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 does not currently connect other data providers to TxS2.

Information on registering an intent to submit data can be found in the Data Provider and TxS2 User Registration and Onboarding procedure under Policies and Procedures, or contact TxS2 staff directly at syndromic.surveillance@dshs.texas.gov for more information.

Currently, we are focusing on facilities that have an electronic health record and provide emergency or urgent care. Our primary goal is to connect hospitals with emergency departments, free-standing emergency centers, and urgent care centers to the TxS2 system.

Data providers and Local Health Departments that intend to connect to TxS2 must sign a Memorandum of Understanding (MOU) with DSHS. Individual TxS2 Users must sign the TxS2 User Access Agreement and the HHS Acceptable Use Agreement form to obtain user credentials. Information on signing the MOU and access agreement can be found in the Data Provider and TxS2 User Registration and Onboarding procedure under Policies and Procedures or contact TxS2 staff directly at syndromic.surveillance@dshs.texas.gov for more information.

The administration of the hospital system and the electronic health record capabilities determine how individual hospitals within a hospital system are connected to TxS2.

The Texas Association of Local Health Officials (TALHO) started a syndromic surveillance system that was intended to be a statewide system. When that organization went defunct, DSHS contracted with Houston Health Department to maintain the former TALHO system until a new system could be stood up. Houston Health Department maintained the former TALHO system until August 31, 2016, and DSHS assumed maintenance of this system on September 1, 2016. Data providers that submitted data to the former TALHO system transitioned off this system to the TxS2 system. If you were submitting to TALHO and do not know if you are submitting to TxS2, please email Syndromic.Surveillance@dshs.texas.gov.

The North Texas Syndromic Surveillance System (NTXSS) hosted by Tarrant County Public Health covers syndromic surveillance activities for Public Health Region (PHR) 2/3. Similarly, Houston Health Department operates a system that covers syndromic surveillance activities for PHR 6/5S.

The model for TxS2 is that data providers located in PHR 2/3 connect to the NTXSS and data providers located in PHR 6/5S connect to the system operated by Houston Health Department. These two systems then feed all their data into the TxS2 system. All other data providers statewide, including those submitting data to the former TALHO system, connect directly to TxS2 through DSHS.

Users in PHR 2/3 and PHR 6/5S can access data for their regions through the NTXSS and Houston Health Department systems, respectively. These users can also gain access to aggregate statewide data through TxS2. Users outside PHR 2/3 and PHR 6/5S can view data for their respective region as well as aggregate statewide data through the TxS2 system.

DSHS staff (central office and PHRs 2/3 and 6/5S) maintain a collaboration with Tarrant County Public Health and Houston Health Department to ensure success for the TxS2 system. More information about this collaboration can be found under Policies and Procedures.

Requests for technical assistance for the TxS2 system should be directed to TxS2Support@dshs.texas.gov. 

The TxS2 system is configured to support the PHIN Messaging Guide for Syndromic Surveillance. The technical specifications can be found in the Data Provider Onboarding and Messaging procedure under Policies and Procedures or contact TxS2 staff directly at TxS2Support@dshs.texas.gov for more information.

The patient’s data are captured from the EHR and sent automatically to the TxS2 system. TxS2 IT staff work directly with the facility’s IT staff to set up the data transfer protocols. Facilities do not have to manually input the data outside the normal entry in their EHR and there is not any change in the clinical process in the patient visit.  

The goal is to have as near real-time data as possible, given the technology constraints of each facility. The frequency of submission is established as the connection to the data provider is made.  Data providers are strongly encouraged to submit data at least once every 24 hours.

The Limited Data Set or TxS2 data elements are the 48 data elements of interest as listed in the PHIN Messaging Guide for Syndromic Surveillance (Section 4, Document page 95). TxS2 is configured to support these elements.

Users can see all the data elements submitted for an individual record, based on their permissions in the system. Therefore, data provider staff can see all the data elements for records within their facility, while LHDs can see this level of detail for their entire PHR.

Hospitals and hospital systems can see data from within the hospital/hospital system and aggregate PHR and statewide data. LHDs can see data from 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.

While other jurisdictions can see data from across the PHR for situational awareness, it is the responsibility of the LHD, or PHR acting as the LHD, to determine the appropriate response to an alert in their jurisdiction.

