Center for Surveillance Epidemiology and Laboratory Services NNDSSRelated

Center for Surveillance, Epidemiology, and Laboratory Services NNDSS-Related. Highlights from 2018 CSTE Annual Conference and ELC HIS Monitoring Project: Red. Cap Demonstration • Access the NMI Technical Assistance and Training Resource Center at https: //www. cdc. gov/nmi/tatrc/index. html! • Subscribe to monthly NMI Notes news updates athttps: //www. cdc. gov/nmi/news. html ! July 17, 2018 Division of Health Informatics and Surveillance

Agenda § § § Welcome and Announcements NNDSS-related Highlights from 2018 CSTE Annual Conference – Overview of 2018 CSTE Annual Conference—Shaily Krishan (CSTE) – Review of Approved 2018 CSTE Position Statements—Kathryn Turner (ID) – Recap of Conference Workshop: “Enhancing Surveillance Through Partnerships and Innovation”—Kate Goodin (AZ) & Kathryn Turner (ID) – CSTE Data Standardization Workgroup—Kate Goodin (AZ) – CSTE Data Release Workgroup—Janet Hui (CSTE) – Plan for the Year Ahead—Kate Goodin (AZ) – Q & A for CSTE Annual Conference Overview ELC HIS Monitoring Project: REDCap Demonstration—Leota Amsterdam (CDC) – Q & A for REDCap Demonstration 2

Center for Surveillance, Epidemiology, and Laboratory Services NMI Announcements Lesliann Helmus, MSPH, CHTS-CP Associate Director for Surveillance Michele Hoover Lead, State Implementation and Technical Assistance

NMI e. SHARE Webinar Highlights from the 2018 CSTE Annual Conference Tuesday, July 17, 2018 3: 00 -4: 30 pm ET Kate Goodin, MPH, MS Kathryn Turner, Ph. D, MPH Meredith Lichtenstein Cone, MPH Shaily Krishan, MPH Janet Hui, MPH

Agenda • Highlights from 2018 CSTE Annual Conference o Overview of 2018 CSTE Annual Conference- Shaily Krishan (CSTE) o Review of approved 2018 CSTE Position Statements- Kathryn Turner (ID) o Recap of S/I conference workshop- Kate Goodin (AZ), Kathryn Turner (ID) o CSTE Data Standardization Workgroup- Kate Goodin (AZ) o CSTE Data Release Workgroup- Janet Hui (CSTE) o Plan for year ahead- Kate Goodin (AZ) • Q & A for CSTE conference overview

Overview of 2018 CSTE Annual Conference

2018 CSTE Annual Conference

Attendance • 1, 725 registered attendees • State Health Agency: 48% • Local Health Agency: 18% • Federal Agency: 14% • Student: 2. 5% • • Conference Sessions Mon-Wed, June 11 -13 8 tracks >950 total presentations o 325 Breakout o 297 Quick o 70 Lightning o 194 Posters o 113 Roundtables • 5 Sponsor Roundtables Overview of 2018 CSTE Annual Conference Workshops • Sunday, June 10 • 15 workshops • 1, 379 attendees

2018 CSTE Annual Conference • • • CSTE Annual Business Meeting Thursday, June 14 Review of Voting Rights and Council Audit State of CSTE Address – Janet Hamilton Presentation of Proposed Bylaws Change o Change in bylaws Article IV, Section 7 to simplify Executive Board run-off election process • 2018 Position Statements • New Business and Installation of New President, Sarah Park

CSTE Executive Board 2018 -2019 Officers Steering Committee Chairs President: Sarah Park, HI Vice President: Janet Hamilton, FL President-Elect: Sharon Watkins, PA Secretary-Treasurer: Marci Layton, NYC Infectious Disease: Richard Danila, MN Chronic Disease/MCH/Oral Health: Robert Graff, ID Environmental/Occupational/Injury: Melissa Jordan, FL Surveillance/Informatics: Kate Goodin, AZ (Maricopa County) Cross Cutting I: Barbara Gabella, CO Cross Cutting II: Ken Komatsu, AZ

For more information… 2018 Annual Conference Presentation Recordings – Coming Soon! • CSTE Confex Website: https: //cste. confex. com/cste/2018/meetingapp. cgi/Home/0 2018 Position Statements – Coming Soon! • Position Statement Archive: https: //www. cste. org/page/Position. Statements?

