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Meeting Minutes

Subject: Notes from BioSense Governance GroupDate: April 20, 2017, 12:30 pm – 2:00 pm EasternFacilitator: Stacey Hoferka

Present on Call:Associations:ISDS: David SwensonNACCHO: Bill StephensCSTE: Jim Collins ASTHO: Jaime Howgate

Federal:CDC: Roseanne EnglishCDC: Cassandra DavisCDC: David WalkerCDC: Alan DavisCDC: Aaron Kite-Powell CDC: Max WorlundCDC: Rosanne EnglishCDC: Anthony WilsonCDC: Kim RaymondCDC: Sue SwensenCDC: Umed AjaniCDC: Mitch MorrisCDC: Farah Naz (contractor)DoD: Paul LewisVA: Mike Holodniy

State Public Health:Stacey HoferkaCaleb WiedemanNatasha CloseJeff Lee

Local Public Health:Holly WhittakerJessica White

Non-Public Health:Brian Dixon

GuestsYushiuan ChenDavid Atrubin

Additional Support Personnel:Hither Jembere (ASTHO)Mary Ann Cooney (ASTHO)Tim Carney (ASTHO)Camille Fields (ASTHO)Roland Gamache (ASTHO)Becky Lampkins (CSTE)Amy Ising (ISDS)Emilie Lamb (ISDS)

Non-BGG Public Health:Krystal CollierRosa ErgasOscar Alleyne

MEETING NOTES:

March meeting notes are out for approval

© Association of State and Territorial Health Officials 2013 2231 Crystal Drive, Ste 450, Arlington, VA202-371-9090 www.astho.org

Meeting Minutes

This governance meeting was the last official meeting for Jeff Lee, Stacey Hoferka, Laura McCrary and Caleb Wiedeman and Bill Stephens. Stacey and Tim both gave a word of thanks to the outgoing members.

General CDC Updates

Mike Coletta gave an update on CDC’s current work. Working hard to optimize and improve the performance of the system as we bring in more data

and more sites. There is continued work with Johns Hopkins on near-term, mid-term and long-term things about

the application itself. We continue to push the application past where it's been in the past. Have worked through the process of updating the CC and DD categories, this is a way for us to

take some of the more popular queries and put them into the system so that it runs in the background so that you can get your results a lot quicker. It already exists for two categories that were in the system. One was visits of interest and one was travel. Additionally, it's a bit of a misnomer in the background, the query that runs to build the CC and DD category does not just have to hit chief complaint and diagnosis. So we'll be looking to see if there are other things like triage note or admit reason or other things that we want to include in those definitions, so just be thinking about that broadly and give us your suggestions. When you log in and you go to CC and DD category, you will see a few new categories. Please feel free to work with those and give us your feedback.

o Natasha: I was just wondering does the definitions for those get updated also in the system so we can look and see what terms were included.

o Mike: Yes, it's under "More." If you go under "More," and then the syndrome definition, you go to the CC and DD category.

o Aaron: It does, however, I will say that that table that gets populated is not the best way to describe the definition, unfortunately. I've been in touch and speaking with Johns Hopkins University APL, and we're thinking about other ways of presenting the relationships among terms

o Mike: I'll also mention that, as I said, we've been working really closely with the CDC injury prevention folks, and they've written actually really good documentation about the terms that they use, the ones they exclude, why they use them, why they exclude them, et cetera. That's working its way through CDC clearance, and unfortunately because of the huge scrutiny on this, it has to go all the way up through HHS, so it's going take a minute, but we do plan to post that on the new ISDS forum under that proper place there for the opioid overdose information.

o Jessica: We've been asking about opioid syndromic surveillance for a long time here in Arizona, and I also lead the Region 9 data sharing group. We're working on opioids, as I believe you know. So I'm wondering how the community of practice plays a role in these CC and DD categories since we're also working on it. How do we review? How do we give our input?

o Mike: So there's a call ICS is putting on tomorrow afternoon. Aaron will be on it and the people from CDC interprevention center will be on it and others in the community. I think the goal is to get a lot of it coordinated. Note that the CDC folks are working