Each organization determines who has access to view data in TxS2 and DSHS assigns user accounts for those individuals. It is the responsibility of the data provider and LHDs to notify DSHS when users should no longer have access to TxS2.

Data in TxS2 are protected health information (PHI). All data are stored in a secure database and accessed only by authorized users. 

In the event of an alert that results in an investigation and follow-up with potential cases, the users in the appropriate jurisdiction can work with the data provider(s) to re-identify patients during the investigation.

The patient’s chief complaints are grouped into broad syndrome categories. The analysis software is customizable regarding syndromes and ad hoc queries. TxS2 uses a set of 13 syndromes, which are the typical set used in other states. These syndromes include botulism-like, exposure, fever, gastrointestinal illness, hemorrhagic illness, influenza-like illness, injury, neurological, rash, reportable diseases/records of interest, respiratory, shock/coma, and other.

No. Most of the data in TxS2 are symptomatic data, not laboratory confirmed diagnosis data. In addition, some elements required for a notifiable condition report are not collected, such as name, date of birth, and address. Therefore, there is not any change in how reportable/notifiable conditions are reported.

The DSHS EMS Registry and the Poison Control registry both send data to TxS2. LHD users can see line level data for the EMS Registry, and everyone can see aggregate data for Poison Control.

We are currently researching what other useful data streams could be added, and we continue to focus on recruiting hospitals, free-standing emergency rooms, and urgent care clinics into TxS2.

Historic data from data providers is incorporated into the TxS2 system, as available, to help establish the baseline. The system generates alerts based on aberrations above the baseline. Users can see the expected number of cases for a particular syndrome versus the observed number of cases on a given day, as well as the geographic distribution of those cases. These alerts can be further analyzed to determine if there is a potential outbreak.

More information about using the TxS2 system as well as a protocol for responding to alerts can be found in Training, as well as on the Use Cases and Success Stories page. 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.

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. Both of these documents, as well as online training resources for both syndromic surveillance and ESSENCE, can be found under Training.

DSHS reviews 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 on use cases, syndromic surveillance activities, and success stories from partners using syndromic surveillance across the state are shared under Use Cases and Success Stories as they are available. If you have questions or recommendations regarding use cases or would like to share your syndromic surveillance activities and success stories, please contact DSHS at syndromic.surveillance@dshs.texas.gov.

In addition, DSHS works with partners to provide training. If you are interested in receiving or providing training, please email syndromic.surveillance@dshs.texas.gov. 

Data providers can use the system for:

• Integration into existing ER tracking or infection control procedures
• Forewarning about health trends affecting neighboring regions
• Analysis of data
• Collaboration with public health while protecting hospital/patient confidentiality
• Monitoring population health of catchment area
• Tracking post-surgical infections
• Participation in the Promoting Interoperability Program

Public health officials can use the system for:

• Querying data for symptoms or syndromes of concern
• Situational awareness, especially with rapidly spreading gastrointestinal or respiratory illness
• Mapping of clusters
• Early event detection
• Outbreak case identification
• Natural disaster or severe weather impact assessment
• Exposure contact identification
• Exposure source investigation
• Targeted education
• Hospital acquired infection tracking
• National disease trend monitoring

The eight Syndromic Surveillance Regional Advisory Committees (SSRACs) are regionally based (PHR-based) and membership of each SSRAC consists of representatives from that PHR as well as representation from LHDs and data providers within that respective PHR. The purpose of the SSRACs is for the representatives within each PHR to discuss the functional aspects of syndromic surveillance and regional issues as well as best practices and success stories of syndromic surveillance utilization. Information gathered from the eight SSRACs is then presented to the SSGC. Contacts for each SSRAC can be found at /txs2/contact.aspx. 

Providers participating in either the Medicaid EHR incentive program or MIPS can utilize their participation in syndromic surveillance to meet certain federal requirements. MIPS is part of the Quality Payment Program (QPP) under The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

Eligible Professionals in urgent care centers or free-standing emergency centers can register their intent to submit data to TxS2. Information on registering an intent to submit data can be found in the Data Provider and TxS2 User Registration and Onboarding procedure under Policies and Procedures or contact TxS2 staff directly at syndromic.surveillance@dshs.texas.gov for more information.

Requests for Promoting Interoperability public health reporting documentation for syndromic surveillance should be sent to syndromic.surveillance@dshs.texas.gov. The facility’s name and attestation period should be included in the request.