HomeMy WebLinkAboutCONSENT PH Data Sharing ESSENCE Amend 1 615 Sheridan Street
Port Townsend, WA 98368
9eehson www.JeffersonCountyPublicHealth.org
('or Consent Agenda
Public Heal
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Josh D. Peters, County Administrator
FROM: Apple Martine, Jefferson County Public Health Director
Lara Cittadini, CHIP Program Manager
DATE: D.11
SUBJECT: Agenda item — Amendment 1 to Data Sharing Agreement with WA Department
of Health for confidential information or limited dataset(s) related to the
Electronic Surveillance System for the Early Notification of Community-based
Epidemics (ESSENCE); Date of execution through 12/31/2028
STATEMENT OF ISSUE:
Jefferson County Public Health (JCPH) requests Board approval of Jefferson County Data Sharing Agreement
(DSA) with WA Department of Health (DOH) — date of execution - 12/31/2028
ANALYSIS/STRATEGIC GOALS/PROS and CONS:
"ESSENCE" is a CDC-hosted platform which authorized users may access through a web browser interface.
ESSENCE contains syndromic surveillance data from Washington and other participating states, and includes
analytical tools with which authorized users may interact with the data. Local health jurisdictions use this data
to identify and respond to public health threats and track health condition trends, evaluated interventions,
and provide quality public health services.
"WA ESSENCE" means the Washington State Department of Health hosted ESSENCE platform containing data
from Washington state healthcare facilities. This amendment revises the Data Sharing Agreement to include
WA ESSENCE language.
This amendment adds an Appendix "E" concerning "Tribal Data Sovereignty." This amendment also extends
the period of performance.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
There is no charge for this service. There is no fiscal impact.
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always working for a safer and healthier community
AD-25-056-A l
RECOMMENDATION:
JCPH management requests Board approval of Amendment 1 to the DSA with DOH — date of execution -
12/31/2028.
REVIEWED BY:
(.)'/(C ?'c
Jos . Peters, County Administrator Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
Always working for a safer and healthier community
CONTRACT REVIEW FORM ( Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: WA Dept of Health Contract No: AD-25-056-A1
Contract For: Data Sharing - ESSENCE, Amendment 1 I crm: upon signing - 12/31/28
COUNTY DEPARTMENT: Public Health
Contact Person: Veronica Shaw
Contact Phone: x 409
Contact email: veronica@co.jefferson.wa.us
AMOUNT: $o PROCESS: Exempt from Bid Process
Revenue: Cooperative Purchase
Expenditure: Competitive Sealed Bid
Matching Funds Required: Small Works Roster
Sources(s)of Matching Funds Vendor List Bid
Fund # RFP or RFQ
Munis Org/Obj Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES CO NCE NI 3. 5.080 AND CHAPTER 42.23 RCW.
CERTIFIED: { I N/A:Q Dec. 5,2025
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBA ED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: El N/A: [ Dec. 5, 2025
Signature Date
STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche):
Electronically approved by Risk Management on 12/11/2025.
STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 12/10/2025.
State contract language - difficult to change. Contract amendment.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
1
VF�:*. WW1Inyton Stele Department Of
iH E A LT H CONTRACT AMENDMENT
1. NAME OF CONTRACTOR 2. CONTRACT NUMBER
Jefferson County
Public Health Department CLH31870
la. ADDRESS OF CONTRACTOR(STREET) 2a. AMENDMENT NUMBER
615 Sheridan St
lb. CITY,STATE,ZIP CODE 1
Port Townsend,WA 98368
3. ® THIS ITEM APPLIES ONLY TO BILATERAL AMENDMENTS.
The Contract identified herein,including any previous amendments thereto,is hereby amended as set forth in Item 5 below by mutual
consent of all parties hereto.
4. ❑THIS ITEM APPLIES ONLY TO UNILATERAL AMENDMENTS.
The Contract identified herein,including any previous amendments thereto,is hereby unilaterally amended as set forth in Item 5
below pursuant to that changes and modifications clause as contained therein.
5. DESCRIPTION OF AMENDMENT: The purpose of this amendment is to include WA ESSENCE language:
5a. Data Sharing Agreement: is amended in its entirety and replaces the Data Sharing Agreement in accordance with the
Data Sharing Agreement,attached hereto and incorporated herein.
5b. Period of Performance: is extended through December 31,2028.
5e. The Effective Date of this Amendment: is the Date of Execution.
6. All other terms and conditions of the original contract and any subsequent amendments thereto remain in full force and
effect.
7. All other terms and conditions of the original contract and any subsequent amendments thereto remain in full force and
effect.
Space intentional left empty
DOH Amendment 31870-1 Page 1 of 32
JeffCo:AD-25-056-AI
8. OThis is a unilateral amendment. Signature of contractor is not required below.
®Contractor hereby acknowledges and accepts the terms and conditions of this amendment. Signature is required below.
Jefferson County Washington
State of Washington Department of Health dba Public Health Department
By: By:
Signature Signature
Heidi Eisenhour
Print Name Print Name
Chair,Board of County Commissioners
Title Title
Date Date
Jefferson County Washington Jefferson County Washington
dba Public Health Department dba Public Health Department
APPROVED A TO FORM ONLY: RECOMMENDING APPRO AL:
4:44///
By: ....., .4e,e557
for
ignature Signature
Philip C. Hunsucker Glenn Gilbert
Print Name Print Name
Chief Civil Deputy Prosecuting Attorney Public Health Assistant
Title Title
12/12/2025 /Z/5/29 Z5
Date Date
This document has been approved as to form only by the Assistant Attorney General.
DOH Amendment 31870-1 Page 2 of 32
DATA SHARING AGREEMENT
FOR
CONFIDENTIAL INFORMATION OR LIMITED DATASET(S)
BETWEEN
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
AND
Jefferson County Public Health Department
This Agreement documents the conditions under which the Washington State Department of
Health (DOH) shares confidential information or limited Dataset(s) with other entities.
CONTACT INFORMATION FOR ENTITIES RECEIVING AND PROVIDING INFORMATION
INFORMATION RECIPIENT INFORMATION PROVIDER
Organization Name Jefferson County Public Health Washington State Department of
Department Health (DOH)
Business Contact Name Lara Cittadini Cynthia Harry
Title CHIP Program Manager Deputy Chief Data Officer
Address 615 Sheridan St. 1610 NE 150th St. MS: K17-9
Port Townsend, WA 98368 Shoreline, WA 98155-9701
Telephone # 360-385-9448 206-472-4530
Email Address Icittadini@co.iefferson.wa.us cynthia.hara2doh wa.
IT Security Contact Mikey Forville John Weeks
Title Information Technology Chief Information Security
Foreman Officer
Address N/A PO Box 47890
Olympia, WA 98504-7890
Telephone# 360-385-9171 _ 360-999-3454
Email Address mforville@co.iefferson.wa.us 5ecurity�a doh.wa.gov
Privacy Contact Name Veronica Shaw Michael Paul
Title Deputy Director DOH Chief Privacy Officer
Address 615 Sheridan St. P. O. Box 47890
Port Townsend, WA 98368 Olympia, WA 98504-7890
Telephone# 360-385-9409 564-569-9692
Email Address veronica@co.iefferson.wa.us Privacyofficer@doh wa gay
DOH Amendment 31870-1 Page 0 of 32
DEFINITIONS
Authorized user means a recipient's employees, agents, assigns, representatives, independent
contractors, or other persons or entities authorized by the data recipient to access, use or
disclose information through this agreement.
Authorized user agreement means the confidentiality agreement a recipient requires each of its
Authorized Users to sign prior to gaining access to Public Health Information.
Breach of confidentiality means unauthorized access, use or disclosure of information received
under this agreement. Disclosure may be oral or written, in any form or medium.
Breach of security means an action (either intentional or unintentional) that bypasses security
controls or violates security policies, practices, or procedures.
Confidential information means information that is protected from public disclosure by law.
There are many state and federal laws that make different kinds of information confidential. In
Washington State, the two most common are the Public Records Act RCW 42.56, and the
Healthcare Information Act, RCW 70.02.
Data provider means any individual or entity that provides data to the RHINO program. This
includes all participating hospitals, clinics, and providers.
Data storage means electronic media with information recorded on it, such as CDs/DVDs,
computers and similar devices.
Data transmission means the process of transferring information across a network from a sender
(or source), to one or more destinations.
Direct identifier Direct identifiers in research data or records include names; postal address
information ( other than town or city, state and zip code); telephone numbers, fax numbers, e-
mail addresses; social security numbers; medical record numbers; health plan beneficiary
numbers; account numbers; certificate/license numbers;vehicle identifiers and serial numbers,
including license plate numbers; device identifiers and serial numbers; web universal resource
locators ( URLs); internet protocol (IP) address numbers; biometric identifiers, including finger
and voice prints; and full face photographic images and any comparable images.
Disclosure means to permit access to or release,transfer,or other communication of confidential
information by any means including oral, written, or electronic means, to any party except the
party identified or the party that provided or created the record.
Encryption means the use of algorithms to encode data making it impossible to read without a
specific piece of information, which is commonly referred to as a "key". Depending on the type
of information shared, encryption may be required during data transmissions, and/or data
storage.
DOH Amendment 31870-1 Page 1 of 32
ESSENCE means the CDC National Syndromic Surveillance Program (NSSP) Electronic
Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE)
platform. ESSENCE is a CDC-hosted platform which authorized users access through a web
browser interface. ESSENCE contains syndromic surveillance data from Washington and other
participating states, and includes analytical tools with which authorized users may interact with
the data.
Health care information means any information, whether oral or recorded in any form or
medium, that identifies or can readily be associated with the identity of a patient and directly
relates to the patient's health care...." RCW 70.02.010(7)
Health information is any information that pertains to health behaviors, human exposure to
environmental contaminants, health status, and health care. Health information includes
health care information as defined by RCW 70.02.010 and health related data as defined in
RCW 43.70.050.
Health Information Exchange (HIE) means the statewide hub that provides technical services to
support the secure exchange of health information between HIE participants.
Health official means any individual determined by the public health authority to be necessary
for a public health response pursuant to RCW 43.70.057 Section GB
Human research review is the process used by institutions that conduct human subject
research to ensure that:
• the rights and welfare of human subjects are adequately protected;
• the risks to human subjects are minimized, are not unreasonable, and are outweighed
by the potential benefits to them or by the knowledge gained; and
• the proposed study design and methods are adequate and appropriate in light of the
stated research objectives.
Research that involves human subjects or their identifiable personal records should be
reviewed and approved by an institutional review board (IRB) per requirements in federal and
state laws and regulations and state agency policies.
Human subjects research; human subject means a living individual about whom an investigator
(whether professional or student) conducting research obtains (1) data through intervention or
interaction with the individual, or(2) identifiable private information.
Identifiable data or records contains information that reveals or can likely associate the identity
of the person or persons to whom the data or records pertain. Research data or records with
direct identifiers removed, but which retain indirect identifiers, are still considered identifiable.
Indirect identifiers are indirect identifiers in research data or records that include all geographic
identifiers smaller than a state , including street address, city, county, precinct, Zip code, and
their equivalent postal codes, except for the initial three digits of a ZIP code;all elements of dates
( except year ) for dates directly related to an individual, including birth date, admission date,
DOH Amendment 31870-1 Page 2 of 32
discharge date, date of death; and all ages over 89 and all elements of dates ( including year)
indicative of such age, except that such age and elements may be aggregated into a single
category of age 90 or older.
Limited dataset means a data file that includes potentially identifiable information. A limited
dataset does not contain direct identifiers.
Normal business hours are state business hours Monday through Friday from 8:00 a.m. to 5:00
p.m. except state holidays.
Potentially identifiable information means information that includes indirect identifiers which
may permit linking an individual to that person's health care information. Examples of potentially
identifiable information include:
• birth dates;
• admission, treatment or diagnosis dates;
• healthcare facility codes;
• other data elements that may identify an individual. These vary depending on factors
such as the geographical location and the rarity of a person's health condition, age, or
other characteristic.
Restricted confidential information means confidential information where especially strict
handling requirements are dictated by statutes, rules, regulations or contractual agreements.