Review of approved 2018 CSTE Position Statements

2018 Position Statements • 18 -EH-01 – “Standardized Surveillance for Carbon Monoxide Poisoning” o o • 18 -ID-01 – “Standardized Case Definition for Surveillance of RSV-Associated Mortality” o o • Simplifies methods for surveillance into two tiers of surveillance activities: (1) case reporting/case ascertainment based on public health legal authorities, and (2) analysis of administrative data without access to personal identifiers. Recommends continued national notifiability using updated case definition with no change in CDC notification timeframe. Creation of standardized case definition, which will allow for more accurate estimates of RSV-associated deaths to be used as baseline measures before licensure and implementation of new treatment/prevention methods. Does NOT recommend RSV-Associated Mortality be added to the Nationally Notifiable Conditions List. 18 -ID-02 – “Case Definition for Non-pestis Yersiniosis” o o Creation of standardized case definition due to increase in culture-confirmed and culture-independent Yersinia infections in recent years. Does NOT recommend Non-pestis Yersiniosis be added to the Nationally Notifiable Conditions List.

2018 Position Statements • 18 -ID-03 – “Revision to the Case Definition for National Diphtheria Surveillance” o o o • 18 -ID-04 – “Update to Yellow Fever Case Definition” o o • Updates case definition to include non-respiratory infections and to more clearly differentiate between disease caused by toxin-producing vs. non-toxin-producing bacteria. Recommends restricting reporting of respiratory diphtheria to cases of toxin-producing C. diphtheriae and initiating reporting of non-respiratory disease caused by toxinproducing C. diphtheriae. Recommends continued national notifiability using updated case definition with no change in CDC notification timeframe. Updates case definition to include laboratory diagnostic tests and to clarify potential occurrence of yellow fever vaccine-associated viscerotropic disease vs. wild-type yellow fever disease. Recommends continued national notifiability using updated case definition with no change in CDC notification timeframe. 18 -ID-05 – “Standardized Case Definition for Candida auris” o o Updates case definition to reflect changes in performance characteristics of lab tests used to identify C. auris. Recommends clinical cases of C. auris be added to the Nationally Notifiable Conditions List and be notified to CDC on a routine basis.

2018 Position Statements • 18 -ID-06 – “Revisions to the Surveillance Case Definition, Case Classification, Public Health Reporting, and National Notification for Listeriosis” o o • 18 -ID-07 – “Public Health Reporting and National Notification for Hepatitis A” o o • Updates case definition to address the consistency of case classifications involving maternal/neonatal or non-sterile site specimen sources, to address new laboratory diagnostic testing methods, and to add a probable case definition. Recommends continued national notifiability using updated case definition with no change in CDC notification timeframe. Updated case definition to include nucleic acid amplification tests in laboratory criteria and improve the list of disease-specific data elements and criteria for case ascertainment. Recommends continued national notifiability using the updated case definition with no change in CDC notification timeframe. 18 -ID-08 – “Public Health Reporting and National Notification for Salmonella enterica serotype Typhi (S. Typhi) and Salmonella enterica serotypes Paratyphi A, B (tartrate negative), and C (S. Paratyphi) Infections” o o o Renames typhoid fever to S. Typhi Infection. Reclassifies infections with S. Paratyphi A, B (tartrate negative), and C as S. Paratyphi Infection instead of salmonellosis. Standardizes case definition for S. Paratyphi Infection and added S. Paratyphi Infection to the Nationally Notifiable Conditions List to be notified to CDC on a routine basis.

Recap of S/I Conference Workshop: Enhancing Surveillance Through Partnerships and Innovation

Enhancing Surveillance Through Partnerships and Innovation: Agenda • • • CDC Public Health Data Strategy Data preparedness for event response o CDC’s assessment and findings o Data preparedness effort in Emergency Operations Center o Use of syndromic surveillance data for event response o Use of National Notifiable Disease Surveillance System (NNDSS) data/ messages for event response o STLT perspective on information sharing during event response Development and Adoption of Information Exchange Standards o Overview of Health Level 7 International (HL 7), Clinical Document Architecture (CDA), Fast Healthcare Interoperability Resources (FHIR), Standards Development o State perspective on adopting and implementing data standards/ information exchange standards o CDC data standardization and harmonization efforts Data Standardization Workgroup o Update on the progress and plans of the Data Standardization Workgroup Invited speaker: James Daniel, Public Health Coordinator, Office for the Chief Technology Officer

