NETSS/NEDSS Review Webpage




Hepatitis

Instructions:
CSTE has asked your State Epidemiologist to forward this review of the data elements between CDC’s legacy and NEDSS message for Hepatitis. NETSS was the legacy message format for the hepatitis variables sent to CDC. Below, CDC has provided an outline of the methodology and results in its variable comparison between NEDSS and NETSS. As the lead for Hepatitis in your state health agency, we would like you to review excel file below, which illustrates the comparison of old and new variables between the legacy system, NETSS, and the new requirements for sending NEDSS data. When evaluating this, we would like you to determine how feasible these new data elements are for your state and whether you are requesting any changes to the content or required/optional attribute of the variables. You can provide comments at the bottom of this page. This will help us ensure that both your needs and the needs of the CDC are being met.
Download file: http://www.cste.org/Assessment/NEDSS/files/NEDSSDataElementsHepatitis.xls

Background
NETSS was fully implemented by 1995 and since that time, there have been severe restrictions imposed on any changes being made to NETSS. When initially implemented, NETSS included disease-specific data elements for acute hepatitis A, B, non-A/non-B, but not for acute hepatitis C. Since 1995 there have been changes in hepatitis disease epidemiology, hepatitis laboratory tests, and new hepatitis conditions have become nationally notifiable (i.e., chronic hepatitis B, perinatal hepatitis B virus infection, and hepatitis C virus infection, chronic or resolved). While additional core and disease-specific data elements were not permitted to be added to NETSS after its implementation (even for diseases that became nationally notifiable after 1995), NEDSS was able to capture the additional data elements needed for surveillance for new and existing nationally notifiable infectious diseases. NEDSS often split one legacy variable into two variables in NEDSS, thus artificially increasing the number of variables. Lastly, there are a number of variables that repeat across hepatitis conditions, thus artificially increasing the number of NEDSS variables as compared to NETSS (see repeating variable worksheet in the attached). These are some of the reasons there are more NEDSS variables than NETSS variables for a given condition.

Methodology
We conducted a study to compare the variables CDC is requesting be reported through the NEDSS message with the previous NETSS surveillance system legacy message for hepatitis. The purpose of this message is to communicate the results of this analysis. Here is an outline of the implementation steps for this project:
• An Excel spreadsheet of the variables in PHIN (NEDSS) Implementation Guides was created for Hepatitis. The attached Excel spreadsheet contains worksheets containing data elements for the following categories: generic data elements, hepatitis generic data elements, acute hepatitis A, acute hepatitis B, acute hepatitis C, perinatal hepatitis B virus infection, chronic hepatitis b, and hepatitis C virus infection chronic or resolved (aka past or present). The rows in the attached Excel spreadsheet represent NEDSS variables and most columns represent NEDSS variable attributes. ( Note that NEDSS Implementation Guides are documents on the PHIN web site that provide the technical and business content needed to message data to CDC). • A variable-by-variable review was performed, comparing the variables in the NEDSS message to the NETSS legacy message. To document the results of the comparison, a column (shaded in yellow) was inserted into the spreadsheets corresponding to the NETSS legacy message. When there was a CDC legacy message (NETSS) variable that corresponded to a NEDSS variable, a "yes" was inserted into the column to denote a match. The results of the variable-by-variable comparison were shared with the Hepatitis Program. And, the Hepatitis Program was asked to verify the accuracy of variable comparison and to recommend any necessary corrections. Additional columns (highlighted in yellow) were inserted into the spreadsheets indicating whether the NEDSS Implementation Guide variables were in the CDC Hepatitis Data Mart and whether they were variables the Hepatitis Program needs in the CDC Hepatitis Data Mart. The Hepatitis Program was asked to verify this information as well. Lastly, the variables in the Hepatitis Data Mart were compared to the variables in the NEDSS Implementation Guide to ascertain whether any variables were in the Data Mart that were not in the NEDSS Implementation Guide, that the CDC Hepatitis Program needed. • The Hepatitis program was asked to note if the NEDSS Implementation Guide message included all the variables they needed, whether there were any variables that did not need to be sent to CDC, or whether there were additional variables they needed. • The Hepatitis program was asked to review the required and optional field attributes for each NEDSS variable and, if needed, to identify changes to required or optional field designations. Note that in the worksheets, if the "Min" column contains a "0" for the specified variable, the variable is considered optional to report in the NEDSS message. If the "Min" column contains a "1" for the given variable, the variable is considered required. • Lastly, the CDC program was asked to provide a statement regarding how they reached consensus with their state partners, about which variables should be sent to CDC;

Results of the Analysis:
Variable statistics from this analysis indicate overall that 32.5% of the NEDSS message variables represent variables previously in the NETSS legacy message while 67.5% of the variables are new NEDSS variables. The percentage of NEDSS variables that were previously in the NETSS legacy message are listed below by category:
• 25.0% of the generic data elements • 30.8% of the hepatitis generic data elements • 52.4% of the acute hepatitis A data elements • 57.5% of the acute hepatitis B data elements • 37.1% of the acute hepatitis C data elements • There are no disease-specific perinatal hepatitis B virus infection or hepatitis C virus infection chronic or resolved data elements in the NETSS legacy message (they are in NEDSS). • There is no data collection form or screen in NEDSS (or NETSS) for chronic hepatitis B.

General Comments:
The Hepatitis program has requested to change the following fields from optional to be required for the NEDSS message: • DEM165 (county code of subject's residence) and, • The following hepatitis laboratory variables: HEP110 through HEP126 (see rows 8-24 of the hepatitis generic data elements spreadsheet) • Note that all the hepatitis lab tests (HEP110 through HEP126) are not required for each of the hepatitis viruses. Only the lab tests pertinent to a virus would be required. The Hepatitis Program has requested that variable HEP144, titled outbreak_a_type in the Hepatitis Data Mart, be added to the NEDSS message that CDC receives (see row 26 of the acute hepatitis A data elements worksheet). In order to ascertain which variables should be reported to CDC for hepatitis, the Hepatitis program identified knowledgeable and experienced state field staff conducting hepatitis surveillance and through that collaboration, reached a decision regarding the data elements that should be reported to CDC.

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Council of State and Territorial Epidemiologists ©2006