Violations may result in enhanced legal sanctions.
State holidays State legal holidays, as provided in RCW 1.16.050.
WA ESSENCE means the Washington State Department of Health hosted Electronic Surveillance
System for the Early Notification of Community-based Epidemics (WA ESSENCE) platform which
authorized users access through a web browser interface. WA ESSENCE contains syndromic
surveillance data from Washington state healthcare facilities and includes analytic and
visualization tools for users to interact with the data.
DOH Amendment 31870-1 Page 3 of 32
GENERAL TERMS AND CONDITIONS
I. USE OF INFORMATION
The Information Recipient agrees to strictly limit use of information obtained or created
under this Agreement to the purposes stated in Exhibit I (and all other Exhibits
subsequently attached to this Agreement). For example, unless the Agreement specifies
to the contrary the Information Recipient agrees not to:
• Link information received under this Agreement with any other information.
• Use information received under this Agreement to identify or contact
individuals.
The Information Recipient shall construe this clause to provide the maximum protection
of the information that the law allows.
II. SAFEGUARDING INFORMATION
A. CONFIDENTIALITY
Information Recipient agrees to:
• Follow DOH small numbers guidelines as well as dataset specific small
numbers requirements. (Appendix D)
• Limit access and use of the information:
■ To the minimum amount of information .
▪ To the fewest people.
▪ For the least amount of time required to do the work.
• Ensure that all people with access to the information understand their
responsibilities regarding it.
• Ensure that every person (e.g., employee or agent) with access to the
information signs and dates the "Use and Disclosure of Confidential
Information Form" (Appendix A) before accessing the information.
• Retain a copy of the signed and dated form as long as required in Data
Disposition Section.
The Information Recipient acknowledges the obligations in this section survive
completion, cancellation, expiration or termination of this Agreement.
DOH Amendment 31870-1 Page 4 of 32
B. SECURITY
The Information Recipient assures that its security practices and safeguards meet
Washington State Office of Washington Technology Solutions (WaTech) security
standard's: Asset Management Policy I WaTech; Physical and Environmental
Protection Policy I WaTech; Network Security Standard I WaTech; Mobile Device
Security Standard I WaTech; Remote Access Standard I WaTech.
For the purposes of this Agreement, compliance with the HIPAA Security Standard and
all subsequent updates meets WaTech security standards in SEC-08 "Data Sharing
Policy" and SEC-01 through SEC-13 "WaTech Policies"
The Information Recipient agrees to adhere to the Data Security Requirements in
Appendix B. The Information Recipient further assures that it has taken steps
necessary to prevent unauthorized access, use, or modification of the information in
any form.
Note: The DOH Chief Information Security Officer must approve any changes to this
section prior to Agreement execution. IT Security Officer will send approval/denial
directly to DOH Contracts Office and DOH Business Contact.
C. BREACH NOTIFICATION
The Information Recipient shall notify the DOH Chief Information Security Officer
(securitv@doh wa.gov) within one (1) business days of any suspected or actual breach of
security or confidentiality of information covered by the Agreement.
III. RE-DISCLOSURE OF INFORMATION
Information Recipient agrees to not disclose in any manner all or part of the information
identified in this Agreement except as the law requires, this Agreement permits, or with
specific prior written permission by the Secretary of the Department of Health.
If the Information Recipient must comply with state or federal public record disclosure
laws, and receives a records request where all or part of the information subject to this
Agreement is responsive to the request: the Information Recipient will notify the DOH
Privacy Officer of the request ten (10) business days prior to disclosing to the requestor.
The notice must:
• Be in writing;
• Include a copy of the request or some other writing that shows the:
• Date the Information Recipient received the request; and
• The DOH records that the Information Recipient believes are
responsive to the request and the identity of the requestor, if
known.
DOH Amendment 31870-1 Page 5 of 32
IV. ATTRIBUTION REGARDING INFORMATION
Information Recipient agrees to cite "Washington State Department of Health" or other
citation as specified, as the source of the information subject of this Agreement in all text,
tables and references in reports, presentations and scientific papers.
Information Recipient agrees to cite its organizational name as the source of
interpretations, calculations or manipulations of the information subject of this
Agreement.
V. OTHER PROVISIONS
With the exception of agreements with British Columbia for sharing health information,
all data must be stored within the United States.
VI. AGREEMENT ALTERATIONS AND AMENDMENTS
This Agreement may be amended by mutual agreement of the parties. Such amendments
shall not be binding unless they are in writing and signed by personnel authorized to bind
each of the parties
VII. CAUSE FOR IMMEDIATE TERMINATION
The Information Recipient acknowledges that unauthorized use or disclosure of the
data/information or any other violation of sections II or III, and appendices A or B, may
result in the immediate termination of this Agreement.
VIII. CONFLICT OF INTEREST
The DOH may, by written notice to the Information Recipient:
Terminate the right of the Information Recipient to proceed under this Agreement if it is
found, after due notice and examination by the Contracting Office that gratuities in the
form of entertainment, gifts or otherwise were offered or given by the Information
Recipient, or an agency or representative of the Information Recipient, to any officer or
employee of the DOH,with a view towards securing this Agreement or securing favorable
treatment with respect to the awarding or amending or the making of any determination
with respect to this Agreement.
In the event this Agreement is terminated as provided above, the DOH shall be entitled
to pursue the same remedies against the Information Recipient as it could pursue in the
event of a breach of the Agreement by the Information Recipient. The rights and
remedies of the DOH provided for in this section are in addition to any other rights and
remedies provided by law. Any determination made by the Contracting Office under this
clause shall be an issue and may be reviewed as provided in the "disputes" clause of this
Agreement.
DOH Amendment 31870-1 Page 6 of 32
IX. DISPUTES
Except as otherwise provided in this Agreement, when a genuine dispute arises
between the DOH and the Information Recipient and it cannot be resolved,either party
may submit a request for a dispute resolution to the Contracts and Procurement Unit.
The parties agree that this resolution process shall precede any action in a judicial and
quasi-judicial tribunal. A party's request for a dispute resolution must:
• Be in writing and state the disputed issues, and
• State the relative positions of the parties, and
• State the information recipient's name, address, and his/her department
agreement number, and
• Be mailed to the DOH contracts and procurement unit, P. 0. Box 47905,
Olympia, WA 98504-7905 within thirty (30) calendar days after the party
could reasonably be expected to have knowledge of the issue which
he/she now disputes.
This dispute resolution process constitutes the sole administrative remedy available
under this Agreement.
X. EXPOSURE TO DOH BUSINESS INFORMATION NOT OTHERWISE PROTECTED BY LAW
AND UNRELATED TO CONTRACT WORK
During the course of this contract, the information recipient may inadvertently become
aware of information unrelated to this agreement. Information recipient will treat such
information respectfully, recognizing DOH relies on public trust to conduct its work. This
information may be hand written, typed, electronic, or verbal, and come from a variety
of sources.
XI. GOVERNANCE
This Agreement is entered into pursuant to and under the authority granted by the laws
of the state of Washington and any applicable federal laws. The provisions of this
Agreement shall be construed to conform to those laws.
In the event of an inconsistency in the terms of this Agreement, or between its terms
and any applicable statute or rule, the inconsistency shall be resolved by giving
precedence in the following order:
• Applicable Washington state and federal statutes and rules;
• Any other provisions of the Agreement, including materials incorporated by
reference.
DOH Amendment 31870-1 Page 7 of 32
XII. HOLD HARMLESS
Each party to this Agreement shall be solely responsible for the acts and omissions of its
own officers, employees,and agents in the performance of this Agreement. Neither party
to this Agreement will be responsible for the acts and omissions of entities or individuals
not party to this Agreement. DOH and the Information Recipient shall cooperate in the
defense of tort lawsuits, when possible.
XIII. LIMITATION OF AUTHORITY
Only the Authorized Signatory for DOH shall have the express, implied, or apparent
authority to alter, amend, modify, or waive any clause or condition of this Agreement
on behalf of the DOH. No alteration, modification, or waiver of any clause or condition
of this Agreement is effective or binding unless made in writing and signed by the
Authorized Signatory for DOH.
XIV. RIGHT OF INSPECTION
The Information Recipient shall provide the DOH and other authorized entities the right
of access to its facilities at all reasonable times, in order to monitor and evaluate
performance,compliance, and/or quality assurance under this Agreement on behalf of
the DOH.
XV. SEVERABILITY
If any term or condition of this Agreement is held invalid, such invalidity shall not affect
the validity of the other terms or conditions of this Agreement, provided, however, that
the remaining terms and conditions can still fairly be given effect.
XVI. SURVIVORSHIP
The terms and conditions contained in this Agreement which by their sense and context,
are intended to survive the completion, cancellation, termination, or expiration of the
Agreement shall survive.
XVII. TERMINATION
Either party may terminate this Agreement upon 30 days prior written notification to
the other party. If this Agreement is so terminated, the parties shall be liable only for
performance rendered or costs incurred in accordance with the terms of this Agreement
prior to the effective date of termination.
XVIII. WAIVER OF DEFAULT
This Agreement,or any term or condition, may be modified only by a written amendment
signed by the Information Provider and the Information Recipient. Either party may
propose an amendment.
DOH Amendment 31870-1 Page 8 of 32
Failure or delay on the part of either party to exercise any right, power, privilege or remedy
provided under this Agreement shall not constitute a waiver. No provision of this Agreement
may be waived by either party except in writing signed by the Information Provider or the
Information Recipient.
XIX. ALL WRITINGS CONTAINED HEREIN
This Agreement and attached Exhibit(s) contains all the terms and conditions agreed
upon by the parties. No other understandings, oral or otherwise, regarding the subject
matter of this Agreement and attached Exhibit(s) shall be deemed to exist or to bind
any of the parties hereto.
XX. PERIOD OF PERFORMANCE
This Agreement shall be effective from date of execution through December 31, 2028.
SPECIAL TERMS AND CONDITIONS
XXI. The information recipient shall:
a. Not utilize the information obtained through this agreement except for purposes
of public health and/or healthcare practice which do not constitute research
activities as defined in RCW 42.48.010. Additional uses, including use of the data
to conduct research, require an amendment or separate agreement. Information
recipient must make a new data request to use this data for research purposes,
and research projects require approval of the Washington State Institutional
Review Board (WSIRB) and execution of a Confidentiality Agreement for the
research project.
b. Take all reasonable steps to prevent unauthorized access to the ESSENCE or WA
ESSENCE platforms and any data obtained through this agreement which may be
considered private or confidential under state or federal law.
c. Not publish or otherwise disclose any data which may directly or indirectly
identify an individual, except as allowed by law within the confines of a public
health investigation. Furthermore, the information recipient shall not publish the
identity of a data provider(hospital, clinic, or provider) except with the consent
of the data provider.
d. Not attempt to determine the identity of persons whose information is included
in the data set or use the data in any manner that identifies individuals or their
families, except to investigate events of potential public health importance (e.g.,
notifiable conditions, outbreaks).
DOH Amendment 31870-1 Page 9 of 32
e. Not attempt to obtain additional information about a patient or their visit from a
patient's electronic medical record except for purposes agreed upon by the data
provider (hospital, clinic, or provider) and the information recipient.
f. Not provide or otherwise utilize data obtained through this agreement for
purposes of regulatory action or law enforcement against a data provider, except
as required by state or federal law.
XXII. The Information Recipient may:
a. Publish, redisclose, or release aggregated data in order to protect public health
so long as DOH Small Numbers Publishing Guidelines (Appendix D) and RHINO
Data Best Practices included in the RHINO Guidebook are adhered to and direct
or indirect identifiers are excluded.
b. Link data obtained through this Agreement with data from other sources, in order
to identify or characterize a specific health problem or evaluate the success of a
specific health program within their statutory authority to provide quality public
health services. Any linked dataset containing data elements obtained through
this agreement are subject to the terms of this Agreement, similar agreements
governing linked datasets, and all state and federal laws that govern any included
datasets.
c. Use data obtained through this Agreement to follow up on specific visits in order
to investigate events of potential public health importance (e.g., notifiable
conditions, outbreaks). In support of such an investigation, data obtained
through this Agreement may be shared with health officials on a "need to know"
basis, sharing the fewest number of data elements with the fewest number of
individuals, for the least amount of time necessary.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the date of last
signature below.
