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

The FAQ list will be updated as needed.

  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?