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Application Development

The Office of the Medical Examiner (OME) is a statewide system for investigation of sudden and unexpected death in Utah. OME, in the Utah Department of Health (UDOH), certified over 2000 of the 13,920 deaths in Utah in 2008. 

Information from OME death investigations is currently stored in three separate UDOH data silos that have limited interoperability. These three electronic data systems include death certificates, medical examiner investigations, and laboratory results. Without interoperability, OME staff is required to enter the same data into multiple systems. In addition, the process of requesting laboratory analysis and receiving results is paper based, significantly slowing final cause of death determination in a majority of cases. 

Epidemiological studies and surveillance activities are hindered by the lack of systems integration in UDOH and often require retrospective data linkage. As an example, in 2005, CDC and the UDOH reported that deaths in Utah caused by drug poisoning from non-illicit drugs had increased fivefold from 1991 to 2003. This significant finding relied on retrospective linkage of death certificates, medical examiner records, and toxicology results to describe the problem.

In 2008, funding from a bioterrorism grant from the US Department of Homeland Security was secured to support development of a unique, integrated system for medical examiner and death certificate data.

 

Objectives

The objectives of the Utah Medical Examiner Database project are: 

  • To provide a single point of entry for medical examiner pathologists and staff to manage investigation information. 
  • To develop an operational system that links death certificate, medical examiner, and laboratory data in real time as a resource for epidemiology and public health surveillance.
Referenced File
Submitted by hparton on

The detailed analysis of the epidemiological literature on the 2003 SARS epidemic published in peer reviewed journals has shown that a majority (78%) of the epidemiological articles were submitted after the epidemic had ended, although the

corresponding studies had relevance to public health authorities during the epidemic. The conclusion was that to minimize the lag between research and the exigency of public health practice in the future, researchers should consider adopting common, predefined protocols and ready-to-use instruments to improve timeliness, and thus, relevance, in addition to standardizing comparability across studies.

 

Objective

This paper describes how the ideas and tools of e-commerce can be translated to the investigation of outbreaks: epidemiologists will ‘shop’ the best available items for their

questionnaire, enhance the chances of producing interoperable questionnaires, and speed up the whole process.

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Submitted by hparton on

Secure and confidential exchange of information is the cornerstone of public health practice. Often, this exchange has to occur between public health agencies across jurisdictions. Examples include notification of reportable diseases when the testing and residence of the patient are in different counties. The cross-jurisdictional issues become exaggerated in times of communicable disease outbreaks or events of interest that are not yet classified as outbreaks. Currently, such communication occurs between state and local agencies and between agencies and community clinicians on a personal level, with phone, fax and snail mail. There are a multitude of secured websites hosted by the Utah Department of Health (UDOH) that offer access to single applications requiring approved users to remember multiple sites and logins/passwords. The goal of this project was to develop a centralized, single sign-on secure web portal, from which users could access multiple applications and communicate securely with each other.

 

Objective

There is an urgent need for improved communication between stakeholders involved in outbreak investigations, public health reporting and events of interest occurring between different jurisdictions within the same state. Currently, state and local public health agency personnel rely on personal communications involving phone, fax and snail mail. UDOH sought to develop and encourage the use of a secured web portal that allows access to a variety of applications using a single sign-on. This was achieved by developing a secured communications framework called PHAccess that allows tools and applications to be implemented within a secure web environment, using open source software and Agile methodology techniques. The user-centric design currently hosts an electronic report-staging area, ELR/EMR reporting, webbased reporting, secure messaging between stakeholders and a state laboratory result look-up feature. Currently, there are over 700 registered users; 3693 secure messages that have been exchanged and the site has been accessed over 12,205 times since January 2009. Informal feedback from users has been encouraging and formal evaluation is planned, along with expansion and integration with state level health information exchange projects. 

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Submitted by hparton on

State laws mandate clinicians and laboratories to report occurrences of reportable diseases to public health entities. For this purpose, a set of case-reporting specifications are published and maintained by public health departments. There are several problems with the existing case-reporting specifications: (1) they are described on individual state websites and posters and not structured or executable; (2) the specifications are often misleading representing case classification rather than case reporting criteria; (3) they vary across jurisdictions and change over time; and (4) reporting facilities are required to interpret the criteria and maintain logic in their own systems. To overcome these problems, we are designing and developing a prototype system to represent case-reporting specifications that can be authored and maintained by public health and published openly.

 

Objective

In this paper, we describe the content and functional requirements for a knowledge management system that can be authored by public health authorities to inform reporting facilities ‘what’s reportable where’.

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In the Northern part of Norway, all General Practitioners (GPs) and hospitals use electronic health records (EHR). They are connected via an independent secure IP-network called the Norwegian Health Network. The newly developed “Snow Agent System” can utilize this environment by distributing processes to, and extracting epidemiological data directly from, the EHR system in a geographic area. This system may enable the GPs to discover local disease outbreaks that may have affected the current patient by providing epidemiological data from the local population. Currently, work is being done to add more functionality to the system. The overall goal for this project is to contribute to a system that will share epidemiological information between GPs and provide them with information about contagious diseases that may be useful in a clinical setting.