INFORMATION PROVIDER INFORMATION RECIPIENT
Jefferson County Washington
State of Washington Department of Health dba Jefferson County Public Health
Signature
Heidi Eisenhour
Print Name Print Name
Date Date
DOH Amendment 31870-1 Page 10 of 32
EXHIBIT I
1. PURPOSE AND JUSTIFICATION FOR SHARING THE DATA
Provide a detailed description of the purpose and justification for sharing the data, including
specifics on how the data will be used.
Washington Department of Health supports local health jurisdictions(LHJs)and tribes in their
disease and injury surveillance and control activities by providing timely access to data.
ESSENCE or WA ESSENCE data is some of the timeliest information available, with over 90%
of emergency departments reporting visits within 24 hours. Public health authorities use this
information to identify and respond quickly to public health threats such as novel pathogens,
as well as track injury and health condition trends, evaluate interventions implemented, and
use ESSENCE or WA ESSENCE data within their statutory authority to provide quality public
health services. Additionally, Washington Department of Health must provide local health
jurisdictions and tribes access to the healthcare encounter data for their jurisdiction by
statute (RCW 43.70.057). Washington Department of Health will provide the requestor with
ESSENCE or WA ESSENCE access for identified users so that they may perform their duties of
public health disease monitoring and control.
Is the purpose of this agreement for human subjects research that requires Washington State
Institutional Review Board (WSIRB) approval?
❑ Yes E No
If yes, has a WSIRB review and approval been received? If yes, please provide copy of
approval. If No, attach exception letter.
❑ Yes ❑ No
2. PERIOD OF PERFORMANCE
This Exhibit shall have the same period of performance as the Agreement unless otherwise
noted below:
Exhibit I shall be effective from date of execution through
3. DESCRIPTION OF DATA
Information Provider will make available the following information under this Agreement:
The Information Provider will provide access to the CDC National Syndromic Surveillance
Program (NSSP) Electronic Surveillance System for the Early Notification of Community-
based Epidemics (ESSENCE) platform or the WA ESSENCE platform for a limited number of
DOH Amendment 31870-1 Page 11 of 32
authorized users employed or contracted by the Information Recipient. User accounts will
be established and managed by the Information Provider.
Authorized users will, upon execution of this Agreement and receipt of signed
confidentiality agreements (Appendix A)from each authorized user, have access to the
complete dataset contained within ESSENCE or WA ESSENCE for the Information Recipient's
jurisdiction. For example, an authorized user employed by a local health jurisdiction (LHJ)
will have access to all ESSENCE or WA ESSENCE data reported by facilities located in that
jurisdiction, and all ESSENCE or WA ESSENCE data for residents of that jurisdiction.An
authorized user employed by a hospital will have access only to data from that hospital.
Authorized users have the ability to interact with and analyze the data within the ESSENCE
or WA ESSENCE platforms. Additionally, authorized users have the ability download partial
or complete datasets from the platform for additional analysis outside of the ESSENCE or
WA ESSENCE platforms.
Data elements which may be found in ESSENCE or WA ESSENCE for each record (visit)
include:
• Facility name
• Facility type
• Admission reason code
• Patient's chief complaint(s)—original and processed entries
• Patients discharge diagnosis(es)
• Patient's Date of Birth
• Patient's age
• Visit/Admission date and time
• Discharge date and time
• Date and time of death (if applicable)
• Patient's medical record number
• Zip code city, county, and state of patient residence
• Discharge disposition
• Patient's sex
• Patient's race
• Patient's ethnicity
• Facility zip code
• Procedure code
• Initial Temperature
• Initial ED acuity assessment
• Onset date
• Clinical Impression
• Problem list
• Medication list
• Initial pulse oximetry
DOH Amendment 31870-1 Page 12 of 32
• Initial systolic and diastolic blood pressures
• Height
• Weight
• Body mass Index
• Pregnancy status
• Smoking status
• Travel history
• Visit type
• Mode of arrival
• Clinical Impression
• Triage notes
• Insurance coverage
• Insurance company ID
• Discharge instructions
• Various administrative and system data elements
It is important to note that, while the above listed data elements may exist in the ESSENCE
or WA ESSENCE platforms, the elements included for each individual record may vary.This
is a result of variances in data submission among facilities.
The information described in this section is:
® Restricted Confidential Information (Category 4)
❑ Confidential Information (Category 3)
❑ Potentially identifiable information (Category 3)
❑ Internal [public information requiring authorized access] (Category 2)
n Public Information (Category 1)
Any reference to data/information in this Agreement shall be the data/information as
described in this Exhibit.
4. STATUTORY AUTHORITY TO SHARE INFORMATION
DOH statutory authority to obtain and disclose the confidential information or limited
Dataset(s) identified in this Exhibit to the Information Recipient:
RCW 43.20.050—Powers and duties of state board of health
RCW 43.70.050—Collection,use,and accessibility of health-related data
RCW 70.02.050—Disclosure without patient's authorization
RCW 43.70.057-Hospital emergency room patient care information—Data collection,
maintenance,analysis,and dissemination—Rules
RCW 43.70.130—Powers and duties of secretary—General.
DOH Amendment 31870-1 Page 13 of 32
Information Recipient's statutory authority to receive the confidential information or limited
Dataset(s) identified in this Exhibit
RCW 70.05.060- Powers and duties of local board of health.
RCW 43.70.545 - Data collection and reporting rules.
WAC 246-101-505- Duties of the local health officer or the local health department
United States Federal Indian Law
Indian Self Determination Act 1975
5. ACCESS TO INFORMATION
METHOD OF ACCESS/TRANSFER
n DOH Web Application (indicate application name):
Washington State Secure File Transfer Service(sft.wa.gov)
❑ Encrypted CD/DVD or other storage device
❑ Health Information Exchange (HIE)**
® Other:Authorized users will access the data through the CDC NSSP ESSENCE
platform or the WA ESSENCE platform. Individual users may request access by
contacting RHINO@doh.wa.gov.
**NOTE: DOH Chief Information Security Officer must approve prior to Agreement
execution. DOH Chief Information Security Officer will send approval/denial directly to
DOH Contracts Office and DOH Business Contact.
FREQUENCY OF ACCESS/TRANSFER
❑ One time: DOH shall deliver information by (insert date)
n Repetitive: frequency or dates (insert dates if applicable)
M As available within the period of performance stated in Section 2.
6. REIMBURSEMENT TO DOH
Payment for services to create and provide the information is based on the actual expenses
DOH incurs, including charges for research assistance when applicable.
Billing Procedure
• Information Recipient agrees to pay DOH by check or account transfer within
30 calendar days of receiving the DOH invoice.
DOH Amendment 31870-1 Page 14 of 32
m Upon expiration of the Agreement, any payment not already made shall be
submitted within 30 days after the expiration date or the end of the fiscal year,
which is earlier.
Charges for the services to create and provide the information are:
❑ $
® No charge.
7. DATA DISPOSITION
Unless otherwise directed in writing by the DOH Business Contact, at the end of this
Agreement, or at the discretion and direction of DOH, the Information Recipient shall:
• Immediately destroy all copies of any data provided under this Agreement
after it has been used for the purposes specified in the Agreement . Acceptable
methods of destruction are described in Appendix B. Upon completion, the
Information Recipient shall submit the attached Certification of Data Disposition
(Appendix C) to the DOH Business Contact.
❑ Immediately return all copies of any data provided under this Agreement
to the DOH Business Contact after the data has been used for the purposes
specified in the Agreement, along with the attached Certification of Data
Disposition (Appendix C)
(1 Retain the data for the purposes stated herein for a period of time not to
exceed (e.g., one year, etc.), after which Information
Recipient shall destroy the data (as described below) and submit the attached
Certification of Data Disposition (Appendix C) to the DOH Business Contact.
N Other (Describe): Authorized users have the ability to download (copy)
partial or complete datasets from the platform. Upon request by DOH program
staff, at the end of the Agreement term, or when no longer needed, the
Information Recipient shall destroy all copies of any data provided under this
Agreement. Acceptable methods of destruction are described in Appendix B.
8. RIGHTS IN INFORMATION
Information Recipient agrees to provide, if requested, copies of any research papers or
reports prepared as a result of access to DOH information under this Agreement for DOH
review prior to publishing or distributing.
In no event shall the Information Provider be liable for any damages, including, without
limitation, damages resulting from lost information or lost profits or revenue, the costs of
recovering such Information,the costs of substitute information, claims by third parties or
for other similar costs, or any special, incidental, or consequential damages, arising out of
DOH Amendment 31870-1 Page 15 of 32
the use of the information. The accuracy or reliability of the Information is not guaranteed
or warranted in any way and the information Provider's disclaim liability of any kind
whatsoever, including, without limitation, liability for quality, performance,
merchantability and fitness for a particular purpose arising out of the use, or inability to
use the information.
® If checked, please submit the following:
• Copies of all papers, presentations, reports, or publications developed
using data obtained under this agreement to the attention of:the
RHINO program at RHINO@doh.wa.gov.
9. ALL WRITINGS CONTAINED HEREIN
This Agreement and attached Exhibit(s) contains all the terms and conditions agreed upon
by the parties. No other understandings, oral or otherwise, regarding the subject matter
of this Agreement and attached Exhibit(s) shall be deemed to exist or to bind any of the
parties hereto.
IN WITNESS WHEREOF,the parties have executed this Exhibit as of the date of last signature
below.
INFORMATION PROVIDER INFORMATION RECIPIENT
Jefferson County Washington
State of Washington Department of Health dba Public Health Department
By: By:
Signature Signature
Heidi Eisenhour
Print Name Print Name
Chair, Board of County Commissioners
Title Title
Date Date
Jefferson County Washington Jefferson County Washington
dba Public Health Department dba Public Health Department
APPROVED AS TO FORM ONLY: RECOMMENDING APPROVAL:
By: Philip C..Huns"cker, Chief Civil DPA By:
Signature December 10, 2025 Signature
DOH Amendment 31870-1 Page 16 of 32
Philip C. Hunsucker Glenn Gilbert
Print Name Print Name
Chief Civil Deputy Prosecuting Attorney Public Health Assistant
Title Title
Date Date /7/ /0�5
DOH Amendment 31870-1 Page 17 of 32
APPENDIX A
USE AND DISCLOSURE OF CONFIDENTIAL INFORMATION
People with access to confidential information are responsible for understanding and following
the laws, policies, procedures, and practices governing it. Below are key elements:
A. CONFIDENTIAL INFORMATION
Confidential information is information federal and state law protects from public
disclosure. Examples of confidential information are social security numbers, and
healthcare information that is identifiable to a specific person under RCW 70.02. The
general public disclosure law identifying exemptions is RCW 42.56.
B. ACCESS AND USE OF CONFIDENTIAL INFORMATION
1. Access to confidential information must be limited to people whose work
specifically requires that access to the information.
2. Use of confidential information is limited to purposes specified elsewhere in this
Agreement.
C. DISCLOSURE OF CONFIDENTIAL INFORMATION
1. An Information Recipient may disclose an individual's confidential information
received or created under this Agreement to that individual or that individual's
personal representative consistent with law.
2. An Information Recipient may disclose an individual's confidential information,
received or created under this Agreement only as permitted under the Re-
Disclosure of Information section of the Agreement, and as state and federal laws
allow.
D. CONSEQUENCES OF UNAUTHORIZED USE OR DISCLOSURE
An Information Recipient's unauthorized use or disclosure of confidential information is
the basis for the Information Provider immediately terminating the Agreement. The
Information Recipient may also be subject to administrative, civil and criminal penalties
identified in law.
E. ADDITIONAL DATA USE RESTRICTIONS:
People with access to the information must sign and date the "Use and Disclosure of
Confidential Information Form" (Appendix A) before accessing the information. The
Information Recipient must retain a copy of the signed and dated form for each user as
long as required in Data Disposition Section. The Information Recipient must forward a
copy of the signed and dated form for each user to the RHINO program at
RHINO@doh.wa.go. to obtain access credentials for new users.
