48-Hr Hospital Opioid OD Reporting

REQUIREMENTS

Pursuant to the Illinois Hospital Licensing Act and Administrative Rule 77 IAC 250.1520 (g): When a drug overdose treatment is provided in a hospital’s Emergency Department (ED), the case shall be reported to the Illinois Department of Public Health (IDPH) within 48 hours after providing treatment for the drug overdose – or at such time the drug overdose is confirmed.

If known, the hospital must report:

  1. Whether an opioid antagonist was administered; if so, the name of the antagonist
  2. The cause of the overdose, including but not limited to, whether the overdose was caused by a prescription opioid or heroin
  3. The demographic information of the person treated including, but not limited to, the patient’s:
    1. Age
    2. Sex
    3. County code
    4. Zip code
    5. Race, and
    6. Ethnicity, using the CDC’s race and ethnicity groups

The person completing the form shall not disclose the name, address, or any other personal information of the individual experiencing the overdose.

The identity of the person and hospital reporting shall not be disclosed to the subject of the report.

IMPLEMENTATION – OPIOID OVERDOSE REPORTING

Since January 2017, IDPH has been piloting the automation of reporting overdoses, using the syndromic surveillance data already submitted by all acute care hospitals in Illinois. The syndromic surveillance data is a data submission, in near real-time, for all ED visits from each acute care hospital to IDPH. It includes demographic information, as well as date, time, diagnosis, and chief complaint of every visit. Syndromic surveillance data currently sent to IDPH provide the required opioid overdose reporting elements for about 75 percent of Illinois hospitals. If sufficient data are submitted in the syndromic surveillance feed, IDPH can extract the cases that are required to be reported under this law, without the manual reporting of each case by the hospital.

What hospitals need to do (3 STEP PROCESS)

  1. Register for access to the BioSense Platform, by August 31, 2018
    • Every facility has an IDPH Portal Registration Authority (PRA) on staff. The PRA is the main contact or liaison between the facility and IDPH. The PRA will request access to syndromic surveillance for hospital users (*NOTE most hospital infection control staff have access to similar surveillance systems and can likely refer you to the PRA).
    • To request access, the PRA will visit:
      https://redcap.dph.illinois.gov/surveys/?s=Y884WCDC9M and enter the hospital user information for the staff that will be responsible for opioid overdose reporting.
    • Once requested, an administrator must create an account for the hospital user(s) in the BioSense Platform. Please allow 5-7 business days to receive an email with your USER login information for BioSense.
  2. Complete an initial validation process, by October 31, 2018
    • After receiving login access to the BioSense platform (as described above), hospital users will log on to BioSense to view aggregate opioid data for their facility – hospitals will be able to view a dashboard that displays the daily counts of opioid or heroin overdose encounters that are currently detected in syndromic surveillance. Encounters are tallied that meet the IDPH syndromic case definition (below).
    • Each hospital must perform an internal comparison to confirm or validate that the data IDPH receives (as shown in BioSense) is representative of their opioid and heroin overdose burden.
    • Syndromic data is analyzed using information in the chief complaint text fields and diagnosis codes. One query counts both heroin and opioid overdoses together. The syndromic surveillance query will classify ED visits as opioid or heroin overdoses if the following words or codes are included:
      Search field Case Definition in Use 07/23/18
      Diagnosis – ICD-10 T40.0X(1/4)A, T40.1X(1/4)A, T40.2X(1/4)A, T40.3X(1/4)A, T40.4X(1/4)A, T40.6X(1/4)A
      T40.00(1/4)A, T40.10(1/4)A, T40.20(1/4)A, T40.30(1/4)A, T40.40(1/4)A, T40.60(1/4)A
      T40.09(1/4)A, T40.19(1/4)A, T40.29(1/4)A, T40.39(1/4)A, T40.49(1/4)A, T40.69 (1/4)A