Meeting Minutesclosely with their grantees as well, and getting feedback, and figuring the best way to incorporate everybody's feedback which is challenging. We are also planning to get some of this documentation out there, get people engaged in that conversation within the community and within these meetings and within the forum, and somehow harness that power, it’s the first time at this scale that I think we've ever done it as a community. We've certainly done things like this, but I don't know if it's been as intense a scrutiny and as intense of a scale, but others could comment on that. We have some plans. They're not perfect. We're open to suggestion on that.

o Roland: I just want mention too, I think we have a whole discussion point on how we're going communicate back and forth with the community of practice. So this is one of the many items that I think would fit into that part as well.

In terms of legacy, as you know, we have, in many cases back to 2012 era data that needs to be loaded into the system from many of our sites. So we've been working through that. To date, we have three that are completed, two that are in process right now and expect to have completed by June, and then a whole stack that are actually going through the back-and-forth and testing and when I say completed, what I mean is all the way through to ESSENCE. There's a large stack of one, two, three, four, five, six, seven, eight, nine that are moving to the production tables but not yet put into ESSENCE. We'd like to do a total double-check before we put it into ESSENCE because once it gets into ESSENCE, it's a lot harder to delete, so we're doing a lot of testing on those data to make sure we catch any defects and problems. There's 500 million or so records to go through. It's a lot, and it's moving along nicely, and so we'll just keep plugging away on that. we just don't know what it's going to take with the back and forth with the sites, with the processing of all these records, et cetera, et cetera, but our hope is that sometime late in the year we'll be 100 percent complete with all the backload of all the data. There's a lot of nuance on this, and its site-by-site, and a lot of really complicated requirements, some people don't want their data at all, and it's kind of a mixed bag, so just working through it and it's a little hard to convey to you guys. Any questions about legacy?

o Stacey- Did you give us specific time – CNMS, did you give a timeline on where that's at?o Mike: CNMS is – they did some testing once again just to triple-check – so for those that

don't know, so CNMS, so the way things were architected before, depending on how you sent the data depended on where it landed and how it was treated, and that caused a lot of processing issues in general, but the stuff that came through CNMS was all pooled together and is all mixed together in a bowl, so our task is to segregate – first of all extract it from that table, which is a huge table of records and Roseanne can fill in here on the details I mess up, but we'll extract it and then we'll parse it through. It's currently not in the state where it's associated with the site, so we have to go through, extract it and then connect it to the facility table and extract it to its proper site location in the new structure. The code has been done and, the more of the older data we go through, the more we find different defects, so we’re doing triple checks, then they're going to run at full bore and go through all of those records and extract them and then we're going to segregate them into their pools, and the they'll be ready to go through the regular transition process. So there's a large number of records there we can process on the new server, about 25 million records a day, so that's going to take a couple of weeks to go through. And so that process is ongoing. I expect, Stacey, that in the next month or so you'll see significant progress and some tangible evidence that it's


Meeting Minutesall been gone through that process and showing up in your production tables and potentially even starting to load into ESSENCE, but Roseanne or anybody can fill in where I screwed up.

o Roseanne: I think that's pretty accurate. Our first step is, of course, to run the CMNS conversion and establish the new rules applying the foundational requirements, and then we'll start splitting out the data to their appropriate site destination

o David: You mentioned 2012. Is that as far back as it's going with legacy data? o Mike: I think some sites plan to upload more. Right now, we'll be happy to get through

2012 and then kind of entertain those broader loads because people are working overtime right now

New sites- we published an onboarding window schedule to bring on new sites who have not historically brought data to the platform. We have five that will be coming in our window that begins next week. That will be Rhode Island; Santa Cruz, California; South Carolina; Solano, California; and Marian County. Marian has sent data before, but we're going through the process again to get them back up to speed from where they left off from the transition. They, you'll recall backed out and now they're back in. So we’re going through that process with them, get everybody back onboard, and that window will go through the end of July. We are doing some assessing of how much bandwidth it's taking to do these five. People who may not be totally familiar with the platform and how things are working, so we haven't done as much of that. Most everybody went through the transition had a chance to kind of be a part of the conversation all along the way, so that may change our second window a little bit, and stay tuned for that.