An Information Recipient agrees to abide by the best practices for data use outlined in
the RHINO Guide.
ESSENCE User Code of Conduct
DOH Amendment XXXXX-1 Page 18 of 32
System Monitoring —As an authorized user, you understand and acknowledge that your
use of this system will be monitored for system management and to ensure protection
against unauthorized access or use. Unauthorized access or use may subject a user to
administrative, civil, criminal, or other adverse action to the extent allowed by law.
Warnings, Alerts, and Anomalies —Syndromic surveillance systems emphasize the use
of statistical alerting algorithms to help users determine where to focus additional
attention.Time series visualization and statistical alerts alone are generally insufficient
for issuing public alerts or warnings. Users typically"drill down"to these data to assess
the distribution of affected emergency department (ED) visits (or other events captured
by the syndromic surveillance system) and may use additional variables such as person,
place, or time and other clinical assessments. Analyses may include quality checks to
confirm data are complete and accurate.
To that end, users are expected to respect the role of state and local jurisdictions and
their respective authority related to public health matters within their jurisdiction by
• Consulting a jurisdiction whose data you intend to access and use (including
jurisdictions within your own)to discuss a finding or interpretation of these data
before issuing a public statement or warning, taking public health action,or
seeking further information from data providers within the other jurisdiction
when that action includes disclosure of information derived in part or in whole
from the other jurisdiction's data*.
• Informing those who use your data about significant anomalies already
understood or under investigation to prevent duplication of effort and
unnecessary queries.This includes anomalies due to artifacts (like exercises or
batched data) and those due to real local events.
Data Sharing —the design of the BioSense** Platform ensures that all sites contribute data
toward national syndromic surveillance (with limited details at aggregate levels)while also
allowing jurisdictions to control whether and how much data are shared at local and state
levels. Users are expected to act responsibly by
• Assuming the risk and liability of any of their use or misuse of the BioSense
Platform or data produced, including use that complies with third-party rights
(i.e., downstream Data Use Agreements).
• Sharing data with other authorized users in accord with applicable agreements
and laws.
• Ensuring that the use of these data is in accord with acceptable practices for
ensuring the protection, confidentiality, and integrity of contents.
DOH Amendment 31870-1 Page 19 of 32
• Making NO attempt to identify individuals represented in these data or data
sources except as part of an authorized public health investigation follow-up and
to the extent allowed by applicable law.
• Making NO attempt to use these data where prohibited by local, state, or federal
law or regulation.
■ Keeping usernames and passwords confidential;this system is intended for
authorized users only.
Violation of Code of Conduct may result in CDC disallowing access to the BioSense
Platform and associated data and tools within. By accepting this code of conduct,you
acknowledge that you are an authorized user of the BioSense Platform and have read
and understand the BioSense Platform Code of Conduct.
*Cross-jurisdictional consultation and coordination are strongly encouraged, to assist in
the interpretation of data and gain further information to inform effective public health
action. While beneficial, this should not prevent a jurisdiction from exercising their
authority to protect public health.
**BioSense and ESSENCE are used interchangeably
Print Name: Lolinthea Hinkley
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Signature: I1`�'7 K .
Date: /a Uo�S I .
Email Address: L-g nk/e y /, �'*"t rs7;i, , (A. S
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Phone Number: °)2v5 r ��9
Print Name: Tori Ball ( v;Gfpric. II)
Signature:
Date: I243 f aaas
Email Address: V ba 11 Ot, co.)d-kcSOn . IA.1a
Phone Number: (3620) 3 0 - 94ZZ
DOH Amendment 31870-1 Page 20 of 32
APPENDIX B
DATA SECURITY REQUIREMENTS
Protection of Data
The storage of Category 3 and 4 information outside of the State Governmental Network requires
organizations to ensure that encryption is selected and applied using industry standard
algorithms validated by the NIST Cryptographic Algorithm Validation Program. Encryption must
be applied in such a way that it renders data unusable to anyone but authorized personnel, and
the confidential process, encryption key or other means to decipher the information is protected
from unauthorized access. All manipulations or transmissions of data within the organizations
network must be done securely.
The Information Recipient agrees to store information received under this Agreement (the data)
within the United States on one or more of the following media, and to protect it as described
below:
A. Passwords
1. Passwords must always be encrypted. When stored outside of the authentication
mechanism, passwords must be in a secured environment that is separate from the data
and protected in the same manner as the data. For example passwords stored on mobile
devices or portable storage devices must be protected as described under section F. Data
storage on mobile devices or portable storage media.
2. Complex Passwords are:
• At least 8 characters in length.
• Contain at least three of the following character classes: uppercase letters,
lowercase letters, numerals, special characters.
• Do not contain the user's name, user ID or any form of their full name.
• Do not consist of a single complete dictionary word but can include a passphrase.
• Do not consist of personal information (e.g., birthdates, pets' names, addresses,
etc.).
• Are unique and not reused across multiple systems and accounts.
• Changed at least every 120 days.
B. Hard Disk Drives/Solid State Drives— Data stored on workstation drives:
1. The data must be encrypted as described under section F. Data storage on mobile devices
or portable storage media. Encryption is not required when Potentially Identifiable
Information is stored temporarily on local workstation Hard Disk Drives/Solid State Drives.
Temporary storage is thirty (30) days or less.
DOH Amendment 31870-1 Page 21 of 32
2. Access to the data is restricted to authorized users by requiring logon to the local
workstation using a unique user ID and Complex Password, or other authentication
mechanisms which provide equal or greater security, such as biometrics or smart cards.
Accounts must lock after 5 unsuccessful access attempts and remain locked for at least
15 minutes, or require administrator reset.
C. Network server and storage area networks(SAN)
1. Access to the data is restricted to authorized users through the use of access control
lists which will grant access only after the authorized user has authenticated to the
network.
2. Authentication must occur using a unique user ID and Complex Password, or other
authentication mechanisms which provide equal or greater security, such as
biometrics or smart cards. Accounts must lock after 5 unsuccessful access attempts,
and remain locked for at least 15 minutes, or require administrator reset.
3. The data are located in a secured computer area, which is accessible only by
authorized personnel with access controlled through use of a key, card key, or
comparable mechanism.
4. If the servers or storage area networks are not located in a secured computer area or
if the data is classified as Confidential or Restricted it must be encrypted as described
under F. Data storage on mobile devices or portable storage media.
D. Optical discs(CDs or DVDs)
1. Optical discs containing the data must be encrypted as described under F. Data
storage on mobile devices or portable storage media.
2. When not in use for the purpose of this Agreement, such discs must be locked in a
drawer, cabinet or other physically secured container to which only authorized users
have the key, combination or mechanism required to access the contents of the
container.
E. Access over the Internet or the State Governmental Network(SGN).
1. When the data is transmitted between DOH and the Information Recipient, access is
controlled by the DOH, who will issue authentication credentials.
2. Information Recipient will notify DOH immediately whenever:
a) An authorized person in possession of such credentials is terminated or
otherwise leaves the employ of the Information Recipient;
DOH Amendment 31870-1 Page 22 of 32
b) Whenever a person's duties change such that the person no longer requires
access to perform work for this Contract.
3. The data must not be transferred or accessed over the Internet by the Information
Recipient in any other manner unless specifically authorized within the terms of the
Agreement.
a) If so authorized the data must be encrypted during transmissions using a key
length of at least 128 bits. Industry standard mechanisms and algorithms,such
as those validated by the National Institute of Standards and Technology
(NIST) are required.
b) Authentication must occur using a unique user ID and Complex Password (of
at least 10 characters). When the data is classified as Confidential or
Restricted, authentication requires secure encryption protocols and multi-
factor authentication mechanisms, such as hardware or software tokens,
smart cards, digital certificates or biometrics.
c) Accounts must lock after 5 unsuccessful access attempts, and remain locked
for at least 15 minutes, or require administrator reset.
F. Data storage on mobile devices or portable storage media
1. Examples of mobile devices are: smart phones, tablets, laptops, notebook or netbook
computers, and personal media players.
2. Examples of portable storage media are:flash memory devices(e.g. USB flash drives),and
portable hard disks.
3. The data must not be stored by the Information Recipient on mobile devices or portable
storage media unless specifically authorized within the terms of this Agreement. If so
authorized:
a) The devices/media must be encrypted with a key length of at least 128 bits, using
industry standard mechanisms validated by the National Institute of Standards and
Technologies (NIST).
• Encryption keys must be stored in a secured environment that is separate from
the data and protected in the same manner as the data.
b) Access to the devices/media is controlled with a user ID and a Complex Password (of
at least 6 characters), or a stronger authentication method such as biometrics.
c) The devices/media must be set to automatically wipe or be rendered unusable after
no more than 10 failed access attempts.
DOH Amendment 31870-1 Page 23 of 32
d) The devices/media must be locked whenever they are left unattended and set to lock
automatically after an inactivity activity period of 3 minutes or less.
e) The data must not be stored in the Cloud. This includes backups.
f) The devices/media must be physically protected by:
• Storing them in a secured and locked environment when not in use;
• Using check-in/check-out procedures when they are shared; and
• Taking frequent inventories.
4. When passwords and/or encryption keys are stored on mobile devices or portable storage
media they must be encrypted and protected as described in this section.
G. Backup Media
The data may be backed up as part of Information Recipient's normal backup process
provided that the process includes secure storage and transport, and the data is encrypted
as described under F. Data storage on mobile devices or portable storage media.
H. Paper documents
•
Paper records that contain data classified as Confidential or Restricted must be protected by
storing the records in a secure area which is only accessible to authorized personnel. When
not in use, such records is stored in a locked container, such as a file cabinet, locking drawer,
or safe,to which only authorized persons have access.
I. Data Segregation
1. The data must be segregated or otherwise distinguishable from all other data. This is to
ensure that when no longer needed by the Information Recipient, all of the data can be
identified for return or destruction. It also aids in determining whether the data has or
may have been compromised in the event of a security breach.
2. When it is not feasible or practical to segregate the data from other data, then all
commingled data is protected as described in this Exhibit.
J. Data Disposition
If data destruction is required by the Agreement, the data must be destroyed using one or
more of the following methods:
Data stored on: Is destroyed by:
Hard Disk Drives/Solid State Using a "wipe" utility which will overwrite the data at
Drives least three (3) times using either random or single
character data, or
DOH Amendment 31870-1 Page 24 of 32
Degaussing sufficiently to ensure that the data cannot
be reconstructed, or
Physically destroying the disk , or
Delete the data and physically and logically secure data
storage systems that continue to be used for the
storage of Confidential or Restricted information to
prevent any future access to stored information. One
or more of the preceding methods is performed before
transfer or surplus of the systems or media containing
the data.
Paper documents with On-site shredding, pulping, or incineration, or
Confidential or Restricted Recycling through a contracted firm
information y g g provided the
Contract with the recycler is certified for the secure
destruction of confidential information.
Optical discs (e.g. CDs or DVDs) Incineration, shredding, or completely defacing the
readable surface with a course abrasive.
Magnetic tape Degaussing, incinerating or crosscut shredding.
Removable media (e.g. floppies, Using a "wipe" utility which will overwrite the data at
USB flash drives, portable hard least three (3) times using either random or single
disks, Zip or similar disks) character data.
Physically destroying the disk.
Degaussing magnetic media sufficiently to ensure that
the data cannot be reconstructed.
K. Notification of Compromise or Potential Compromise
The compromise or potential compromise of the data is reported to DOH as required in
Section II.C.
DOH Amendment 31870-I Page 25 of 32
APPENDIX C
CERTIFICATION OF DATA DISPOSITION
Date of Disposition
❑ All copies of any Datasets related to agreement DOH# have been deleted from
all data storage systems. These data storage systems continue to be used for the storage
of confidential data and are physically and logically secured to prevent any future access
to stored information. Before transfer or surplus, all data will be eradicated from these
data storage systems to effectively prevent any future access to previously stored
information.