      F11,120, F11.121, F11.122, F11.129,
      F11.220, F11.221, F11.222, F11.229,
      F11.920, F11.921, F11.922, F11.929,

      Diagnosis – ICD-9 965.00, 965.01, 965.02, 965.09, E850.0, E850.1, E850.2
      Diagnosis –SNOMED 295174006, 295175007, 295176008, 295165009, 242253008, 297199006, 295213004
      Chief complaint-Text Poison or overdose or nodding or snorting or ingesting or intoxication or unresponsive, or loss of consciousness or shortness of breath or altered mental status
      AND
      reference to heroin, speedball, dope, opioid/opiate/opium, methadone, suboxone, oxyco/oxyi/oxymor, Percocet, Vicodin, fentanyl, hydrocodone, morphine, codeine, dilaudid, tramadol, buprenorphine, Synthetic OR F11.10, F11.20, F11.90
      Chief complaint - Text Reference to Narcan or naloxone
      Excluding Denials of heroin, drug use, withdraw, detoxification
    • Each hospital should run a similar query of their ED data to detect opioid and heroin overdoses and compare this to the number that IDPH’s syndromic surveillance data captured over the first two quarters of 2018 (January-June 2018).
    • Results of the validation by hospitals, including raw counts of the number the hospital captured will be reported to IDPH using an online form that will be made available.
    • IDPH will review the hospitals’ validation and initiate follow-up conversations where reporting is incomplete.
    • The most frequent reasons that a hospital’s syndromic data may not capture the overdoses are:
      1. A chief complaint that lacks detail on cause, such as only OD or overdose or drug reaction. If the chief complaints come from a pick list, this may be difficult to edit.
      2. Diagnosis data is incomplete or received with a significant delay.
    • IDPH staff will work with hospitals that report poor validation results. Triage notes, if received, can also be included in the syndromic query. Most solutions to improve automated reporting may be accomplished through a technical update to the syndromic surveillance feed. As necessary, IDPH will coordinate meetings to discuss this with individual sites to first try to update the feed before alternative manual reporting options are considered.
  3. Perform ongoing validation
    • On an ongoing basis, hospitals should review their data in the BioSense platform to confirm reporting.

IMPLEMENTATION – OPIOID ANTAGONIST ADMINISTRATION REPORTING

Hospitals must report any opioid antagonist administered in the hospital ED to IDPH. This information is not captured through syndromic surveillance and requires hospitals to generate a separate electronic report from their pharmacy system.

What hospitals need to do

  1. Begin sending opioid antagonist administration data to IDPH on or by December 31, 2018
    • On a daily basis, hospitals must send a separate report created from the hospital ED pharmacy data capturing opioid antagonists administered in the past 48 hours. Hospitals will export this report from the pharmacy data as a pipe or comma delimited file with .csv extension. Required elements of the report:
      Element Description
      Facility ID Same Facility ID your hospital is using in MSH4.2 for SS HL7 messages
      Patient ID The same Patient unique ID you are using in PID3.1 for SS HL7 Message
      Date Date when the opioid antagonist was administered.
      Medication Name Name of the opioid antagonist
      Medication code RxNorm or other code system
      Dose Milligrams
      VisitID The same visit ID you are using in PV1.19 for SS HL7 message
    • To transfer this report to IDPH, each hospital will use the same secure transfer method it is using for Syndromic Surveillance reporting (i.e., SFTP or VPN). The opioid antagonist .csv report will be dropped to the same folder in which the syndromic surveillance files are located.
    • Hospitals must utilize the following: Existing SFTP connection to IDPH:
      URL: moveit.illinois.gov
      IP Address: 163.191.60.21 port 22

      Directory for Uploads: /Distribution/DPH/SS-HL7/
      Naming convention for report files: NPI_YYYYMMDD.csv

      Example
      Facility with NPI number: 123456789
      File production date of: 2017/08/01 (i.e., August 1, 2017)
      The File Name would be: 123456789 _20170801.csv

    • IDPH will link the records in the opioid antagonist report to the opioid overdose cases captured through syndromic surveillance report based on the VisitID and the Facility ID.

Frequently Asked Questions

General FAQ

  1. Who is my hospital Portal Registration Authority (PRA)?
  2. Which hospital staff should be given access to review the opioid overdoses reported for our hospital?
  3. Can my facility PRA assign more than 1 user access to report our ED opioid overdose reporting?
  4. What should we do if our facility needs additional guidance or technical support regarding submission of the opioid antagonist administration data?

