OJPHI: Vol. 5
Journal Information
Journal ID (publisher-id): OJPHI
ISSN: 1947-2579
Publisher: University of Illinois at Chicago Library
Article Information
©2013 the author(s)
open-access: This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes.
Electronic publication date: Day: 4 Month: 4 Year: 2013
collection publication date: Year: 2013
Volume: 5E-location ID: e50
Publisher Id: ojphi-05-50

Evaluation of Emergency Department Data Quality following PHIN Syndromic Surveillance Messaging Guide
Hwa-Gan Chang*1
Charlene Weng1
Charlie DiDonato2
Dave DiCesare1
Jian-Hua Chen1
Debra Blog1
1NYSDOH, Albany, NY, USA;
2NTT Data, Albany, NY, USA
*Hwa-Gan Chang, E-mail: hgc04@health.state.ny.us


To evaluate the readiness and timeliness of ED data submitted by hospitals following PHIN syndromic surveillance messaging guide and to evaluate the availability of minimum data elements. To validate the accuracy and completeness of data from ADT messages compared with data currently reported to the NY syndromic surveillance system.


The final rules released by the Centers for Medicare and Medicaid Services specified the initial criteria for eligible hospitals to qualify for an incentive payment by demonstrating meaningful use of certified Electronic Health Record (EHR) technology. Syndromic surveillance reporting is one of three public health objectives that eligible hospitals can choose for stage 1. The PHIN messaging guide for syndromic surveillance was published for hospitals to construct emergency department data using Admit Discharge Transfer (ADT) messages, with the minimum dataset that is standard among hospitals and public health agencies.

Currently New York hospitals are reporting emergency department (ED) visit data to the NY syndromic surveillance (SS) system. Patient chief complaint data are monitored for trends of illness at the community level in order to detect possible outbreaks and situational awareness.


12 hospitals using three EHR certified vendors pilot tested syndromic surveillance data for MU. Hospitals started to transmit ED data in HL7 v 2.5.1 to the NY pre-certification server beginning October 2011. The month of data from July 2012 was evaluated for availability by data elements listed in the implementation guide. The ADT message types were analyzed and the timeliness of reporting was calculated from visit date to report date of the first message type. The data from the pre-certification server was matched against data from the production SS system by medical record number and visit date to evaluate the data content.


There were 5 hospitals from vendor A, 3 from vendor B and 4 from vendor C participating in the pilot testing; 5854, 9882, and 13316 ED visits were reported from the three vendors respectively for the month of July. The type of first message by vendor is shown in Table 1. The availability of data elements is listed in Table 2. There were 79%, 82%, and 87% ED visit records received within 24 hours for vendor A, B, and C respectively. One hospital from vendor A, 3 hospitals from vendor B and 4 hospitals from vendor C also reported ED data to the production system, and their comparison with pilot testing data is shown in Table 3.


The types of ADT messages first reported varied by vendor and hospital. Not all data elements specified in the implementation guide were available or complete, and varied by vendor. An average 83% of first messages were received within 24 hours and the chief complaint from ADT messages did not match well with the current ED system in production. It is a very time consuming and resource demanding process to move a hospital from successful attestation stage to production and requires public health, EHR vendor, and hospital IT to work together. The learning experience from these three vendors in implementing syndromic surveillance for MU will help public health and EHR vendors to prepare for stage 2.

[TableWrap ID: t1-ojphi-05-50] Table 1: 

Type of First ADT Message by Vendor

ADT Message Vendor A N(%) Vendor B N(%) Vendor C N(%)
A01 2543 (43%) 43 198(2%)
AIM 2757 (47%) 0 12396(93%)
A08 553 (10%) 1635 (17%) 686 (5%)
A03 0 8204 (83%) 8
total 5854 9882 13316

[TableWrap ID: t2-ojphi-05-50] Table 2: 

Data Element Availability by Vendor

MDS data elements availability Vendor A Vendor B Vendor C
Date of birth 100% 100% 100%
Gender 100% 100% 100%
Zipcode 100% 100% 100%
Race 96% 99% 97%
Ethnicity 100% 0% 87%
Symptoms Onset Date 0% 0% 0%
Chief Complaint: text 80% 95% 91%
Admit Reason 72% 58% 91%
Diagnosis Code 0% 4% 14%
Discharge Disposition 50% 95% 90%
Temperature 0% 3% 24%
Pulse Oximetry 0% 0% 24%

[TableWrap ID: t3-ojphi-05-50] Table 3: 

Percent Matched Data Content by Vendor

Data Element Vendor A % Vendor B % Vendor C %
Date of birth 99% 74% 100%
Zipcode 93% 99% 99%
Sex 99% 100% 100%
Discharge disposition 52% 65% 75%
Chief complaint 19% 0% 83%

Article Categories:
  • ISDS 2012 Conference Abstracts

Keywords: Syndromic surveillance, Meaningful Use, PHIN messaging guide.

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org