❑ All copies of any Datasets related to agreement DOH# have been eradicated from
all data storage systems to effectively prevent any future access to the previously stored
information.
❑ All materials and computer media containing any data related to agreement DOH
have been physically destroyed to prevent any future use of the materials and
media.
❑ All paper copies of the information related to agreement DOH # have been
destroyed on-site by cross cut shredding.
[� All copies of any Datasets related to agreement DOH # that have not been
disposed of in a manner described above, have been returned to DOH.
❑ Other
The data recipient hereby certifies, by signature below, that the data disposition requirements
as provided in agreement DOH # , Section J, Disposition of Information, have been
fulfilled as indicated above.
Signature of data recipient Date
DOH Amendment 31870-1 Page 26 of 32
APPENDIX D
DOH SMALL NUMBERS GUIDELINES
• Aggregate data so that the need for suppression is minimal. Suppress all non-zero
counts which are less than ten.
• Suppress rates or proportions derived from those suppressed counts.
• Assure that suppressed cells cannot be recalculated through subtraction, by using
secondary suppression as necessary. Survey data from surveys in which 80%or more
of the eligible population is surveyed should be treated as non-survey data.
• When a survey includes less than 80%of the eligible population,and the respondents
are unequally weighted, so that cell sample sizes cannot be directly calculated from
the weighted survey estimates,then there is no suppression requirement for the
weighted survey estimates.
• When a survey includes less than 80%of the eligible population, but the respondents
are equally weighted,then survey estimates based on fewer than 10 respondents
should be "top-coded" (estimates of less than 5% or greater than 95%should be
presented as 0-5%or 95-100%).
ADDITIONAL DATASET SPECIFIC SMALL NUMBERS REQUIREMENTS
Exceptions to the Suppression Rules:
Department of Health Agency Standards for Reporting Data with Small Numbers allow for case-
by-case exceptions in certain circumstances, so that the public may receive information when
public concern is elevated and/or protective actions are warranted.Two examples of such
situations are:
• In a cluster investigation, intense public interest often combines with very small numbers
of cases. In order to be responsive to the community and allay fear,the Data Recipient
may decide it is important to make an exception to the small numbers publishing
standard while still protecting privacy.
• Similarly, in a public health emergency such as a communicable disease outbreak or
other all-hazards incident, case counts may be released when the numbers are very
small.This should be done in the context of an imminent public health threat, such as
person to person spread of disease, where immediate action is indicated to protect
public health.
DOH Amendment 31870-1 Page 27 of 32
When releasing small numbers to the public in the context of the above exceptions, DOH
recommends limiting the amount of information shared in order to protect the identity of the
person(s) involved. In these cases, DOH recommends reporting only the person's gender, decade
of age, and county of residence. For minors, ages should be reported as<18.
For further guidance, please refer to Department of Health Agency Standards for Reporting Data
with Small Numbers.This document contains recommendations and best practices for
protecting the privacy of Washington residents when presenting data to the public.
DOH Amendment 31870-1 Page 28 of 32
APPENDIX E
Tribal Data Sovereignty Principles
These Tribal Data Sovereignty Principles were drafted in partnership with WA Tribes based on the Governor's
Indian Health Advisory Council's Principles. These principles are included in our data sharing agreements at
DOH as a reflection of our commitment to uphold these principles and our government-to-government
relations with Tribes.
Tribal data sovereignty asserts the rights of Tribal Nations to govern the collection, ownership, and application
of their own data,this derives from Tribes' inherent right to govern their peoples, lands, and resources.To
uphold Tribal Data Sovereignty principles, DOH may sign Tribe-specific Data Sharing Agreements, which
include provisions for data sharing and consent for data use via a Tribal Nation Data Use Form.
By signing this agreement, the Information Recipient acknowledges the sovereignty of the Tribal Nations
outlined in these principles.
1. Inherent Authority to Manage Data. Tribes hold the sovereign authority to manage the collection,
ownership, application and interpretation of their own data even when it is collected by federal, state,
or local governments and/or other third parties.
2. Ownership of and Authority Over Tribal Data. Tribes retain an ownership interest in data and
authority even when the Tribe's data are located in a state, federal or other datasets. This interest
remains when the Tribe's data are aggregated with other data.
3. Informed Consent. Tribes have the right to informed consent on how their data, including protected
health information about Tribal members, are used or shared with third parties.
4. Equitable Access to Data. Tribes have the right to exercise their Tribal data sovereignty and must
have the same or enhanced access to state data as other public health jurisdictions to effectively carry
out their governmental duties.
5. Partnership. The agency will make reasonable efforts to collaborate with Tribes,as equal partners,
as outlined in the RCW 43.376.020 (Government-to-government relationships—State agency duties)
and DOH Collaboration & Consultation guidance, and other Tribal data initiatives.
6. Privacy and Security Protections. DOH will work collaboratively with Tribes and use required
administrative, technical and physical security practices to protect Tribal data and the confidentiality
of Tribal data.
7. Tribal Sovereignty and Third-Party Relationships. DOH respects the sovereign rights of Tribes to
enter into other agreements or collaborate with third parties as they deem appropriate.
8. Tribal Data Sovereignty and Third-Party Accountability. DOH will ensure third-party
accountability for adherence to these principles, any applicable privacy laws, and Tribal expectations
for the appropriate use of Tribal data.
DOH Amendment 31870-1 Page 29 of 32
DOH Contract #PRV31870-0
DATA SHARING AGREEMENT
FOR
CONFIDENTIAL INFORMATION OR LIMITED DATASET(S)
BETWEEN
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
AND
JEFFERSON COUNTY dba JEFFERSON COUNTY PUBLIC HEALTH
This Agreement documents the conditions under which the Washington State Department of
Health (DOH) shares confidential information or limited Dataset(s)with other entities.
CONTACT INFORMATION FOR ENTITIES RECEIVING AND PROVIDING INFORMATION
_l
INFORMATION RECIPIENT INFORMATION PROVIDER
Organization Name Jefferson County, dba Washington State Department of
Jefferson County Public Health Health (DOH)
Business Contact Name Veronica Shaw Cynthia Harry
Title Deputy Director Deputy Chief Data Officer
Address 615 Sheridan St, 1610 NE 150th St. MS: K17-9
Port Townsend, WA 98368 Shoreline, WA 98155-9701
Telephone# 360-385-9409 206-472-4530
Email Address veronica@co.jefferson.wa.us cyntkh4ailita.,a{,�tdoh,wa.gov
IT Security Contact Scott Dewald John Weeks
Title Network Administrator Chief Information Security
Officer
Address PO Box 47890
Olympia, WA 98504-7890
Telephone# 360-385-9355 360-999-3454 _
Email Address SDeWald@co.jefferson.wa.us Seruriiy@d h.ww.xPz.
Privacy Contact Name ocean mason Michael Paul
Title Public Health Nurse DOH Chief Privacy Officer
Address 615 Sheridan St. P.O. Box 47890
Port Townsend, WA 98368 Olympia, WA 98504-7890
Telephone# 360-379-4480 564-569-9692
Email Address omason@co.jefferson.wa.us Pparacx.officarOcjoh•wargoV
Page l of 29
AD-2S-056 rev 07/2022
DOH Contract 1tPRV31870-0
DEFINITIONS
Authorized user means a recipient's employees, agents, assigns, representatives, independent
contractors, or other persons or entities authorized by the data recipient to access, use or
disclose information through this agreement.
Authorized user agreement means the confidentiality agreement a recipient requires each of its
Authorized Users to sign prior to gaining access to Public Health Information.
Breach of confidentiality means unauthorized access, use or disclosure of information received
under this agreement. Disclosure may be oral or written, in any form or medium.
Breach of security means an action (either intentional or unintentional) that bypasses security
controls or violates security policies, practices, or procedures.
Confidential information means information that is protected from public disclosure by law.
There are many state and federal laws that make different kinds of information confidential. In
Washington State, the two most common are the Public Records Act RCW 42.56, and the
Healthcare Information Act, RCW 70.02.
Data provider means any individual or entity that provides data to the RHINO program.This
includes all participating hospitals,clinics, and providers.
Data storage means electronic media with information recorded on it, such as CDs/DVDs,
computers and similar devices.
Data transmission means the process of transferring information across a network from a sender
(or source),to one or more destinations.
Direct identifier Direct identifiers in research data or records include names; postal address
information ( other than town or city, state and zip code); telephone numbers, fax numbers, e-
mail addresses; social security numbers; medical record numbers; health plan beneficiary
numbers; account numbers;certificate/license numbers; vehicle identifiers and serial numbers,
including license plate numbers; device identifiers and serial numbers; web universal resource
locators ( internet protocol (IP) address numbers; biometric identifiers, including finger
and voice prints; and full face photographic images and any comparable images.
Disclosure means to permit access to or release,transfer,or other communication of confidential
information by any means including oral, written, or electronic means, to any party except the
party identified or the party that provided or created the record.
Encryption means the use of algorithms to encode data making it impossible to read without a
specific piece of information, which is commonly referred to as a "key". Depending on the type
of information shared, encryption may be required during data transmissions, and/or data
storage.
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ESSENCE means the CDC National Syndromic Surveillance Program (NSSP) Electronic
Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE)
platform. ESSENCE is a CDC-hosted platform which authorized users access through a web
browser interface. ESSENCE contains syndromic surveillance data from Washington and other
participating states, and includes analytical tools with which authorized users may interact with
the data.
Health care information means any information,whether oral or recorded in any form or
medium,that identifies or can readily be associated with the identity of a patient and directly
relates to the patient's health care...." RCW 70.02.010(7)
Health information is any information that pertains to health behaviors,human exposure to
environmental contaminants, health status, and health care. Health information includes
health care information as defined by RCW 70.02.010 and health related data as defined in
RCW 43.70.050.
Health Information Exchange(HIE) means the statewide hub that provides technical services to
support the secure exchange of health information between HIE participants.
Health official means any individual determined by the public health authority to be necessary
for a public health response pursuant to RCW 43.70.057 Section 6B
Human research review is the process used by institutions that conduct human subject
research to ensure that:
® the rights and welfare of human subjects are adequately protected;
O the risks to human subjects are minimized,are not unreasonable,and are outweighed
by the potential benefits to them or by the knowledge gained; and
• the proposed study design and methods are adequate and appropriate in light of the
stated research objectives.
Research that involves human subjects or their identifiable personal records should be
reviewed and approved by an institutional review board (IRB) per requirements in federal and
state laws and regulations and state agency policies.
Human subjects research; human subject means a living individual about whom an investigator
(whether professional or student) conducting research obtains (1) data through intervention or
interaction with the individual,or(2) identifiable private information.
Identifiable data or records contains information that reveals or can likely associate the identity
of the person or persons to whom the data or records pertain. Research data or records with
direct identifiers removed, but which retain indirect identifiers,are still considered identifiable.
Indirect identifiers are indirect identifiers in research data or records that include all geographic
identifiers smaller than a state , including street address, city, county, precinct, Zip code, and
their equivalent postal codes,except for the initial three digits of a ZIP code;all elements of dates
( except year ) for dates directly related to an individual, including birth date, admission date,
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discharge date, date of death; and all ages over 89 and all elements of dates ( including year)
indicative of such age, except that such age and elements may be aggregated into a single
category of age 90 or older.
Limited dataset means a data file that includes potentially identifiable information. A limited
dataset does not contain direct identifiers.
Normal business hours are state business hours Monday through Friday from 8:00 a.m. to 5:00
p.m. except state holidays.
Potentially identifiable information means information that includes indirect identifiers which
may permit linking an individual to that person's health care information. Examples of potentially
identifiable information include:
• birth dates;
A admission,treatment or diagnosis dates;
• healthcare facility codes;
• other data elements that may identify an individual. These vary depending on factors
such as the geographical location and the rarity of a person's health condition,age,or
other characteristic.
Restricted confidential information means confidential information where especially strict
handling requirements are dictated by statutes, rules, regulations or contractual agreements.
Violations may result in enhanced legal sanctions.
State holidays State legal holidays, as provided in RCW 1.16.050.