Data Preparedness The planning, exercising, and implementation of capacities and capabilities to enable Public Health to do useful things with available data in a coordinated and timely way during emergency response Data that are: • Available for public health analysis • Timely to inform decision making • Actionable to inform rapid response

Common Issues timeliness resources accuracy flexibility infrastructure

Potential Solutions workforce development standardization data sharing and reporting foundational partnerships trust

Examples in Practice • NNDSS for sending case-based data during public health emergencies o Developing a flexible strategy to quickly expand data collection for case-based surveillance in an emergency response § Opportunity for your engagement: CDC will be seeking ideas and reactions from jurisdictions § For your thought: how should we be providing data more rapidly and how could we responsibly use preliminary data? • NSSP in practice supporting state and local jurisdictions in emergencies o Provides flexible options for user access o Can rapidly deploy features, dashboards, new jurisdictional environments o Staff provide support for training o NSSP can act as a data broker for CDC EOC

Invited Speaker: Jim Daniel • • • Office of the Chief Technology Officer o HHS Ignite Accelerator - Provides HHS staff a startup environment to test new ideas. o HHS Ventures Fund - Investing in and scaling internal innovations that dramatically improve HHS’s capabilities. o Kidney. X - public-private partnership to accelerate innovation in the prevention, diagnosis, and treatment of kidney diseases. o Entrepreneurs-in-Residence Program (EIR) - addresses the challenge of finding unique skillsets needed to solve the nation’s most critical challenges in health, health care, and the delivery of human services. o Leveraging the Power of Data - Increasing HHS’s capacity to leverage its voluminous existing data assets and make use of advancements in data science is at the core of this strategic shift. We want to develop department-level data infrastructure in order to enhance our analytical capabilities and the overall value of the data collected. o Conflict free consulting Public Health Innovation o Pivot to thinking more about value add of Public Health – especially to Medicaid/Medicare and other payers § Thinking beyond HITECH 90/10 funding o Consumer access to Immunization Information Systems to improve immunization rates o Integrating IIS data with Medicaid data to report Quality Measures o Linking birth data with Medicaid data to report on birth outcomes o Using death data and other public health data to support national level opioid dashboards o Reducing provider burden – 21 st Century Cures § Environmental scan of public health reporting Meaningful Use rule making

CSTE Data Standardization Work Group (DSWG): Status Update

DSWG Progress • Work Group Charge: o To convene epidemiologists and informaticians to develop consensus on common definitions for core surveillance data elements to address jurisdictional variation. CSTE 2017 Fall 2017 March 2018 CSTE 2018 Idea for DSWG Planning committee Kickoff call Presentation/discussion • Developed framework for consensus discussion and proposal development • Distributed survey to workgroup members for feedback on process, tools, work to date, and future scope • Draft proposal for Illness Onset Date ready for review; discussions ongoing for Diagnosis Date

DSWG Scope Lab Dates Residency Event Date When to report to CDC MMG Development/ Feedback New versus existing events What is next for this work group? Sexual orientation and gender identity Homelessness Travel How/when to apply new case definitions Pregnancy Status Race and Ethnicity

DSWG Next Steps • Finalize proposal for Illness Onset Date and promote it first to SPIS to begin vetting process • Expand representation to additional jurisdictions and program areas on workgroup, including involvement from CDC infectious disease programs • Regroup with steering committee to discuss long-term roadmap o Survey feedback from workgroup members o Discussions from CSTE workshop • Explore subgroups to tackle data elements and concepts

DSWG: How to Engage • Next meeting: July 27 th from 1 -2 pm ET/ 12 -1 pm CT • Email: • Molly Crockett: Molly. Crockett@Mass. Mail. State. MA. US • Shannon Harney: Shannon. Harney@tn. gov Basecamp: https: //3. basecamp. com/3164497/join/1 gu. TDJpymp. Sc

CSTE Data Release Work Group: Status Update

Data Release: Workgroup Description Workgroup Chair: Mary. Kate Martelon (MA) Workgroup Charge: Develop guidance and/or suggested language for public health agencies to develop release and suppression policies for aggregate data

Data Release: Activities • Review examples of jurisdictional release and suppression policies for aggregate data • Conduct comparison of jurisdictional approaches related to release and suppression policies for aggregate data • Develop guidance for jurisdictions to develop release and suppression policies for aggregate data, including sample language and best practices • Develop electronic form for external parties to request aggregate data

