 and (J12.89 or J20.8 or J40 or J22 or J80)
  • COVID (virus not identified) - U07.2
  • Coronavirus - B34.2, B97.21, B97.29 (moved from above)
  • COVID exposure - Z03.818, Z20.828
  • Cough - R05
  • SOB – R06.00, R06.01, R06.02, R06.03, R06.09
  • Fever - R50.9, R50, R50.8, R50.81
  • Sore throat - J02.9
  • Muscle ache - M79.1
  • Headache - R51
  • Diarrhea - R19.7
  • Loss of smell & taste - R43.0, R43.1, R43.2, R43.8, R43.9
  • Fatigue/malaise - R53.81, R53.82, R53.83

REMOVED 11/2020

  • Phlebitis and thrombophlebitis – I80
  • Venous Thromboembolism – I82
  • Pulmonary embolism – I26
  • Stroke – I63-I66, G45.9
  • Arterial thromboembolism – I74
  • Kawasaki's - M30
  • Toxic shock syndrome - A48.3

UPDATED 5/21/2020

  • Phlebitis and thrombophlebitis – I80
  • Venous Thromboembolism – I82
  • Pulmonary embolism – I26
  • Stroke – I63-I66, G45.9
  • Arterial thromboembolism – I74
  • Kawasaki's - M30
  • Toxic shock syndrome - A48.3

UPDATED 4/9/2020

  • Influenza Like Illness - J09-J11
  • Pneumonia - J12-J18
    • Specific pneumonia - J12, J16-J18
  • COVID (virus identified) - U07.1
  • COVID - B97.29 and (J12.89 or J20.8 or J40 or J22 or J80)
  • COVID (virus not identified) - U07.2
  • Coronavirus - B34.2, B97.21
  • COVID exposure - Z03.818, Z20.828
  • Cough - R05
  • SOB – R06.00, R06.01, R06.02, R06.03, R06.09
  • Fever - R50.9, R50, R50.8, R50.81
  • Sore throat - J02.9
  • Muscle ache - M79.1
  • Headache - R51
  • Diarrhea - R19.7
  • Loss of smell & taste - R43.0, R43.1, R43.2, R43.8, R43.9
  • Fatigue/malaise - R53.81, R53.82, R53.83

Frequently Asked Questions about Hospital Alerting for Syndromic Surveillance

Updated 5/4/20

These frequently asked questions are in response to the above notification letter. MDH reserves the right to update answers to questions as additional information is made available and understood.

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Updated 5/4/20

As part of Minnesota's overall surveillance efforts, MDH urgently needs data that tells us more about who is seeking care in a hospital setting for symptoms that may be related to COVID-19. This syndromic surveillance effort requires MDH to be able to compute "ratios" of the volume of inpatient and emergency department patients presenting with COVID or COVID-like symptoms as a function of total daily emergency department and hospital patient volume. This will enable monitoring of hot-spots as social distancing policies are adjusted and assist in the state's response effort.

MDH is utilizing an existing service to support this activity. Prior to the COVID-19 pandemic, beginning a few years ago, the Department of Human Services (DHS) funded the Encounter Alert Service (EAS) infrastructure to support statewide care coordination. MDH has been working with DHS to leverage this existing EAS infrastructure to fulfill the syndromic surveillance use case since more than half of the hospital capacity in MN (as measured by licensed beds) already participates in EAS. Therefore, MDH has asked that all MN hospitals participate in the EAS, by sending ADT data to EAS for all patients. Then, EAS can filter the ADT stream for COVID and COVID-like diagnoses, and send MDH ADT messages data that does not include names, addresses, or date of birth. EAS is also providing MDH information about the total number of visits in order to compute the "ratios" described above.

Situational Awareness results from the process of active information gathering to assess health threats, as well as health system and human services resources, health-related response assets, and other information that could impact the public's health to inform decision making, resource allocation, and other actions.

Syndromic Surveillance is public health surveillance that emphasizes the use of near real-time pre-diagnostic data and statistical tools to detect and characterize unusual activity for further public health investigation. Syndromic surveillance systems may be utilized for outbreak-specific situational awareness to further characterize an outbreak beyond initial detection and notification processes, to monitor the spread of an outbreak, and/or to monitor the effectiveness of outbreak response and intervention strategies. These data help public health officials detect, monitor, and respond quickly to local public health threats and events of public health importance.

This data is currently being used by MDH to identify trends in COVID-19-related symptoms and chief complaints through emergency department and inpatient hospital visits (through admission, discharge, and transfer data).

As the COVID-19 pandemic progresses, it is possible that MDH will update its inclusion criteria for syndromic surveillance. At this time, the current syndromic surveillance inclusion criteria include:

  • Influenza Like Illness
  • Pneumonia
  • COVID (includes COVID, virus identified, virus not identified)
  • Coronavirus
  • COVID exposure
  • Cough
  • SOB
  • Fever
  • Sore throat
  • Muscle ache
  • Headache
  • Diarrhea
  • Loss of smell and taste
  • Fatigue/malaise

These criteria may be updated as more information is learned about COVID-19.

At this time, MDH is focusing on Minnesota-based hospitals only. A future phase could include hospitals in other states or other settings, but our priority now is to connect Minnesota hospitals.

Updated 5/4/20

MDH will use the following data elements in the ADT messages:

  • Presented symptoms, diagnosis, sending facility, patient age, gender, race, ethnicity, city, zip code, county, event and admit date and time, and possibly census tract.
  • Patient name, address and birth dates will not be included in the data submitted to MDH.
  • Reports will be aggregated to a level where patient identity will be protected.
  • Reports will be aggregated to a level where individual facility names will be protected.