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GENERAL TERMS AND CONDITIONS
I. USE OF INFORMATION
The Information Recipient agrees to strictly limit use of information obtained or created
under this Agreement to the purposes stated in Exhibit I (and all other Exhibits
subsequently attached to this Agreement). For example, unless the Agreement specifies
to the contrary the Information Recipient agrees not to:
® Link information received under this Agreement with any other information.
o Use information received under this Agreement to identify or contact
individuals.
The Information Recipient shall construe this clause to provide the maximum protection
of the information that the law allows.
II. SAFEGUARDING INFORMATION
A. CONFIDENTIALITY
information Recipient agrees to:
• Follow DOH small numbers guidelines as well as dataset specific small
numbers requirements. (Appendix D)
• Limit access and use of the information:
• To the minimum amount of information
• To the fewest people.
For the least amount of time required to do the work.
* Ensure that all people with access to the information understand their
responsibilities regarding it.
• Ensure that every person (e.g., employee or agent) with access to the
information signs and dates the "Use and Disclosure of Confidential
Information Form" (Appendix A) before accessing the information.
• Retain a copy of the signed and dated form as long as required in Data
Disposition Section.
The Information Recipient acknowledges the obligations in this section survive
completion, cancellation, expiration or termination of this Agreement.
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B. SECURITY
The Information Recipient assures that its security practices and safeguards meet
Washington State Office of the Chief Information Officer (OCIO) security standard
141.10 Se curly.frrformciuon Tect nc,,oq;
For the purposes of this Agreement,compliance with the HIPAA Security Standard and
all subsequent updates meets OICIO standard 141.10 "Securing Information
Technology Assets."
The Information Recipient agrees to adhere to the Data Security Requirements in
Appendix B. The Information Recipient further assures that it has taken steps
necessary to prevent unauthorized access, use, or modification of the information in
any form.
Note: The DOH Chief Information Security Officer must approve any changes to this
section prior to Agreement execution. IT Security Officer will send approval/denial
directly to DOH Contracts Office and DOH Business Contact.
C. BREACH NOTIFICATION
The Information Recipient shall notify the DOH Chief Information Security Officer
(securrtyatal+ psol within one (1)business days of any suspected or actual breach of
security or confidentiality of information covered by the Agreement.
III. RE-DISCLOSURE OF INFORMATION
Information Recipient agrees to not disclose in any manner all or part of the information
identified in this Agreement except as the law requires,this Agreement permits, or with
specific prior written permission by the Secretary of the Department of Health.
If the Information Recipient must comply with state or federal public record disclosure
laws, and receives a records request where all or part of the information subject to this
Agreement is responsive to the request: the Information Recipient will notify the DOH
Privacy Officer of the request ten (10) business days prior to disclosing to the requestor.
The notice must:
• Be in writing;
• Include a copy of the request or some other writing that shows the:
Date the Information Recipient received the request; and
" The DOH records that the Information Recipient believes are
responsive to the request and the identity of the requestor, if
known.
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IV. ATTRIBUTION REGARDING INFORMATION
Information Recipient agrees to cite "Washington State Department of Health" or other
citation as specified,as the source of the information subject of this Agreement in all text,
tables and references in reports, presentations and scientific papers.
Information Recipient agrees to cite its organizational name as the source of
interpretations, calculations or manipulations of the information subject of this
Agreement.
V. OTHER PROVISIONS
With the exception of agreements with British Columbia for sharing health information,
all data must be stored within the United States.
VI. AGREEMENT ALTERATIONS AND AMENDMENTS
This Agreement may be amended by mutual agreement of the parties. Such amendments
shall not be binding unless they are in writing and signed by personnel authorized to bind
each of the parties
VII. CAUSE FOR IMMEDIATE TERMINATION
The Information Recipient acknowledges that unauthorized use or disclosure of the
data/information or any other violation of sections II or III, and appendices A or B, may
result in the immediate termination of this Agreement.
VIII. CONFLICT OF INTEREST
The DOH may, by written notice to the Information Recipient:
Terminate the right of the Information Recipient to proceed under this Agreement if it is
found, after due notice and examination by the Contracting Office that gratuities in the
form of entertainment, gifts or otherwise were offered or given by the Information
Recipient, or an agency or representative of the Information Recipient, to any officer or
employee of the DOH,with a view towards securing this Agreement or securing favorable
treatment with respect to the awarding or amending or the making of any determination
with respect to this Agreement.
In the event this Agreement is terminated as provided above, the DOH shall be entitled
to pursue the same remedies against the Information Recipient as it could pursue in the
event of a breach of the Agreement by the Information Recipient. The rights and
remedies of the DOH provided for in this section are in addition to any other rights and
remedies provided by law. Any determination made by the Contracting Office under this
clause shall be an issue and may be reviewed as provided in the "disputes" clause of this
Agreement.
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IX. DISPUTES
Except as otherwise provided in this Agreement,when a genuine dispute arises between
the DOH and the Information Recipient and it cannot be resolved,either party may submit
a request for a dispute resolution to the Contracts and Procurement Unit. The parties
agree that this resolution process shall precede any action in a judicial and quasi-judicial
tribunal. A party's request for a dispute resolution must:
• Be in writing and state the disputed issues, and
m State the relative positions of the parties, and
4. State the information recipient's name, address, and his/her department
agreement number,and
O Be mailed to the DOH contracts and procurement unit, P. O. Box 47905,
Olympia, WA 98504-7905 within thirty (30) calendar days after the party
could reasonably be expected to have knowledge of the issue which
he/she now disputes.
This dispute resolution process constitutes the sole administrative remedy available
under this Agreement.
X. EXPOSURE TO DOH BUSINESS INFORMATION NOT OTHERWISE PROTECTED BY LAW
AND UNRELATED TO CONTRACT WORK
During the course of this contract, the information recipient may inadvertently become
aware of information unrelated to this agreement. Information recipient will treat such
information respectfully, recognizing DOH relies on public trust to conduct its work. This
information may be hand written, typed, electronic, or verbal, and come from a variety
of sources.
XI. GOVERNANCE
This Agreement is entered into pursuant to and under the authority granted by the laws
of the state of Washington and any applicable federal laws. The provisions of this
Agreement shall be construed to conform to those laws.
In the event of an inconsistency in the terms of this Agreement,or between its terms and
any applicable statute or rule,the inconsistency shall be resolved by giving precedence in
the following order:
• Applicable Washington state and federal statutes and rules;
9 Any other provisions of the Agreement, including materials incorporated by
reference.
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XII. HOLD HARMLESS
Each party to this Agreement shall be solely responsible for the acts and omissions of its
own officers,employees,and agents in the performance of this Agreement. Neither party
to this Agreement will be responsible for the acts and omissions of entities or individuals
not party to this Agreement. DOH and the Information Recipient shall cooperate in the
defense of tort lawsuits,when possible.
XIII. LIMITATION OF AUTHORITY
Only the Authorized Signatory for DOH shall have the express, implied, or apparent
authority to alter, amend, modify, or waive any clause or condition of this Agreement on
behalf of the DOH. No alteration, modification, or waiver of any clause or condition of
this Agreement is effective or binding unless made in writing and signed by the Authorized
Signatory for DOH.
XIV. RIGHT OF INSPECTIQN
The Information Recipient shall provide the DOH and other authorized entities the right
of access to its facilities at all reasonable times, in order to monitor and evaluate
performance, compliance, and/or quality assurance under this Agreement on behalf of
the DOH.
XV. SEVERABILITY
If any term or condition of this Agreement is held invalid, such invalidity shall not affect
the validity of the other terms or conditions of this Agreement, provided, however,that
the remaining terms and conditions can still fairly be given effect.
XVI. SURVIVORSHIP
The terms and conditions contained in this Agreement which by their sense and context,
are intended to survive the completion, cancellation, termination, or expiration of the
Agreement shall survive.
XVII. TERMINATION
Either party may terminate this Agreement upon 30 days prior written notification to the
other party. If this Agreement is so terminated, the parties shall be liable only for
performance rendered or costs incurred in accordance with the terms of this Agreement
prior to the effective date of termination.
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XVIII. WAIVER OF DEFAULT
This Agreement,or any term or condition,may be modified only by a written amendment
signed by the Information Provider and the Information Recipient. Either party may
propose an amendment.
Failure or delay on the part of either party to exercise any right, power,privilege or remedy
provided under this Agreement shall not constitute a waiver.No provision of this Agreement
may be waived by either party except in writing signed by the Information Provider or the
Information Recipient.
XIX. ALL WRITINGS CONTAINED HEREIN
This Agreement and attached Exhibit(s)contains all the terms and conditions agreed upon
by the parties. No other understandings,oral or otherwise, regarding the subject matter
of this Agreement and attached Exhibit(s) shall be deemed to exist or to bind any of the
parties hereto.
XX. PERIOD OF PERFORMANCE
This Agreement shall be effective from date of execution through 4/30/2027.
SPECIAL TERMS AND CONDITIONS
XXI. The information recipient shall:
a. Not utilize the information obtained through this agreement except for purposes
of public health and/or healthcare practice which do not constitute research
activities as defined in RCW 42.48,010. Additional uses, including use of the data
to conduct research, require an amendment or separate agreement. Information
recipient must make a new data request to use this data for research purposes,
and research projects require approval of the Washington State Institutional
Review Board (WSIRB) and execution of a Confidentiality Agreement for the
research project.
b. Take all reasonable steps to prevent unauthorized access to the ESSENCE
platform and any data obtained through this agreement which may be
considered private or confidential under state or federal law.
c. Not publish or otherwise disclose any data which may directly or indirectly
identify an individual,except as allowed by law within the confines of a public
health investigation. Furthermore,the information recipient shall not publish the
identity of a data provider (hospital,clinic, or provider) except with the consent
of the data provider.
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d. Not attempt to determine the identity of persons whose information is included
in the data set or use the data in any manner that identifies individuals or their
families,except to investigate events of potential public health importance (e.g.,
notifiable conditions, outbreaks).
e. Not attempt to obtain additional information about a patient or their visit from a
patient's electronic medical record except for purposes agreed upon by the data
provider(hospital, clinic,or provider) and the information recipient.
f. Not provide or otherwise utilize data obtained through this agreement for
purposes of regulatory action or law enforcement against a data provider,except
as required by state or federal law.
XXII. The Information Recipient may:
a. Publish, redisclose, or release aggregated data in order to protect public health
so long as DOH Small Numbers Publishing Guidelines (Appendix D) and RHINO
Data Best Practices Included in the RHINO Guidebook are adhered to and direct
or indirect identifiers are excluded.
b. Link data obtained through this Agreement with data from other sources,in order
to identify or characterize a specific health problem or evaluate the success of a
specific health program within their statutory authority to provide quality public
health services. Any linked dataset containing data elements obtained through
this agreement are subject to the terms of this Agreement, similar agreements
governing linked datasets, and all state and federal laws that govern any included
datasets.
c. Use data obtained through this Agreement to follow up on specific visits in order
to investigate events of potential public health importance(e.g., notifiable
conditions, outbreaks), In support of such an investigation,data obtained
through this Agreement may be shared with health officials on a "need to know"
basis, sharing the fewest number of data elements with the fewest number of
individuals,for the least amount of time necessary,
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000 Contract #amv31870-0
IN WITNESS WHEREOF, the parties have executed this Agreement as of the date of last
signature below.
INFORMATION PROVIDER INFORMATION RECIPIENT
Jefferson County Washington,
State of Washington Department ofHealth dba Jefferson County Public Health
Signature sgna�,�
HeidiEiaenhour Chair
Michelle Campbell '
Board of County Commissioners
Print Name Printmnnne
09 'll/7026
/ '-
Date Date
Approvpj as to 0
only:
for 08/22/2025
-Philip C— rHunsucker Date
Chief Civil Deputy Prosecuting Attorney
Jefferson County Washington
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EXHIBIT I
1. PURPOSE AND JUSTIFICATION FOR SHARING THE DATA
Provide a detailed description of the purpose and justification for sharing the data, including
specifics on how the data will be used.
Washington Department of Health supports local health jurisdictions(LHJs)and tribes in their
disease and injury surveillance and control activities by providing timely access to data.