Data Release: Deliverables • Assessment of jurisdictional approaches to release and suppression for aggregate data • Repository of sample jurisdictional release agreements for aggregate data • Sample release and suppression guidelines for aggregate data • Sample aggregate data request form

Data Release: Status of Deliverables • Assessment of jurisdictional approaches to release and suppression for aggregate data o Completed: Each workgroup member presented their jurisdiction’s policy • Repository of sample jurisdictional release agreements for aggregate data o Completed: The workgroup crafted a spreadsheet that outlines similarities and differences of jurisdictional policies and procedures • Sample release and suppression guidelines for aggregate data o In progress

Data Release: Moving Forward • Complete sample release and suppression guidelines for aggregate data including sample request form • Future calls will hopefully include discussions with statisticians and lawyers to help craft sample policy

Data Release: Contact Information • Next call: August 10, 2018 • For questions or if you would like to join the workgroup, contact: o Mary. Kate Martelon (Massachusetts) § mary. kate. martelon@state. ma. us o Janet Hui (CSTE) § jhui@cste. org

Surveillance and Informatics Program: Plan for 2018 -2019

S/I Plan for Year Ahead • Continuation and capitalization of ongoing projects o Reportable Conditions Knowledge Management System (RCKMS) o NNDSS Modernization Initiative (NMI) o Digital Bridge o Antimicrobial Resistance Surveillance Task Force (ARSTF) • Standardization o CDC harmonization efforts o CSTE data standardization workgroup • Leverage partnerships o ASTHO Informatics Directors Peer Network (IDPN) o Mature representation across states and jurisdictions

Questions? Questions on Position Statements? • Email Meredith Lichtenstein Cone (mlichtenstein@cste. org) Questions on the Data Release Workgroup? • Email Janet Hui (jhui@cste. org) Questions on the Data Standardization Workgroup? • Email Shaily Krishan (skrishan@cste. org)

Appendix: S/I Conference Workshop Summary Slides

CDC Public Health Data Strategy Summary, takeaways from CDC PH Data strategy talk: • Workforce needs o Develop and maintain a data science savvy workforce o Training on approaches and tools (structured vs unstructured) o Centralized support for data science approaches • Enterprise approach to data collection and management o Interoperability of systems and tools across programs o Mutual value proposition between CDC and state/local agencies o Systems development vs acquire • CDC wants to partner with states to modernize use, collection, sharing of information o Focus on timely collection and use of data o Spend more time understanding and exploring data – not preparing, matching, and cleaning o Partners are not always sure of what happens to data once it arrives at CDC. Would like to address this in a collective process. • Questions and requests: o How are these strategies going to be reinforced through FOAs? o How should states be approaching leveraging ELC funding to invest in informatics infrastructure (interoperability, workforce development, data sharing) o State’s face similar workforce issues, how can there be a shared process? o How can we use these approaches to provide resources centrally for new lab tests (ELR and case reporting) and the emergence of new conditions?

Paula Yoon, CDC Data Preparedness for Emergency Response: CDC’s Assessment and Findings • • Paula shared her observations from the month she spent in Sierra Leone participating in the Ebola response. Issues she identified were: o Staffing and Workforce - High staff turnover, continuous training needs, variable data skills, limited surge capacity o Tools and Infrastructure - Few tools in the tool kit, no survey instrument gate keeper, lack of IT support in the field o Data Collection and management - No data management plans or SOPs, limited coordination among groups collecting data, no data model or architecture guidelines, few skilled data managers o Coordination and Data Sharing - Limited data sharing across organizations, Epi, lab and clinical data not linked, no data standards or system interoperability, no DUAs in place CDC recently completed a deep dive of past emergency responses to identify ways to improve all aspects of data collection, management and use. Findings included: o Data access and interoperability is a problem - For example, lack of interoperable systems for data activities (i. e. , lack of integration of clinical, epi, and lab data) o Data science workforce is not sufficient or well-equipped, and surge capacity is needed - For example, data capabilities depend on small set of SMEs rather than decentralized pool of personnel o Data science policy , regulatory requirements, and leadership roles are unclear - Leadership and authority for data activities vary from one response to the next. Coordination on data activities is limited internally and externally - For example, privacy protections are inconsistent and not always proportionate to situational needs