To achieve this, we need the GPs to accept and use the system. Nearly one half of information systems fail due to user resistance and staff interference despite the fact that they are technologically sound. One of the reasons for user resistance is lack of user involvement and bad design. The more specialized the system, the more you need user research to unsure success. With this in mind we have decided to take a User-Centred-Design approach to the project.

 

Objective

The Norwegian Centre for Telemedicine plans to establish a peer-to-peer symptom based surveillance network between all GPs, laboratories, accident and emergency units, and other relevant health providers in Northern Norway. This paper describes some initial results from a study of GPs’ user requirements, regarding what they want in return from the system.

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Submitted by elamb on

Events of recent years, particularly concern about a possible avian (H5N1) influenza pandemic, have focused increasing attention on the need for timely surveillance, with real time surveillance as the ultimate goal. In a previous study, we reported on the utility of monitoring clinical laboratory results as a means of estimating the incidence of influenza in the U.S. within 24 hours using the Quest Diagnostics Corporate Informatics Data Warehouse. We have now begun to explore the feasibility of near real time surveillance using an internal application capable of providing alerts on unusual conditions within minutes of their occurrence. Our first application of this technology to infectious disease is monitoring activity related to the possible emergence of avian (H5N1) influenza in the United States.

 

Objective

To explore the utility of a system monitoring program for infectious disease surveillance with real time proactive notification.

Referenced File
Submitted by elamb on

Major challenges in syndromic surveillance today include lack of standardization in syndrome definitions and limited ability to detect outbreaks of specific and rare diseases. To generate situational awareness surveillance results across various regions must be comparable and epidemiologically well defined. In addition, the high cost of obtaining and maintaining powerful computing resources (e.g., parallel computers) needed for data processing and analysis, and absence of a protocol for data sharing, highlight some of the obstacles to achieving situational awareness.

Cloud computing is an enabling technology that can overcome these challenges and facilitate new and novel approaches to surveillance.

 

Objective

We present a Cloud Computing based approach to disease surveillance that facilitates efficient data collection, processing and storage, as well as new concepts for data sharing and data fusion, disease search and situational awareness.

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Submitted by elamb on

Timely outbreak detection, and monitoring of morbidity and mortality among Katrina evacuees, and needs assessment for better planning and response were urgent information intensive priorities during Katrina relief efforts at Houston, and called for immediate deployment of a real-time surveillance and needs assessment system ad hoc, in order to collect and analyze relevant data at the scene. Initial requirement analysis revealed the following capabilities as essential to sustain effective response within the shelters:

• The ability to securely collect and integrate data from evacuees seeking any form of health services from all care providers (academic, volunteers, federal, NGOs and international aid organizations, etc), including demographic information, vital signs, chief complaints, disabilities, chronic conditions, current and past medications, traumas and injuries, exposure to toxic materials, clinical laboratory results, past medical history, discharge notes and diagnoses, and ability to collect free text entries for any other information (similar to a full-blown electronic medical records system).

• Proactive survey of demographic profile, physical and mental health status, as well as special needs assessment (e.g., dialysis, medications, etc) from all evacuees.

• The ability to collect uniform information, using any network-enabled device available: PCs, tablets, and handheld devices. 

• The ability to classify observations by processing sign and symptom, chief complaint, medication, and other diagnostic data (including free text entries) through ad-hoc definition of concepts such as (Gastrointestinal, Respiratory, Fever and Rash, etc). 

 

Objective

This paper presents lessons learned from leveraging Internet-based technologies and Services Oriented Architecture in providing timely, novel, and customizable solutions, just in time and for preparedness against unprecedented events such as natural disasters (e.g., Katrina) or terrorism.

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Submitted by elamb on

I Medical services for outpatients are well developed due to universal public health insurance. Even patients who have mild symptoms can visit a clinic freely in Japan. Thus the monitoring of outpatients provides very timely information to detect unusual events. On the other hand, EMRs haven't had much penetration, less than 10% at clinics and 20% at hospitals. Moreover, almost nobody uses HL7 or other standards for EMRs. Therefore, it is very difficult to develop a syndromic surveillance system using EMRs like the U.S. We have to develop a system for each EMR and it has a heavy cost. In Japan, there are about 40 thousand pharmaciesand almost half of drugs prescribed are delivered through pharmacies. Almost all pharmacies record prescriptions electronically. Objective: So that full automatic syndromic surveillance cover the whole of nation, we construct the system using the information of prescription.

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Submitted by elamb on

After the SARS outbreak in 2003, Beijing established Fever Clinics in major hospitals for the early detection of potential respiratory disease outbreaks. The data collection in Fever Clinics contains the basic patient information, body temperature, cough, and breath condition, as well as a primary diagnosis. Since the symptoms and diagnosis are mainly recorded in free text format, it is very difficult to use for data analysis. Because of the problems in data processing, the data collection has decreased.

 

Objective

This paper describes the methodology in the development of an Integrated Surveillance System for Beijing, China.

Referenced File
Submitted by elamb on
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