On AMS development these may have been mentioned before, but I missed the last call and don't recall, so I wanted to be sure to cover it. We did a follow-up call with a couple of the folks on the phone here and some of our power users on the AMC, the access and management center, which is the tool we use for our site administrators to manage the data they are stewards for, and we – as you know, we were interested in adding in user groups, and there were some question marks about, given the way everything deployed, do user groups still make sense, is there a more efficient way to do it, et cetera. We got some really good feedback, which will make it better but also has created some new requirements. Those have been documented both for user groups and reports. The general user experience feedback on functionality includes things I don't totally understand. Max gave me some notes I don't totally understand. I don't know if he's on the call, but there's a button that was suggested that I'm sorry I didn't get enough intel on. Anyway, suffice it to say we have new requirements, and so that will be folded into the development schedule for AMC. Stacy, anybody from Arizona, and/or Natasha, who are involved in those conversations, if you wat help me fill in the gaps that I’ve missed

o Stacey: I think the button comment was something that Sara was trying to find to make it easier. There's a certain amount of scrolling that you have to do and whatnot, and she was just trying to look for ways to make it easier to look at the different user groups and how you selected different people and things like that. So it's just a feature like that was suggested.

o Mike: we're trying to lessen the click through and scroll, and so those types of comments are super helpful. Anything else about AMC development? Any questions or other updates from people who are more involved in those conversations?


Meeting Minuteso Bill: At one time, there was a way to upload your MFT and it may be there. I may have

just lost track of the function now, but I thought it was through Ad Miner that you could actually upload your MFT, and that doesn't seem to be there anymore.

o Mike: you may recall we're still working on the development and finalizing the requirements for an automated master facility tool. Unfortunately, the bandwidth of our SQL resources has been really tied up in the legacy and optimization stuff and has slowed the development of that stuff. We had, at one point, talked about doing a temporary solution through admin or like you're talking about, but it just didn't come together. So that is definitely on the table. We actually have a presentation, I think, coming up in May similar to what we've done in the past with the community. We worked with ISDS to get on their webinar schedule, and I honestly forgot to put that on my notes what the date is. If folks from ISDS know, they can fill in here, but we'll be talking about the plans for the MFT so people are aware of what that will look like, and we'll do similar process as we did before through the transition where we describe kind of the requirements and how we see them. We'll ask for feedback on the webinar, and then we'll follow up with a small group of people to finalize the requirements and finalize the development. So stay tuned on that, Bill.

NSSP Community of Practice Update (Emilie Lamb)

Emily gave an update on ISDS’ work on the CoP. We are getting a lot of traction with the new groups that have been set up on the

www.healthsurveillance.org web site. So if you haven't set up your membership or you used to have a membership on the old syndromic that worked but you haven't gone in and set up your profile on the new healthsurveillance.org web site, please let myself or one of the other ISDS staff members know. You can contact Mark or you can just fill out the contact us form on the new web site and we can give you your user name and password. If you perhaps misplaced the e-mail or you didn't get it some folks have said the e-mail got caught up in their spam filters but we are getting a lot of good conversation happening among the committees and the workgroups on the new web site. We have forums set up around various topics, so if you have something you'd like to talk with other community members about, please feel free to post something on the forum.

There are regular monthly surveillance COP calls happening next week. That is on Tuesday the 25th at 3:00, and we are going to be having various updates on that call from the different workgroups and committees as well as having some discussion about some of the upcoming summer surveillance concerns, like heat-related illness.

The knowledge repository site is up and we are uploading new content every day. We are looking for volunteers from the community to help us with the upload process. We have about 1,500 resources still left to be uploaded, so if you're interested in helping with that project, we would greatly appreciate it.

