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Electronic Health Record (EHR) Meaningful Use Requirements

Syndromic Surveillance

If your hospital has achieved successful ongoing submission of production syndromic surveillance data to NC Division of Public Health via NCHESS from 2011 certified EHR technology before October 1, 2013, and your hospital owns a 2014 certified EHR technology for Transmission to Public Health Agencies - Syndromic Surveillance, you will be permitted to continue to transmit your syndromic surveillance data using 2011 certified EHR technology for Stage 2. If you are unsure if your hospital has achieved successful ongoing submission of production syndromic surveillance data, please contact Emilie Lamb at or Jonathan Kea at

NC DPH is capable of accepting electronic Syndromic Surveillance from eligible hospitals. NC DPH is not requesting and will not receive electronic syndromic surveillance from eligible professionals. If ongoing submission of syndromic surveillance data was already achieved by an eligible hospital for an EHR reporting period in a prior year and continues throughout the current EHR reporting period using NCHESS, registration of intent for the syndromic surveillance measure is not required. To register your intent to submit syndromic surveillance data to NC DPH, please register via the NC DPH Meaningful Use Site for Registration of Intent (for eligible hospitals only).

Currently all civilian North Carolina hospitals operating a 24/7 emergency department are required to contribute data for syndromic surveillance to the North Carolina Hospital Emergency Surveillance System (NCHESS). NCHESS data are then incorporated into North Carolina's statewide syndromic surveillance system, NC DETECT External link. Syndromic surveillance reporting from emergency departments is mandated by North Carolina General Statute § 130A-480 External link and requires that "For the purpose of ensuring the protection of the public health, the State Health Director shall develop a syndromic surveillance program for hospital emergency departments in order to detect and investigate public health threats that may result from (i) a terrorist incident using nuclear, biological, or chemical agents or (ii) an epidemic or infectious, communicable, or other disease."

NCHESS is the designated pathway for eligible hospitals to meet the meaningful use Syndromic Surveillance objective as part of the Medicare and Medicaid EHR Incentive Programs External link. Hospitals should be aware that the route by which they provide their data to NCHESS will determine whether they can attest to meeting the Syndromic Surveillance objective.

Eligible hospitals can meet the Syndromic Surveillance objective in several ways:

  1. Participation in the NCHESS-Investigative Monitoring Capability (NCHESS-IMC) program. The NCHESS-IMC program provides hospital-wide syndromic surveillance in real-time using technology from Thomson Reuters. The NCHESS-IMC technology has been certified for 11 meaningful use objectives, including 170.302(l) public health surveillance, by the Certification Commission for Health Information Technology (CCHIT). The name of the certified product is "Thomson Reuters (Healthcare) Inc. North Carolina Hospital Emergency Surveillance System" and the CCHIT certification number is CC-1112-352290-4. Hospitals that currently submit data using the IMC module meet the requirements for meaningful use certification; no additional activity is needed.
  2. Participation in the NCHESS-Emergency Department Data Initiative (NCHESS-EDDI) program through one of the following options. The NCHESS-EDDI program, mandated by North Carolina General Statute § 130A-480, requires that hospital emergency departments that are open 24/7 must submit 22 required data elements at least once per day using a format prescribed by the NHCESS-EDDI Data File Collection Cookbook, maintained by the North Carolina Hospital Association (NCHA) External link.
    • Eligible hospitals may request that their current vendor seek certification through one of the ONC-Authorized Testing and Certification Bodies (ONC-ATCB).
    • The hospital may self-certify an existing NCHESS-EDDI solution through the CCHIT EHR Alternative Certification program for Hospitals (EACH) program. Upon such certification, the hospital can then attest to meeting the Syndromic Surveillance meaningful use objective.
    • Hospitals may negotiate with a vendor who has a certified complete EHR or a certified EHR module to provide a data submission to NCHESS. With a vendor who provides a certified complete EHR or EHR module, the hospital may then attest to having met the Syndromic Surveillance objective. NCHA will test messages from the certified EHRs; messages must follow the format laid out in the NCHESS-EDDI Cookbook.
    The end result will be that all syndromic surveillance data submitted to NCDPH by eligible hospitals will be generated by a certified EHR; will be submitted via a certified complete EHR or EHR module; and will not flow outside the established NCHESS program.

For Additional Information

The message testing for Meaningful Use will be provided by the North Carolina Hospital Association. Please contact the NCHA Help Desk with questions about Syndromic Surveillance Meaningful Use objectives.