ESSENCE data is some of the timeliest information available, with over 90% of emergency
departments reporting visits within 24 hours. LHJs and tribes use this information to identify
and respond quickly to public health threats such as novel pathogens, as well as track injury
and health condition trends, evaluate interventions implemented, and use ESSENCE data
within their statutory authority to provide quality public health services. Additionally,
Washington Department of Health must provide local health jurisdictions and tribes access
to the healthcare encounter data for their jurisdiction by statute (RCW 43.70.057).
Washington Department of Health will provide the requestor with ESSENCE access for
identified users so that they may perform their duties of public health disease monitoring and
control.
Is the purpose of this agreement for human subjects research that requires Washington State
Institutional Review Board (WSIRB) approval?
Yes ® No
If yes, has a WSIRB review and approval been received? If yes, please provide copy of
approval. If No, attach exception letter.
r Yes No
2. PERIOD OF PERFORMANCE
This Exhibit shall have the same period of performance as the Agreement unless otherwise
noted below:
Exhibit I shall be effective from date of execution through 4/30/2027.
3. DESCRIPTION OF DATA
Information Provider will make available the following information under this Agreement:
The Information Provider will provide access to the CDC National Syndromic Surveillance
Program (NSSP) Electronic Surveillance System for the Early Notification of Community-
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based Epidemics (ESSENCE) platform for a limited number of authorized users employed or
contracted by the Information Recipient. User accounts will be established and managed by
the Information Provider.
Authorized users will, upon execution of this Agreement and receipt of signed
confidentiality agreements(Appendix A)from each authorized user, have access to the
complete dataset contained within ESSENCE for the Information Recipient's jurisdiction. For
example, an authorized user employed by a local health jurisdiction (LW)will have access to
all ESSENCE data reported by facilities located in that jurisdiction, and all ESSENCE data for
residents of that jurisdiction. An authorized user employed by a hospital will have access
only to data from that hospital.
Authorized users have the ability to interact with and analyze the data within the ESSENCE
platform. Additionally, authorized users have the ability download partial or complete
datasets from the platform for additional analysis outside of the ESSENCE platform.
Data elements which may be found in ESSENCE for each record (visit) include:
• Facility name
• Facility type
• Admission reason code
a Patient's chief complaint(s)—original and processed entries
6 Patients discharge diagnosis(es)
• Patient's Date of Birth
• Patient's age
a Visit/Admission date and time
• Discharge date and time
• Date and time of death (if applicable)
• Patient's medical record number
• Zip code city,county, and state of patient residence
a Discharge disposition
• Patient's sex
• Patient's race
a Patient's ethnicity
• Facility zip code
• Procedure code
• Initial Temperature
• Initial ED acuity assessment
• Onset date
• Clinical Impression
• Problem list
a Medication list
a Initial pulse oximetry
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• Initial systolic and diastolic blood pressures
• Height
• Weight
• Body mass Index
• Pregnancy status
Q Smoking status
• Travel history
• Visit type
• Mode of arrival
• Clinical Impression
• Triage notes
o Insurance coverage
• Insurance company ID
• Discharge instructions
• Various administrative and system data elements
It is important to note that,while the above listed data elements may exist in the ESSENCE
platform,the elements included for each individual record may vary.This is a result of
variances in data submission among facilities.
The information described in this section is:
V1 Restricted Confidential Information (Category 4)
Confidential Information (Category 3)
Il Potentially identifiable information (Category 3)
[ Internal [public information requiring authorized access] (Category 2)
_f Public Information(Category 1)
Any reference to data/information in this Agreement shall be the data/information as
described in this Exhibit.
4. STATUTORY AUTHORITY TO SHARE INFORMATION
DOH statutory authority to obtain and disclose the confidential information or limited
Dataset(s) identified in this Exhibit to the Information Recipient:
RCW 43.20.050—Powers and duties of state board of health
RCW 43.70.050—Collection,use,and accessibility of health-related data
RCW 70.02.050—Disclosure without patient's authorization
RCW 43.70.057-Hospital emergency room patient care information—Data collection,
maintenance,analysis,and dissemination—Rules
RCW 43.70.130—Powers and duties of secretary—General.
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Information Recipient's statutory authority to receive the confidential information or limited
Dataset(s)identified in this Exhibit
RCW 70.05.060- Powers and duties of local board of health.
RCW 43.70.545- Data collection and reporting rules.
WAC 246-101-505-Duties of the local health officer or the local health department
United States Federal Indian Law
Indian Setf Determination Act 1975
5. ACCESS TO INFORMATION
METHOD OF ACCESS/TRANSFER
1 1 DOH Web Application(indicate application name):
_ Washington State Secure File Transfer Service(sft.wa.gov)
❑ Encrypted CD/DVD or other storage device
❑ Health Information Exchange(HIE)**
® Other:Authorized users will access the data through the CDC NSSP ESSENCE
platform
**NOTE: DOH Chief Information Security Officer must approve prior to Agreement
execution. DOH Chief Information Security Officer will send approval/denial directly to
DOH Contracts Office and DOH Business Contact.
FREQUENCY OF ACCESS/TRANSFER
—
One time: DOH shall deliver information by (insert date)
Repetitive: frequency or dates (Insert dates if applicable)
►! As available within the period of performance stated in Section 2.
6. REIMBURSEMENT TO DOH
Payment for services to create and provide the information is based on the actual expenses
DOH incurs, including charges for research assistance when applicable,
Billing Procedure
9 Information Recipient agrees to pay DOH by check or account transfer within
30 calendar days of receiving the DOH invoice.
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• Upon expiration of the Agreement, any payment not already made shall be
submitted within 30 days after the expiration date or the end of the fiscal year,
which is earlier.
Charges for the services to create and provide the information are:
C $
® No charge.
7. DATA DISPOSITION
Unless otherwise directed in writing by the DOH Business Contact, at the end of this
Agreement,or at the discretion and direction of DOH, the Information Recipient shall:
® Immediately destroy all copies of any data provided under this Agreement
after it has been used for the purposes specified in the Agreement .
Acceptable methods of destruction are described in Appendix B. Upon
completion, the Information Recipient shall submit the attached
Certification of Data Disposition (Appendix C)to the DOH Business Contact.
❑ Immediately return all copies of any data provided under this Agreement
to the DOH Business Contact after the data has been used for the purposes
specified in the Agreement, along with the attached Certification of Data
Disposition (Appendix C)
❑ Retain the data for the purposes stated herein for a period of time not to
exceed (e.g., one year, etc.), after which Information
Recipient shall destroy the data (as described below) and submit the
attached Certification of Data Disposition (Appendix C) to the DOH
Business Contact.
® Other(Describe): Authorized users have the ability to download (copy)
partial or complete datasets from the platform. Upon request by DOH
program staff,at the end of the Agreement term, or when no longer
needed,the Information Recipient shall destroy all copies of any data
provided under this Agreement.Acceptable methods of destruction are
described in Appendix B.
8. RIGHTS IN INFORMATION
Information Recipient agrees to provide, if requested, copies of any research papers or
reports prepared as a result of access to DOH information under this Agreement for DOH
review prior to publishing or distributing.
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In no event shall the Information Provider be liable for any damages, including, without
limitation, damages resulting from lost information or lost profits or revenue, the costs of
recovering such Information, the costs of substitute information, claims by third parties or
for other similar costs,or any special, incidental, or consequential damages,arising out of the
use of the information. The accuracy or reliability of the Information is not guaranteed or
warranted in any way and the information Provider's disclaim liability of any kind whatsoever,
including, without limitation, liability for quality, performance, merchantability and fitness
for a particular purpose arising out of the use, or inability to use the information.
® If checked, please submit the following:
Copies of all papers, presentations, reports, or publications developed
using data obtained under this agreement to the attention of:the
RHINO program at ,
9. ALL WRITINGS CONTAINED HEREIN
This Agreement and attached Exhibit(s) contains all the terms and conditions agreed upon by
the parties. No other understandings, oral or otherwise, regarding the subject matter of this
Agreement and attached Exhibit(s) shall be deemed to exist or to bind any of the parties
hereto.
IN WITNESS WHEREOF, the parties have executed this Exhibit as of the date of last signature
below.
INFORMATION PROVIDER INFORMATION RECIPIENT
Jefferson County Washington,
State of Washington Department of Health dba Jefferson County Public Health
Signature Signature
Michelle Campbell Heidi Eisenhour, Chair
Board of County Commissioners
Print Name Print Name
11/04/2025 /Vg f a 6
Date Date
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APPENDIX A
USE AND DISCLOSURE OF CONFIDENTIAL INFORMATION
People with access to confidential information are responsible for understanding and following
the laws, policies, procedures,and practices governing it. Below are key elements:
A. CONFIDENTIAL INFORMATION
Confidential information is information federal and state law protects from public
disclosure. Examples of confidential information are social security numbers, and
healthcare information that is identifiable to a specific person under RCW 70.02. The
general public disclosure law identifying exemptions is RCW 42.56.
B. ACCESS AND USE OF CONFIDENTIAL INFORMATION
1. Access to confidential information must be limited to people whose work
specifically requires that access to the information.
2. Use of confidential information is limited to purposes specified elsewhere in this
Agreement.
C. DISCLOSURE OF CONFIDENTIAL INFORMATION
1. An Information Recipient may disclose an individual's confidential information
received or created under this Agreement to that individual or that individual's
personal representative consistent with law.
2. An Information Recipient may disclose an individual's confidential information,
received or created under this Agreement only as permitted under the Re-
Disclosure of Information section of the Agreement,and as state and federal laws
allow.
D. CONSEQUENCES OF UNAUTHORIZED USE OR DISCLOSURE
An Information Recipient's unauthorized use or disclosure of confidential information is
the basis for the Information Provider immediately terminating the Agreement. The
Information Recipient may also be subject to administrative, civil and criminal penalties
identified in law.
E. ADDITIONAL DATA USE RESTRICTIONS:
People with access to the information must sign and date the "Use and Disclosure of
Confidential Information Form" (Appendix A) before accessing the information. The
Information Recipient must retain a copy of the signed and dated form for each user as
long as required in Data Disposition Section.The Information Recipient must forward a
copy of the signed and dated form for each user to the RHINO program at
RHINO@doh.wa.gov to obtain access credentials for new users.
An Information Recipient agrees to abide by the best practices for data use outlined in
the RHINO Guide.
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ESSENCE User Code of Conduct
System Monitoring —As an authorized user,you understand and acknowledge that your
use of this system will be monitored for system management and to ensure protection
against unauthorized access or use, Unauthorized access or use may subject a user to
administrative, civil, criminal, or other adverse action to the extent allowed by law.
Warnings,Alerts, and Anomalies —Syndromic surveillance systems emphasize the use
of statistical alerting algorithms to help users determine where to focus additional
attention.Time series visualization and statistical alerts alone are generally insufficient
for issuing public alerts or warnings. Users typically"drill down"to these data to assess
the distribution of affected emergency department(ED)visits (or other events captured
by the syndromic surveillance system) and may use additional variables such as person,
place, or time and other clinical assessments.Analyses may include quality checks to
confirm data are complete and accurate.
To that end, users are expected to respect the role of state and local jurisdictions and
their respective authority related to public health matters within their jurisdiction by
Consulting a jurisdiction whose data you intend to access and use (including
jurisdictions within your own)to discuss a finding or interpretation of these data
before issuing a public statement or warning,taking public health action,or
seeking further information from data providers within the other jurisdiction
when that action includes disclosure of information derived in part or in whole
from the other jurisdiction's data*.
a Informing those who use your data about significant anomalies already
understood or under investigation to prevent duplication of effort and
unnecessary queries.This Includes anomalies due to artifacts (like exercises or
batched data) and those due to real local events.
Data Sharing —the design of the BioSense** Platform ensures that all sites contribute data
toward national syndromic surveillance (with limited details at aggregate levels)while also
allowing jurisdictions to control whether and how much data are shared at local and state
levels. Users are expected to act responsibly by
z Assuming the risk and liability of any of their use or misuse of the BioSense
Platform or data produced, including use that complies with third-party rights
(i.e., downstream Data Use Agreements).
a3 Sharing data with other authorized users in accord with applicable agreements
and laws.