The monthly steering committee call next week on Wednesday the 26th

o Caleb: One of the things that did come up on the call is that we had the steering committee nominations. We got those extended out to April 30th. When we had the call last month, we only had one nomination, so we're hoping to get some more with the extra time period going into it. The monthly community of practice call back in March,


http://www.healthsurveillance.org/

Meeting Minutesthere was 68 participants, and that went well, and hopefully – we're hoping to continue that momentum moving forward.

There have been some questions that have come up about the progress on the new version of the PHIN messaging guide. There is a contractor who's been working with ISDS to review the previous versions of the guide, review previous comments that have been submitted, work with CDC and some of the comments that have been received from vendors on the previous versions of the guide, and we're hoping to have a new version of the guide out for the community to submit comments on either by the end of this month if not by the middle of May. We want make sure that the version of the guide that we provide is really user-friendly and easy for the community to submit their comments. We want to make sure that the version of the guide that we provide is user-friendly and easy for the community to submit their comments on. That will start the process of getting a guide ready to go into HL7 balloting, which we would like to start doing in the fall of this year. So keep staying open to that idea, and hopefully we'll be able to send out that announcement very soon.

o Natasha: I had asked whether there was going to be or has been a comparison between 1.1 and 2.0. Did that happen? Is it going to happen? And there's comparison between 1.9 and 2.0, but since 1.9 was never officially adopted, it'd be nice to have a comparison between the two, you know, federally recognized ones

o Emily: I don't know if we're going to have a document that directly compares the two, but in the writing of the new guide, we have looked at all of the previous standards.

o Krystal: Is there still going to be a workgroup formed? And I guess going with Natasha's comment, we're receiving lots of questions from our EHR vendor partners and some of our hospital partners as they prepare for their new certified product and other things that they're doing, and some of those questions are what are the changes and if there's any movement or something like that. There's quite a few people that it would help.

o Roland: so let me understand that. Is that a community of practice issue or a governance board issue?

o Emily: There is going to be a workgroup, so the thought is that we will release this new version of the guide to the community for comment and then there will be a workgroup that reviews those comments and suggestions and comes to a consensus about changes that should be made to the guide based on those comments and suggestions. Krystal, to your point, I would say, you know, as much as your partners want to be involved in the commenting process even before it goes to balloting for a broader community to comment on, I'd say that that feedback would be welcome.

o Krystal: Yeah, I'm just thinking with Courtney being one of the new governance group members, I think it's some good opportunities to bring these different groups together to help on things. At least ask.

o Roland: We had a discussion earlier this week, about a formalized process, on how we’re going to communicate. We have a lot of things going on between the two groups, and we want to make sure that we communicate with everybody involved and the other stakeholders and CDC as well so we know which group is doing which projects and we're not duplicating our joint resources.

o Emily: I think it might be a conversation to have offline between ASTHO and ISDS. Maybe we can bring something back to the governance group for final comment, see if it's that’s in line with how they want us to proceed.


Meeting Minuteso Roland: Maybe we can get a group offline afterwards to figure out what might be a good

method to make sure we communicate among all the groups involved.o

Data Quality Committee (Krystal Collier)

Krysta and David gave an update from the group. There are some workgroups that are underneath the data quality committee that we're actually

very fortunate to have, one of those being the urgent care justification workgroup, and I'm not sure, Dave, do you want to give a quick update on your first meeting?

So we had a meeting a short time ago, and kind of went through what we're planning to do with an abstract, and that'll be hopefully ready for the 2018 ISDS conference. I think we've kind itemized some of the tasks that we'll be looking at. It's thinking it’s a bit more of a literature review, but also kind of an overview of what urgent care is all about, where we are with the definition of urgent care. There's some definitions out there, but they're not all in line, so the idea might be a gap that we could identify and follow up more on.

Other workgroups that are under the data quality committee are also the metadata visualization app, and we also have the syndrome definitions workgroup. We have Rezni Kumar from Maricopa County Department of Public Health, and we also have Zach Stine from Kansas. They're going to be co-chairing that group. They're still new, so those that are interested, please contact them or share with others that would be interested in being a part of this group.