Macarena Garcia: Data preparedness effort in Emergency Operations Center • • How is CDC supporting data preparedness -- the planning, exercising, and implementation of capacities and capabilities to enable CDC to do useful things with available data in a coordinated and timely way during an emergency response. Use of data during an emergency is a complex and evolving challenge that involve many parts of the agency. Goals: o CDC programs and jurisdictional partners are essential to this effort. The goal is to help set up how we support the approach to data as programs transition into an emergency response environment Approach: o Think broadly about how to improve data before and after an emergency o Identify the tools available when it comes to data o Build on what’s already working o Identify groups that are supporting this work o Support these groups in advancing data preparedness at the agency

Aaron Kite-Powell: Use of syndromic surveillance data for event response • NSSP as an example of consolidated infrastructure between CDC, states, and locals and how it can be used in emergency response • Harvey: • Irma: o Houston used NSSP-ESSENCE (local system in transition o Coordinated with multiple jurisdictions prior to landfall phase) § What if any support they would like from us § Three facilities from Texas Region 2/3 § EOC reporting expectations § 35 users granted access o Florida Department of Health (FL-DOH) § Granularly defined access controls applied quickly § Concept of Operations – ESSENCE-FL is used day o Just-in-time training (epi/surv support, dashboards) -to-day as well as during events o Create new syndrome definitions “on the fly”, share reports § FL-DOH reported to CDC EOC o Site allowed NSSP to report to CDC’s Emergency Operations Center (EOC) • • How do we operationalize these support functions for emergency response and what might be some challenges? o Interactive system may not also create customized reports o Configuring database access controls for large number of users may not make sense o Application Programming Interfaces (APIs) § Tool agnostic reproducible methods to de-couple an interface from data § Integration of multiple data sources § Automated reporting in sharable documents… Pressures of reporting during events o EOC ← →Surveillance Epidemiologists o CDC ← → State/Local/Territorial o Practical and Contextualized Information vs “Feeding the Beast” o Tension between very timely data and direct actionability of the data o Investigation to assess public health significance often required

Lesliann Helmus: Use of National Notifiable Disease Surveillance System (NNDSS) for event response • • • NNDSS originally designed for routine disease surveillance activities -- Could it be adapted to allow states to send case-based data during public health emergencies? o Pros: § Would allow jurisdictions to use existing, well understood and wellfunctioning systems § No need to implement a new system when resources are stretched NNDSS team that has been asked to design a flexible strategy to quickly expand data collection for case-based surveillance in an emergency response -- will be seeking ideas and reactions from jurisdictions. As we work to more rapidly provide data, we need to think about new surveillance strategies and we need to think carefully about how we use more preliminary data.

Annie Fine: Local jurisdiction perspective on information sharing during event response • • • Data preparedness begins at the local level. Systems must be in place and users must be trained well in advance of any emergency Utilize the same data collection and transmission systems as are used routinely as much as possible Ideally standardize variable definitions for those variables that are commonly used ahead of time so everyone knows what they mean CDC should request the minimum amount of data needed to respond. Data needs will change throughout the response. Foundational aspects of a National response (i. e. , case definitions, who to test, and what to count) should be decided in consultation with state and local health department responders as they have likely already been developing their own out of necessity Improving data exchange with electronic health records and enabling clinical decision support for public health will improve public health data

Janet Hamilton: STLT perspective on information sharing during event response • • • Initial identification of optimal technologic tools results in more efficient and effective responses Coordination and integration of local epis key to state preparedness efforts Technology will not solve insufficient levels of physical and human resources o Need surveillance/informatics on staff, ready and available to make immediate changes Investigation leadership usually = extensive epidemiologic, disease, and scientific subjectmatter expertise ≠ expert in informatics and surveillance strategies Establish the role to oversee data collection/management at the start of the response o Skills: knowledgeable with existing surveillance systems, processes, procedures, and infrastructure and how they are used currently o Establish a data scientist leader in the ICS structure (CDC, states/jurisdictions) o Hold data collection, management, sharing “how” meetings, include states/jurisdictions o Define report production schedules- what changed when and why Consider stand-alone systems only when no other options are available. If used, immediately implement a plan to retrieve and share the data with other systems.