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® Ensuring that the use of these data is in accord with acceptable practices for
ensuring the protection, confidentiality, and integrity of contents.
• Making NO attempt to identify individuals represented in these data or data
sources except as part of an authorized public health investigation follow-up and
to the extent allowed by applicable law.
• Making NO attempt to use these data where prohibited by local,state, or federal
law or regulation.
® Keeping usernames and passwords confidential;this system is intended for
authorized users only.
Violation of Code of Conduct may result in CDC disallowing access to the BioSense
Platform and associated data and tools within. By accepting this code of conduct,you
acknowledge that you are an authorized user of the BioSense Platform and have read
and understand the BioSense Platform Code of Conduct.
*Cross-jurisdictional consultation and coordination are strongly encouraged,to assist in
the interpretation of data and gain further information to inform effective public health
action. While beneficial,this should not prevent a jurisdiction from exercising their
authority to protect public health.
**BioSense and ESSENCE are used interchangeably
Print Name:
Signature:
Date:
Email Address;
Phone Number:
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APPENDIX B
DATA SECURITY REQUIREMENTS
Protection of Data
The storage of Category 3 and 4 information outside of the State Governmental Network requires
organizations to ensure that encryption is selected and applied using industry standard
algorithms validated by the NIST Cryptographic Algorithm Validation Program. Encryption must
be applied in such a way that it renders data unusable to anyone but authorized personnel, and
the confidential process,encryption key or other means to decipher the information is protected
from unauthorized access. All manipulations or transmissions of data within the organizations
network must be done securely.
The Information Recipient agrees to store information received under this Agreement(the data)
within the United States on one or more of the following media, and to protect it as described
below:
A. Passwords
1. Passwords must always be encrypted. When stored outside of the authentication
mechanism, passwords must be in a secured environment that is separate from the data
and protected in the same manner as the data. For example passwords stored on mobile
devices or portable storage devices must be protected as described under section F. Data
storage on mobile devices or portable storage media.
2. Complex Passwords are:
e At least 8 characters in length.
• Contain at least three of the following character classes: uppercase letters,
lowercase letters, numerals, special characters.
• Do not contain the user's name, user ID or any form of their full name.
• Do not consist of a single complete dictionary word but can include a passphrase.
Do not consist of personal information (e.g., birthdates, pets' names, addresses,
etc.).
• Are unique and not reused across multiple systems and accounts.
* Changed at least every 120 days.
B. Hard Disk Drives/Solid State Drives—Data stored on workstation drives:
1. The data must be encrypted as described under section F. Data storage on mobile devices
or portable storage media. Encryption is not required when Potentially Identifiable
Information is stored temporarily on local workstation Hard Disk Drives/Solid State Drives.
Temporary storage is thirty(30) days or less.
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2. Access to the data is restricted to authorized users by requiring logon to the local
workstation using a unique user ID and Complex Password, or other authentication
mechanisms which provide equal or greater security, such as biometrics or smart cards.
Accounts must lock after 5 unsuccessful access attempts and remain locked for at least
15 minutes,or require administrator reset.
C. Network server and storage area networks(SAN)
1. Access to the data is restricted to authorized users through the use of access control
lists which will grant access only after the authorized user has authenticated to the
network.
2. Authentication must occur using a unique user ID and Complex Password, or other
authentication mechanisms which provide equal or greater security, such as
biometrics or smart cards. Accounts must lock after 5 unsuccessful access attempts,
and remain locked for at least 15 minutes,or require administrator reset.
3. The data are located in a secured computer area, which is accessible only by
authorized personnel with access controlled through use of a key, card key, or
comparable mechanism.
4. If the servers or storage area networks are not located in a secured computer area or
if the data is classified as Confidential or Restricted it must be encrypted as described
under F. Data storage on mobile devices or portable storage media.
D. Optical discs(CDs or DVDs)
1. Optical discs containing the data must be encrypted as described under F. Data
storage on mobile devices or portable storage media.
2. When not in use for the purpose of this Agreement, such discs must be locked in a
drawer, cabinet or other physically secured container to which only authorized users
have the key, combination or mechanism required to access the contents of the
container.
E. Access over the Internet or the State Governmental Network(SGN).
1. When the data is transmitted between DOH and the Information Recipient, access is
controlled by the DOH, who will issue authentication credentials.
2. Information Recipient will notify DOH immediately whenever:
a) An authorized person in possession of such credentials is terminated or
otherwise leaves the employ of the Information Recipient;
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b) Whenever a person's duties change such that the person no longer requires
access to perform work for this Contract.
3. The data must not be transferred or accessed over the Internet by the Information
Recipient in any other manner unless specifically authorized within the terms of the
Agreement.
a) If so authorized the data must be encrypted during transmissions using a key
length of at least 128 bits. Industry standard mechanisms and algorithms,such
as those validated by the National Institute of Standards and Technology
(NIST)are required.
b) Authentication must occur using a unique user ID and Complex Password (of
at least 10 characters). When the data is classified as Confidential or
Restricted, authentication requires secure encryption protocols and multi-
factor authentication mechanisms, such as hardware or software tokens,
smart cards, digital certificates or biometrics.
c) Accounts must lock after 5 unsuccessful access attempts, and remain locked
for at least 15 minutes, or require administrator reset.
F. Data storage on mobile devices or portable storage media
1. Examples of mobile devices are: smart phones, tablets, laptops, notebook or netbook
computers, and personal media players.
2. Examples of portable storage media are:flash memory devices(e.g. USB flash drives),and
portable hard disks.
3. The data must not be stored by the Information Recipient on mobile devices or portable
storage media unless specifically authorized within the terms of this Agreement. If so
authorized:
a) The devices/media must be encrypted with a key length of at least 128 bits, using
industry standard mechanisms validated by the National Institute of Standards and
Technologies(NIST).
• Encryption keys must be stored in a secured environment that is separate from
the data and protected in the same manner as the data.
b) Access to the devices/media is controlled with a user ID and a Complex Password (of
at least 6 characters), or a stronger authentication method such as biometrics.
c) The devices/media must be set to automatically wipe or be rendered unusable after
no more than 10 failed access attempts.
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d) The devices/media must be locked whenever they are left unattended and set to lock
automatically after an inactivity activity period of 3 minutes or less.
e) The data must not be stored in the Cloud. This includes backups.
f) The devices/media must be physically protected by:
4 Storing them in a secured and locked environment when not in use;
• Using check-in/check-out procedures when they are shared; and
s Taking frequent inventories.
4. When passwords and/or encryption keys are stored on mobile devices or portable storage
media they must be encrypted and protected as described in this section.
G. Backup Media
The data may be backed up as part of Information Recipient's normal backup process
provided that the process includes secure storage and transport, and the data is encrypted
as described under F. Data storage on mobile devices or portable storage media.
H. Paper documents
Paper records that contain data classified as Confidential or Restricted must be protected by
storing the records in a secure area which is only accessible to authorized personnel. When
not in use,such records is stored in a locked container,such as a file cabinet,locking drawer,
or safe,to which only authorized persons have access.
I. Data Segregation
1. The data must be segregated or otherwise distinguishable from all other data. This is to
ensure that when no longer needed by the Information Recipient, all of the data can be
identified for return or destruction. It also aids in determining whether the data has or
may have been compromised in the event of a security breach.
2. When it is not feasible or practical to segregate the data from other data, then all
commingled data is protected as described in this Exhibit.
J. Data Disposition
If data destruction is required by the Agreement, the data must be destroyed using one or
more of the following methods:
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Data stored on: Is destroyed by:
Hard Disk Drives/Solid State Using a "wipe" utility which will overwrite the data at
Drives least three (3) times using either random or single
character data, or
Degaussing sufficiently to ensure that the data cannot
be reconstructed,or
Physically destroying the disk, or
Delete the data and physically and logically secure data
storage systems that continue to be used for the
storage of Confidential or Restricted Information to
prevent any future access to stored information. One
or more of the preceding methods is performed before
transfer or surplus of the systems or media containing
the data.
Paper documents with On-site shredding, pulping,or incineration,or
Confidential or Restricted Recycling through a contracted firm provided the
information Contract with the recycler is certified for the secure
destruction of confidential information.
Optical discs (e.g. CDs or DVDs) Incineration, shredding, or completely defacing the
readable surface with a course abrasive.
Magnetic tape Degaussing, incinerating or crosscut shredding.
Removable media (e.g. floppies, Using a "wipe" utility which will overwrite the data at
USB flash drives, portable hard least three (3) times using either random or single
disks, Zip or similar disks) character data.
Physically destroying the disk.
Degaussing magnetic media sufficiently to ensure that
the data cannot be reconstructed.
K. Notification of Compromise or Potential Compromise
The compromise or potential compromise of the data is reported to DOH as required in
Section II.C.
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APPENDIX C
CERTIFICATION OF DATA DISPOSITION
Date of Disposition
❑ All copies of any Datasets related to agreement DOH# have been deleted from
all data storage systems. These data storage systems continue to be used for the storage
of confidential data and are physically and logically secured to prevent any future access
to stored information. Before transfer or surplus, all data will be eradicated from these
data storage systems to effectively prevent any future access to previously stored
information.
(!.'... All copies of any Datasets related to agreement DOH# _have been eradicated from
all data storage systems to effectively prevent any future access to the previously stored
information.
7 All materials and computer media containing any data related to agreement DOH
have been physically destroyed to prevent any future use of the materials and
media,
7 All paper copies of the information related to agreement DOH # have been
destroyed on-site by cross cut shredding.
Fl All copies of any Datasets related to agreement DOH # that have not been
disposed of in a manner described above, have been returned to DOH.
n Other
The data recipient hereby certifies, by signature below, that the data disposition requirements
as provided in agreement DOH # , Section J, Disposition of Information, have been
fulfilled as indicated above,
Signature of data recipient Date
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APPENDIX D
DOH SMALL NUMBERS GUIDELINES
• Aggregate data so that the need for suppression is minimal.Suppress all non-zero
counts which are less than ten.
• Suppress rates or proportions derived from those suppressed counts.
• Assure that suppressed cells cannot be recalculated through subtraction, by using
secondary suppression as necessary. Survey data from surveys in which 80%or more of
the eligible population is surveyed should be treated as non-survey data.
• When a survey includes less than 80%of the eligible population, and the respondents
are unequally weighted,so that cell sample sizes cannot be directly calculated from the
weighted survey estimates,then there is no suppression requirement for the weighted
survey estimates.
• When a survey includes less than 80% of the eligible population, but the respondents
are equally weighted,then survey estimates based on fewer than 10 respondents
should be "top-coded" (estimates of less than 5%or greater than 95%should be
presented as 0-5%or 95-100%).
ADDITIONAL DATASET SPECIFIC SMALL NUMBERS REQUIREMENTS
Exceptions to the Suppression Rules:
Depa=ttiniont of Hea[tN Agency Standards for c t to r)ata with Small Numbers allow for case-
by-case exceptions In certain circumstances,so that the public may receive information when
public concern is elevated and/or protective actions are warranted.Two examples of such
situations are:
• In a cluster investigation,intense public interest often combines with very small numbers
of cases. In order to be responsive to the community and allay fear,the Data Recipient
may decide it is important to make an exception to the small numbers publishing
standard while still protecting privacy.
® Similarly, in a public health emergency such as a communicable disease outbreak or
other all-hazards incident, case counts may be released when the numbers are very
small.This should be done in the context of an imminent public health threat,such as
person to person spread of disease,where immediate action is indicated to protect
public health.
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When releasing small numbers to the public in the context of the above exceptions, DOH
recommends limiting the amount of information shared in order to protect the identity of the
person(s) involved. In these cases, DOH recommends reporting only the person's gender,decade
of age,and county of residence. For minors, ages should be reported as<18.
For further guidance,please refer to Department of Health Agency Standards for Reporting Data
with Small Numbers.This document contains recommendations and best practices for
protecting the privacy of Washington residents when presenting data to the public.
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