For the metadata visualization app, we are the beginning of May going to meet with the participating jurisdictions and show them how far the app has come, get some feedback on what things look like. I've seen a couple of demos and we are actually fortunate to share some with some folks at NSSP

Our data quality meeting, we talked about some questions that had been up about EPIC and working with them in terms of onboarding, understanding some new changes they have with their new certified product, some issues with certain fields, getting completeness, just understanding what the workflow and whatnot are. One of the action items we took from that call was trying to reach out and connect with an EPIC contact to see if we can build a bridge and find someone we can ask some of these questions and get some feedback, and I can say he's been extremely helpful and shared some things with me that I can pass on to our committee that I'm going to be doing, and I'm still trying to work on a call for that. I think those are probably the major updates that we have

o Question: My question is what is the project for the surveillance definition workgroup?o Krystal: we're just starting out, so we don't have the clear goal yet, but I know it's

something that we're working together to establish right now, right up front to figure out how they can contribute and work both with the BioSense governance group and also work with the steering committee and the community of practice and you all at NSSP.

ASTHO Updates

Governance Group Nominations (Hither Jembere)


Meeting MinutesHither Jembere gave an update on the governance group nominations process. The nominations period is complete and we’ve identified new members.

State Representativeso David Atrubin, ESSENCE-FL Program Manager, Florida Department of Healtho Jill Baber, Epidemiologist, North Dakota Department of Health

Local Representative o Yushiuan Chen, Syndromic Surveillance Epidemiologist, Tri-County Health Department,

COo Holly Whittaker, Epidemiologist, Nevada County Public Health Department (previously

served on the BioSense Governance Group and has been re-elected) Non-PH/Provider Representative

o Courtney Fitzgerald, Manager, Consulting Advancement Team, Cerner Public Health Other updates regarding the nomination process Bill Stephens will be stepping down as a

representative for NACCHOo NACCHO has chosen Biru Yang as his replacement. o Biru is the Informatics Manager at the City of Houston Health Department

The final step is, of course, identifying a new chair as Stacy will be stepping down, so that e-mail to offer nominations will be going out soon. Members can self-nominate

The ASTHO team will also be having a new member webinar to get the new members up to speed on the work for the BGG.

Discussion o Stacy: I wanted to say I know that there are a few people who have indicated to me that

they’re planning to be nominated. So I’m at least confident we’ll have an additional state nominee and one data provider nominee while we don’t even have the minimum for local health department nominees and it would be ideal to not just have the minimum number of slots with the number of candidates to fill. I want to say we’re getting a few more people in by extending the deadline for a week. So if governance group members could likewise seek out some of the individuals you think might be very interested in these roles, please get a little bit more proactive to encourage them or nominate them so that our list will be filled out at least with the number of candidates that we need and then plus a few additional choices. I think we need local health departments to be reached out to and get some nominations in that respect as well. I’ve reached out to Florida, I always reach out to Arizona who’s in part on this call so I would encourage, again, maybe an Arizona representative. Otherwise, I’ll brainstorm some more and see who else I can come up with.

o Jamie: I’ve been giving it a little thought so I think we are due for a call anyway on the ASHTO side. If I can join that discussion let me know.

o Stacy: As of right now the data provider would be someone from Cerner. So that’s a vendor representative and certainly other data providers should be encouraged to be nominated as well.


Meeting Minuteso Jessica: Is it true that locals can only nominate locals and states can only nominate states? Is

that the rule here?o Stacey: I think it’s the rule, but if you’ve got someone who’s in a state that needs to be

nominated you could probably forward them around. I was trying to look for more data providers and I would have just sent my suggestions to another state to nominate them on my behalf. So probably a work around if you want to recommend someone to be nominated by the appropriate level jurisdiction. You can try that. Send it maybe if you have to ask though if you can’t find someone to do the nomination, but technically, yes, that’s the rule, but if you find someone that’s interested just find an appropriate jurisdiction to nominate them

Functional BioSense Requests

Stacey introduced the functional BioSense requests discussion.