 

Opioid Overdose Reporting

  1. Does the 48 hour reporting time frame exclude weekends; can weekends be reported the following business day?
  2. We currently have a syndromic surveillance interface between our system and the Illinois Department of Public Health (IDPH), and the patient's chief complaint is submitted to IDPH over this syndromic surveillance interface.  Is the state wanting to make sure we note opioid overdose in the chief complaint or does it need to be in a specific format, different from the chief complaint, if so are there interface specs for this?
  3. What Electronic Health Record (EHR) vendors are submitting syndromic surveillance data to the Illinois Department of Public Health (IDPH)?
  4. Is this reporting mandatory or voluntary?

 

Validation

  1. Will the validation process deadline be extended since some user access to ESSENCE took longer than expected?
  2. What dates are to be used for the validation period?
  3. Can you send us a screenshot of the REDCap form that we need to send in for the validation process?
  4. Where do we submit our validation file?  
  5. Is there a 'suggested format' for the validation file? For example, does that report need any demographic information and is REDCap a secure site for protected health information (PHI) uploads? 
  6. What is REDCap?
  7. When our hospital conducts queries looking for overdoses, often the "substance" is either unknown or a mixture of substances.  How should that be handled?
  8. How do we report dead on arrival (DOA) persons that had an opioid overdose?
  9. How can we verify who currently has access to ESSENCE from our hospital?
  10. Will non-opioid overdoses be inadvertently captured from the chief complaint/diagnosis?
  11. What is meant by “overdoses admitted to Emergency Departments” – does this include direct admits to inpatient units or just emergency rooms proper?
  12. Will there be ESSENCE training available?
  13. I have access to multiple hospitals, are all combined on the ESSENCE dashboard? How do I view data for an individual hospital?
  14. Why is my query for opioid overdoses in the emergency department different from the Illinois Department of Public Health (IDPH) query?

 
Opioid Antagonist Administration Reporting

  1. Are emergency medical services (EMS) reporting opioid overdoses when they administer an opioid antagonist in the field?
  2. Should the opioid antagonist (i.e. Naloxone) reporting from hospital EDs include emergency medical services (EMS) distribution?
  3. Should the hospital ED reporting include when emergency medical services (EMS) administers an opioid antagonist (i.e. Naloxone) to patients in the field, and brings the patient to a facility, but the patient does not require additional opioid antagonist?
  4. How will the emergency medical services (EMS) drug exchange affect the data reporting?
  5. How do we handle opioid antagonists (i.e. Naloxone, Narcan) we give out and not administer ourselves?
  6. Does the Illinois Department of Public Health (IDPH) expect us to report opioid antagonist (i.e. Naloxone) usage hospital-wide, or specific to Emergency Departments?
  7. We are a system of 13 hospitals, when submitting our 1st quarter 2018 opioid overdose file, do I need a distinct CSV for each one?
  8. Is there a list of opioid antagonists that are required for reporting?
  9. What do I report if an opioid antagonist was given in the emergency department for a "presumed" overdose but lab clarification determined it was not an overdose but instead a syncope episode?
  10. We utilize an outside pharmacy that is not open on Sundays.   Can we request a waiver for the daily input of the information for this day of the week?
  11. I am building the query to generate this report, but the dosage and unit are stored in different fields in our electronic health record (EHR). Your document specifies a pipe or comma delimited file, but our report would be dosage|unit. Is this going to present a problem when parsing this data?

 

General FAQ

  1. Who is my hospital Portal Registration Authority (PRA)?
    • Your PRA is the main contact or liaison between your facility and IDPH. Some Health Systems assign one PRA for their Health System or assign each facility their own PRA. Email Michael Orama at Michael.Orama@illinois.gov or Valerie Young at Valerie.Young@Illinois.gov  if you need assistance determining your PRA.
  2. Which hospital staff should be given access to review the opioid overdoses reported for our hospital?
    • While that is an internal decision for your hospital, it should be individual(s) who know the ED data in the hospital Electronic Medical Record and would be responsible for reporting cases.
    • If multiple hospitals are part of a health system, users can be identified to report and have access to multiple facilities. The PRA must indicate this on registration.
  3. Can my facility PRA assign more than 1 user access to report our ED opioid overdose reporting?
    • Yes, they will just have to fill out a Syndromic User Request for each user.
  4. What should we do if our facility needs additional guidance or technical support regarding submission of the opioid antagonist administration data?