Erin Holt: Standards Development- Highlight on HL 7 • • • In order for your needs to be accommodated in Standards, then you need to participate in Standards development Several ways available to participate with and without formal membership: o Review materials and vote in ballots- HL 7 membership required o Participate in ballot reconciliation- HL 7 Workgroup member participation o Comment to improve existing published STU Standards Sign up for the following is free and encouraged to facilitate participation: (user names and passwords- Free) o HL 7 webpage (www. hl 7. org)- accessing Standards, work group resources, ballot desktop, list serve management, and education o Confluence/JIRA (http: //confluence. hl 7. org )- accessing agendas, meeting and call notes o STU comment page (www. hl 7. org/dstucomments/index. cfm) – to submit comments on existing published STU standards Roughly 35 current Public Health related. HL 7 projects spanning various topics across V 2 messages, CDA, and FHIR HL 7 product lines. Like CDA, FHIR presents opportunities for Public Health o Consists of building blocks called resources that can be put together to form implementation guides and profiles o Strong foundation in web standards o Supports RESTful architectures, as well as exchanges with messages and documents Standards will continue to evolve. When choosing to implement a new standard keep, in mind: o There are no silver bullet standards, no quick fix- be prepared to invest o Do your homework § Understand what you stand to gain and lose § Consider your partner and their environment o Is the change worth it?

Jim Collins: Use of Standards in Communicable Disease Reporting, Benefits and Challenges • • • There are different types of standards that come into play in terms of public health surveillance By employing standards, we are best able to participate in a regular and complete transmission of secure information. Software available and deployed that facilitates the inclusion of accepted standards with our systems. Developing and maintaining standards can facilitate health messaging, but also has resource demands that need to be considered and addressed. How best to leverage standards in messaging includes an evaluation of the most effective environment (i. e. consider existing Health Information Exchanges supported by the Trusted Exchange Framework and Common Agreement, TEFCA) Acknowledge that public health is still very much recognized as important in things like TEFCA, and that leveraging that recognition is important.

Paula Yoon: CDC data standardization and harmonization efforts • Lack of data standards results in reduced ability to o Share surveillance data across programs or between jurisdictions o Link or integrate data o Reuse and adapt tools for data collection, storage and analysis o Understand data and use for timely decision making • How to optimize standardized data flow: o Use data standards (questions, elements, values, vocabularies) across diseases o Use standards for data exchange and more efficient pathways to route data o Provide well-defined and consistent reporting requirements o Use less manual and more electronic data exchange o Use interoperable systems and tools that can share data between agencies and across programs o Collaborate on data collection and increase data sharing among programs o Establish Data Use Agreements that enhance data access and utility, and protect privacy and confidentiality o Decrease implementation effort and complexity for vendors of electronic disease surveillance systems o Align with and influence healthcare data standards • Assorted activities in process: o Message Mapping Guide development for case reporting o MMG Authoring Tool o Surveillance Data Platform initiative – SDP Vocabulary Service, Content Based Routing, Standards Management & Harmonization Workgroup o Data Preparedness Workgroup o 2014 CDC Surveillance Strategy and new Public Health Data Strategy o VADS and VSAC – align, consolidate? o NIOSH Occupation and Industry data elements o Healthcare - e. CR, pregnancy status, LOINC codes for new lab tests o Many state initiatives to standardize and harmonize o CSTE Data Standardization Workgroup

Molly Crockett, Shannon Harney: Data Standardization Work Group • Charge: Develop consensus interpretations of the core surveillance data elements o Date of Illness Onset (draft proposal available for review), Diagnosis Date • Lessons learned: o Significant variability across diseases, jurisdictions, surveillance systems o Consensus is cyclical, with online and offline collaboration o Need greater representation across diseases (including CDC) and jurisdictions

CSTE National Office Contact Information CSTE National Office 2872 Woodcock Boulevard, Suite 250 Atlanta, Georgia 30341 770. 458. 3811 770. 458. 8516 cmccoull@cste. org skrishan@cste. org

National Center for Emerging and Zoonotic Infectious Diseases REDCap Demo - 2018 REDCap Team: redcap@cdc. gov 51

What is REDCap? • Research Electronic Data Capture: a web-based tool for building and managing online surveys and databases • The REDCap Consortium: 2700+ institutions in 119+ countries 52

National Center for Emerging and Zoonotic Infectious Diseases https: //rdcp. cdc. gov 53

Subscribe to monthly NMI Notes news updates at ! https: //www. cdc. gov/nmi/news. html! Access the NMI Technical Assistance and Training Resource Center at https: //www. cdc. gov/nmi/ta-trc/index. html! Request NMI technical assistance or onboarding at edx@cdc. gov! Next NMI e. SHARE is August 28, 2018 – details at https: //www. cdc. gov/nmi/eshare. html! For more information, contact CDC 1 -800 -CDC-INFO (232 -4636) TTY: 1 -888 -232 -6348 www. cdc. gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. 54