I brought this up at last month's meeting where I wanted to try and formalize what our process would be for reviewing feedback and user input, primarily stuff that's going into the JIRA system, I imagine, that what are each individual jurisdictions in need of, how are those requests being filled, or if not filled, how long are they open, how do we prioritize them? Those are some of the challenges I think that we have with so many jurisdictions, all using the system and having different needs. I’ve added a few details of how we go forward, but I reflected back on how we did this two years ago. It was a much bigger scope at the time because we were making a big transition from BioSense 2.0 and the previous developers and what they did to track things, and we have, like, 600 items of things people had always requested and had wanted in a system that were unfulfilled, but the transition to Essence waved off so many of those. But it would be a good process to continue, at least in my opinion, that when I submit tickets to JIRA, that I understand I have to compromise with the needs of other jurisdictions, but it would be nice to see on a regular basis this issue's still open. It's in line with things that other jurisdictions need and/or I can see what other jurisdictions are looking at that I might have had in the back of my mind or didn't realize I might want. I'm proposing that we do something similar to what we did back when, you know, this was called the functional requirements gathering process. I just wanted to sort of append to that process something new going forward with the hope that if we review what open items are, what are the needs of users on a quarterly basis, we would never be looking at 600 items. We might be looking at 30, or I don't really have any visibility into the magnitude of what people need right now. I only know what I need in Illinois, for the most part, so this process would be how we open that up. So what I was suggesting, which is on this slide, and if we could possibly agree to that today, then build that into what used to be our functional requirements gathering process. It would be quarterly, publicly available summaries, and I got the sense people wanted something more specific, I tried to provide a timeline of if quarterly was March 31, June 30, September 30 and December 31. But we could provide one of the following. I frequently thought a JIRA report that stems from the templates of reports we create now but is really focused on whether the user's putting in for, like, future enhancements and/or these kind of open-ended user requests or needs. If that could come out of JIRA and be in our report with enough detail to understand what all the requests are.


Meeting Minutes So I would propose quarterly one of these two items be posted somewhere, probably ideally on

My CISDR's web site, with the idea of accomplishing a few tasks, which would be (1) requesting the user community provide input and review, and that could be similar to what was done before on small workgroups, categorizes them and then puts it out for, like, the users to rank. It doesn't have to be the same, but rather than write a new detailed approach here, I would just say follow the past pattern unless it doesn't work anymore. But then also – well, I added another bullet, but I won't talk about that yet. But then also, you know, in partnership with CDC, if CDC works with ASTHO to develop this list of open issues, they could also maybe help scope feasibility. You know, are there tasks that are the highest priority but take six months of resources versus there's ten tasks on here that maybe nobody needs a whole lot, like a lot of people don't need, but they only take, like, a day's worth of resources. Like, that's going to have to be a back-and-forth. So I'm saying that one of the tasks should be CDC input on the feasibility of the requests on the list, which would then be brought to the governance group for approval.

The one part I added in there is that I know that we'd always talked when we did this requirements gathering process the first time that, hey, now that we're in Essence, there's a whole Essence community that tends to talk about what they need on a regular basis. I have no insight into how that works, but if there are at least jurisdictions that have local Essence who are actually developing some of these features, it would be really good to, when we do this quarterly, maybe pull them, bring them together to discuss, you know, are they investing already in something that would benefit the NSSP and should that be coordinated. So I put that in there as a task to keep on the radar. This is what I propose, and again, I would try to build the tasks out further in line with how we did it the first time. Any questions?

o Mike: I forgot to bring up something that you and I had talked about in the past. One thing that we're interested in doing in conjunction with the DOD is pulling together a representation of the ESSENCE installations, and we were hoping the governance group could kind of help us work through that as well, to get some sort of a subset group that can have input like you're saying into the development of ESSENCE, and then that way as different entities like the DOD or a particular state or locality or the CDC have specific monies, we can kind of strategize about money to cover this function that you're interested in. These people have more money, and we're all interested in this function but they can handle it or whatever. We kind of start to coordinate our development efforts as well. So I just forgot to mention that, but I think it's in line with what you're asking for.

o Natasha: I think this is a great idea because I would love to keep an eye on what people are needing and where we're going, and I think the idea of coordinating with the various stakeholders is a great idea

o Roland: I think what we had talked about with Stacy and Mike, CDC and others was trying to coordinate what this plan would be, so coordinate among all the different partners in this and look at the process for how things are put in place right now. As Stacy mentioned, of prioritizing the process and determining where they fit. My guess is that some of these are going to be policy-related, but other ones might be community of practice-related, so we're going to need to set up some method of going through and figuring out which ones go where, so that's kind of what we're working on right now. Mike, I don't know, you followed up a little bit. I saw some e-mail traffic. Do you have anything else to add to that?