 

Opioid Overdose Reporting

  1. Does the 48 hour reporting time frame exclude weekends; can weekends be reported the following business day?
    • No. The data is sent to the Illinois Department of Public Health (IDPH) automatically in near-real time every 15 minutes.  There is no manual process that would be stopped on the weekends.
  2. We currently have a syndromic surveillance interface between our system and the Illinois Department of Public Health (IDPH), and the patient's chief complaint is submitted to IDPH over this syndromic surveillance interface.  Is the state wanting to make sure we note opioid overdose in the chief complaint or does it need to be in a specific format, different from the chief complaint, if so are there interface specs for this?
    • Yes. IDPH wants to confirm that the chief complaint text includes enough specificity for an overdose to be determined and to capture that visit as reportable. The query IDPH uses has flexibility to search more broadly to improve the visits captured, leveraging diagnosis codes or even triage notes, if necessary.  If the chief complaint is not free-text and / or limited to entries of ‘overdose’ only without reference to likely cause, then we will need to evaluate the interface further with the hospital one-on-one.
  3. What Electronic Health Record (EHR) vendors are submitting syndromic surveillance data to the Illinois Department of Public Health (IDPH)?
    • IDPH works with all major vendors that send syndromic surveillance data. For any vendor specific questions please send an email directly to dph.dpsq@illinois.gov for response.
  4. Is this reporting mandatory or voluntary?
    • Both syndromic surveillance and the opioid overdoses in the emergency department are mandatory reporting.

 

Validation

  1. Will the validation process deadline be extended since some user access to ESSENCE took longer than expected?
    • No. The validation deadline does not need to be extended due to any delays with access to ESSENCE. The hospital’s main responsibility is to complete an independent, opioid overdose query from their internal electronic health record (EHR) system. That data should be generated by the hospital and submitted to the Illinois Department of Public Health (IDPH) for further evaluation and compared to results in ESSENCE.
  2. What dates are to be used for the validation period?
    • Quarter 1 2018 (January through March)
  3. Can you send us a screenshot of the REDCap form that we need to send in for the validation process?
    • https://redcap.dph.illinois.gov/surveys/?s=Y884WCDC9M
      1. This in the same link used when requesting access to ESSENCE and is also available on the website. By selecting ‘Request Reason’ = Hospital Opioid Overdose Validation, a field for attaching a data file will be available. 
  4. Where do we submit our validation file?  
  5. Is there a 'suggested format' for the validation file? For example, does that report need any demographic information and is REDCap a secure site for protected health information (PHI) uploads? 
    • Yes, we suggest a .csv or Excel file for data extraction purposes.  The data file for upload should be a daily count of opioid overdoses in the emergency department by day.  No PHI needs to be submitted for IDPH to perform an initial validation on the hospital opioid overdose volume. If discrepancies in the counts require additional follow-up, a more detailed level of review and data exchange will be discussed with hospitals one-on-one. The submission form in REDCap is HIPAA compliant and secure, if a name-base file was submitted for validation.
  6. What is REDCap?
    • REDCap is an application that IDPH is using to build electronic forms to capture information from the hospitals on user access and validation data. The reference to REDCap is common language in the Department, but hospitals do not need any special access to REDCap
  7. When our hospital conducts queries looking for overdoses, often the "substance" is either unknown or a mixture of substances.  How should that be handled?
    • Only heroin or opioid overdoses seen in your hospital’s ED are reportable. If additional causes or substances are listed in the chief complaint it will not interfere with detection of the reportable cases.
  8. How do we report dead on arrival (DOA) persons that had an opioid overdose?
    • If they were not seen in the ED as patients, they are not reportable. If they were registered or admitted to the ED, they would be reportable regardless of final disposition.
  9. How can we verify who currently has access to ESSENCE from our hospital?
    • The Portal Registration Authority (PRA) at your hospital is responsible for requesting access and notifying IDPH when a hospital user should no longer have access. Therefore, the PRA can verify all persons who have access.
  10. Will non-opioid overdoses be inadvertently captured from the chief complaint/diagnosis?
    • The query that is used to detect overdoses has been validated in Illinois and nationally to minimize errors.
  11. What is meant by “overdoses admitted to Emergency Departments” – does this include direct admits to inpatient units or just emergency rooms proper?
    • The reporting requirement is for opioid overdose cases presenting to the emergency departments, regardless of whether or not the patient was subsequently admitted into the facility.
  12. Will there be ESSENCE training available?
  13. I have access to multiple hospitals, are all combined on the ESSENCE dashboard? How do I view data for an individual hospital?
    • The dashboard combines them if you have 2 or more sites. To separate, click the link in the top left corner of any graph/table you are interested in. This will take you to the Query Portal. From there, you will see a data stratification option that can be expanded. Select to stratify by facility and each site will be broken up for you.
  14. Why is my query for opioid overdoses in the emergency department different from the Illinois Department of Public Health (IDPH) query?
    • IDPH uses a query that was built to take into consideration a wide range of data content sent from all hospital EDs in Illinois. Data can vary in quality. Some chief complaint text may be too limited or structured to allow free text entries. Others send diagnoses that are incomplete or take more than 48 hours to be received. Further guidance nationally suggests that some combinations of symptoms and ICD codes that may not indicate an acute poisoning is a true overdose. The definition is developed to help IDPH understand trends to the opioid crisis in Illinois and to be able to respond locally, using a stable baseline of data to detect increases in a community as well as magnitude. As needed, IDPH will work with hospitals one-on-one to improve search queries for complete opioid overdose reporting from the ED.