Audacious Inquiry will receive the admit diagnosis and update the ADT if that diagnosis changes.

That information is related to mandated case reporting and case follow-up for those patients; this information would not be part of the ADT feed – the information is different and for two different purposes.

MDH will be working with the Minnesota Hospital Association to understand the number of requests and to look for ways to align and streamline those requests when possible.

Updated 5/4/20

Audacious Inquiry will do the filtering on all ADTs. It's important for MDH to get the denominator, so Audacious Inquiry needs the entire feed. Audacious Inquiry will delete the others but keep the denominator for reporting data to MDH to ensure that MDH is able to have information on the rate of COVID-like illness among those going to the hospital.

Updated 5/4/20

Audacious Inquiry and Koble-MN will do the filtering for several reasons:

  • It is important to have the denominator for surveillance purposes.
  • Having the source sites do the filtering will also create additional custom work for Audacious Inquiry and Koble-MN.
  • While COVID-19 is the current focus for this surveillance effort, public health has many ongoing and rapidly changing surveillance needs.
  • Both Audacious Inquiry EAS and Koble-MN also support other HIE use cases and initiatives for which a basic, unfiltered ADT feed is essential (for example, the CMS e-Notification Condition of Participation or DHS's alerts for IHP beneficiaries to improve care coordination).

Covered entities are not required to make a minimum necessary determination for public health disclosures that are required by other law. See 45 CFR 164.512 (b)(1)(i). More information about disclosures for public health activities can be found at HHS: Disclosures of Public Health Activities.

Submissions begin as soon as possible and will likely continue for the next year for this first phase. Any future phases will be determined at a later date.

MDH recognizes the unique burden on hospitals on this time. While it is the goal of MDH to get to 100% adoption to support our syndromic surveillance efforts, we understand that implementation will take some time. We are hopeful that all hospitals can make this a priority as soon as practical, and we hope to build on existing connectivity in the next month.

No. This is generally a concern with exchanging from Provider-to-Payor, but not Provider-to-Provider or Provider-to-Public Health.

For example, regional and area reporting for a given region or city would be useful for planning across systems for surge in COVID patients. We may just need separate operational planning tool for us to coordinate tracking and surge across systems in given areas but could benefit from this data feeding back to an operational model for that planning.

MDH is also working on developing data systems for health care capacity. MDH will look at what can be done to support those efforts as well as determining what syndromic data can be provided back at the community level.

Hospitals will continue to report lab results for public health as they have been. Syndromic surveillance is a separate tool for a separate purpose.

Non-COVID data would be purged a couple of days after the initial message to ensure the most up to date information is used for analysis.

This syndromic surveillance activity is a separate use case from event alerting services. However, sharing the hospital and emergency room ADTs will set up an organization to add the event alerting service for care coordination use case at a near future date. Recent federal regulations will require all hospitals to begin sending event notifications (ADTs) within the next year for care coordination purposes. This public health opportunity will help your organization also meet that federal requirement.

Because this work is specific to COVID-19, MDH will make this a top priority to get executed as quickly as possible. We are working to get new grants executed in two weeks or less time. Moving the grant agreement quickly is dependent on hospital staff availability for review of the grant agreement and the signature process.

No, this will not replace those mandated reporting for suspect and confirmed COVID-19 cases.

MDH is still working on the analysis plan for the data; however, facility or patient identities will not be disclosed.

The data being collected for this syndromic surveillance activity will include inpatient and emergency department ADT information. The other settings are also useful information, but at this time, MDH is prioritizing the hospital ADT data.

Hospitals should reach out to Audacious Inquiry or Koble-MN to either 1) update their current participation agreement to include all ADTs for this syndromic surveillance use case, or 2) start a participation agreement and establish a plan to get connected to either Health Information Exchange Service Provider. As stated in the letter, grant funds are available for organizations wanting funding to make this connection. After the participation agreement is signed and the interface is put in place, hospitals will work with their vendor to confirm data quality and to align as needed to COVID-required coding inclusion criteria.

Updated 5/4/20

At this time, MDH is focusing only on COVID-19 syndromic surveillance. It may be possible to use this approach in the future for other related activities, but that will require additional planning after MDH's COVID-19 response has slowed down. The COVID-19 information collected for this syndromic surveillance activity will not be used for any other syndromic surveillance. The reason for expanding to other diagnoses would be to streamline data collection for data that MDH is already collecting for other emerging public health threats and would be used to help minimize the burden of reporting by hospitals.

Added 5/4/20

Hospitals do not need to obtain patient consent to share this information with the Minnesota Department of Health because HIPAA allows for personal health information (PHI) to be shared for public health purposes and the Minnesota Health Records Act allows exceptions for consent when there is specific authorization in law.

Specifically, 45 CFR § 164.512 (b)(1)(i) allows hospitals to use or disclosed PHI for public health activities and purposes to a public health authority that is authorized by law to collect or receive such information for the purpose of preventing or controlling disease. HIPAA doesn't apply to us getting it. Minn. Stat. 144.293, subd. 2 (Minnesota's Health Records Act) also allows the release of patient records if there is a specific "authorization" in law, and 144.05 and 45 CFR 164.512(b)(1)(i) provide that authorization.

Updated Tuesday, 23-Feb-2021 08:19:26 CST