Meeting Minuteso Mike: I would just say a couple things. One is that this would really help us focus as well,

not just these governance group conversations, but just in general. And so it would be super helpful. We're very supportive of anything that can happen between governance group and the rest of the community to kind of organize those things. Additionally, you know, as you know, you guys have access to the – we gave a seat to JIRA to ASTHO so, you know, we didn't want there to be a perception that we somehow only respond to certain things or only show off certain things, so people can dig in and our crew can review what you develop and make sure it's accurate but, you know, you're welcome to go in, organize the material, validate it with our staff to make sure it represents what you thought it did, and then develop this process. I think it would be fantastic.

o Roland: Mike and Stacy, you brought up topics from the past and past discussions you had. Can you both or either one of you talk about what those were to make sure we include those in whatever we're putting together? Especially for the new people coming in next month.

o Mike: Roland, I think that it'd be really important to go back to where we left off. Not to say that you have to go through all 600 items, but Stacy and Marcus and others have done a good job of categorizing those into groupings, and so maybe starting there. As the steering committee has kind of found its feet a little bit, allowing the things that the steering committee is focused on and/or that they see in the community, like the data quality group and those sorts of things, let those be the topics of interest and then for the governance group to put the filter of, like, okay, what does this mean to the system and what it needs to support and how well is it supporting, you know, metadata visualization or these other things and what needs to be developed to make it better and then stick that in as part of the priority. But again, I think you guys are going to have to do a little homework, look back kind of where we left off and then just kick off a process that is sustainable for the community.

o Roland: I didn't understand what you and Stacy meant by conversations in the past. I thought it was something different than just the work that ASTHO had done. I just wanted to make sure that there wasn't something in your conversations in the past that was additional to what we had done previously. You said you had a conversation recently.

o Mike: I was updating Stacy on one of our one-on-one calls about the DOD's interest to get this kind of development ESSENCE installation sub-workgroup or whatever together where we could talk about strategizing who pays for what updates stuff. You didn't miss anything. We just basically exposed it right here in this conversation.

o Stacey: We haven't ever really talked through how the functional requirements work. o Krystal: You had asked me what the syndrome definition role was or how they can

contribute in things like this, and I think this is where I was trying to find out how they could interact with the governance group in some things, if it's prioritizing certain syndromes of interest, this is where you need your help in some things. I think there were some discussions on going through some of the ESSENCE queries and validating them and just some ideas about looking through them to see where they are or if they need help and things like that. So I think these are some of those opportunities where that group can work together with you all.


Meeting Minuteso Mike: One thing I was trying to point out in that question was we've said that the

workgroups kind of have to have a start and an end and a specific project, and I didn't know if theirs had been defined yet cause one of the things that hurt us before was workgroups that never ended and then people getting burned out, and I was just curious what they were going to be taking on, but it sounds like you haven't decided yet.

o Krystal: No, so I know there was some of that burden. There was also some of those where some of us lost out because things went away, but I'll take that back and see if I can get some updates and see if there's ways that maybe the new co-chairs can help work and participate in what happens with these functional requirements conversations in the future.