 

Opioid Antagonist Administration Reporting

  1. Are emergency medical services (EMS) reporting opioid overdoses when they administer an opioid antagonist in the field?
    • Not relevant for this reporting.
  2. Should the opioid antagonist (i.e. Naloxone) reporting from hospital EDs include emergency medical services (EMS) distribution?
    • No. The antagonist reporting is limited to any opioid antagonist administered in the emergency department.
  3. Should the hospital ED reporting include when emergency medical services (EMS) administers an opioid antagonist (i.e. Naloxone) to patients in the field, and brings the patient to a facility, but the patient does not require additional opioid antagonist?
    • No. You only need to report the opioid antagonist administered in the emergency department.
  4. How will the emergency medical services (EMS) drug exchange affect the data reporting?
    • You do not need to report the opioid antagonist given to EMS to replace the one they administered in the field.
  5. How do we handle opioid antagonists (i.e. Naloxone, Narcan) we give out and not administer ourselves?
    • You do not need to report the opioid antagonist you have not administered.
  6. Does the Illinois Department of Public Health (IDPH) expect us to report opioid antagonist (i.e. Naloxone) usage hospital-wide, or specific to Emergency Departments?
    • You only need to report the opioid antagonist administered in the ED.
  7. We are a system of 13 hospitals, when submitting our 1st quarter 2018 opioid overdose file, do I need a distinct CSV for each one?
    • Yes. You need to create a separate file for each facility.
  8. Is there a list of opioid antagonists that are required for reporting?
    • Any opioid antagonist administered needs to be reported.
  9. What do I report if an opioid antagonist was given in the emergency department for a "presumed" overdose but lab clarification determined it was not an overdose but instead a syncope episode?
    • All opioid antagonists administered in the ED must be reported.
  10. We utilize an outside pharmacy that is not open on Sundays.   Can we request a waiver for the daily input of the information for this day of the week?
    • No.  By statute, you must report the opioid antagonist within 48 hours.
  11. I am building the query to generate this report, but the dosage and unit are stored in different fields in our electronic health record (EHR). Your document specifies a pipe or comma delimited file, but our report would be dosage/unit. Is this going to present a problem when parsing this data?
    • Yes, all the required fields need to be in the exact order as the template. You should calculate the dosage in milligrams and populate the dose column with that calculated value.