o Roland: Any other questions for this part of the discussion?o Stacey: Can we try to formalize it I don't think it's a policy issue, so it doesn't require a

couple weeks and it doesn't even probably require a roll call vote, but can I put out there, like, a vote for the governance group to sort of approve this? Because I tried to make it, an official timeline we stick to. If at all possible, can I put out language and see if we can get, like, a yes or nay vote verbally. I was just jotting down some language, so I'll see if people are comfortable with this. Again, it would be that the BioSense governance group approves the modifications to the functional requirements gathering process to be completed on a quarterly basis by the timeline and tasks proposed in the slide that you see here. Is there anyone uncomfortable with a yea, nay vote on this or the language? I was just jotting down some language, so I'll see if people are comfortable with this. Again, it would be that the BioSense governance group approves the modifications to the functional requirements gathering process to be completed on a quarterly basis by the timeline and tasks proposed in the slide that you see here. Is there anyone uncomfortable with a yea, nay vote on this or the language?

o Roland: And we're still working on the date, correct? You haven't put in the date yet?o Stacey: The first one would be June 30o Bill: are you asking for a second? o Stacey: I would rather make sure there's no one opposed to holding a vote, and then I'll

give it a couple seconds. Anyone opposed? Then, yes, I'd be looking for a second.o Bill: I second o Stacey: All in favor? o All: Ayeo Roland: I think we're ready to move forward to the next part of gathering information to

see what we can do, but I don't know if we can really commit because we have partners outside. I mean, outside of just ASTHO involved in this to make sure we get this to function properly in the timeframe, but I just wanted to say I think we're okay with what you proposed so far, but there may be a caveat where we might need to adjust that based on what we gather in the next month.

o Tim: I think what Roland articulated very well there is that when you're hypothesizing a potential date that we could start the first report, I think going back to Mike's point about reviewing what has been in the past has to happen first, and we have to review the best practices of the past, identify the elements that should go in this report and then generate the methodology to get this report published, whether it be on, as you mentioned, ISDS's web site or ASTHO's web site or wherever. So those things need to be


Meeting Minutesironed out before we can come to a firm date as to when the first report would be generated.

o Stacey: At the very least, you can extract something out of JIRA within the next two months and post it that might be a good starting point.

o Tim: I took all the notes of what Mike wanted in that report, and it sounded like a little bit more than just a simple abstraction, but yes. We can put something up very soon, but getting to that polished version of what you guys might envision might take some time.

Stakeholder Engagement

Roland Gamache and Stacey Hoferka provided an update on the stakeholder engagement workgroup

We've had two meetings, about a month apart. So our second meeting was two days ago. Right now it's been a brainstorming session. From our second meeting, we've come out with very specifically let's just start with hospitals or data or healthcare providers. And the workgroup as it currently stands is to outline objectives and tasks to then open it to the community of practice for further input.

We talked about maybe trying to elicit from those who've been doing syndromic surveillance for a long time and what are their best practices, Like, what do they currently give to providers that the providers seem to find valuable? Are they specific use cases that the providers really want information on? Are there dashboards that they've developed in Essence that their providers really like? So we don't have to reinvent the wheel if we could just collect a little bit more knowledge of best practices in this area and then maybe taking that into some sort of a focused group of providers

Something surprising from the last call is when we started mentioning hospitals, people brought up multiple ties that really it's the local health department engaging the hospitals. So we kind of have a dual win here of gauging the stakeholder at the local health department and the hospital potentially at the same time, so that's another area we're trying to explore as well. And then I would say that we're going to have another meeting in a couple weeks, and I think we'll be ready to present something more formal then to the BioSense governance group at that time.

Tapping on the BGG and the community of practice then to find those best practices in a short period of time so we can put that into the report also?

o Holly: I just want to reiterate I think it is important when we do engage the hospital groups mentioned that public health is involved as we are oftentimes the end users with the hospital materials, and it really will help us engage them in a lot of other activities that we could be used for the community practice as well. So I think there will be a good conduit there once we get moving forward.

o Natasha: but I think there was a group that did some querying of their hospital stakeholders to see what they might want. She may have some good insights for us.

o Holly: Natasha: We did talk about large hospital systems that utilize systems like Cerner, and so I think that will be an asset for input on how her group can benefit and how we can benefit from her


Meeting Minutes

Next Steps The CDC is looking for feedback on the CC DD process that you're using ASTHO work on a the functional requirements gathering process Call for Chair Nominations


web viewstacey and tim both gave a word of thanks to ... it to its proper site location in the new...

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