Epi Gateway: A one-stop surveillance shop Christie Luce 2008 PHIN Conference

Epi Gateway Background Was part of EpiCom – the department’s outbreak communications and emergency notification system External facing application (web board + alerting + other sub-applications) 2007 – EpiCom becomes part of the Florida Department of Health Emergency Notification System (FDENS) Sub-applications are left behind 2008 – Epi Gateway is developed and formalized

(External facing site) CHD influenza activity code reporting Pneumonia and influenza mortality reporting EpiCom (External facing site) Electronic case reporting Respiratory laboratory test reporting

Organizational Structure Division of Disease Control A.G. Holley TB Hospital Bureau of Epidemiology Bureau of Sexually Transmitted Diseases Bureau of HIV/AIDS Bureau of TB & Refugee Health Bureau of Immunizations Merlin PRISM HARS TIMS SHOTS

Background Each bureau maintains its own surveillance system Former “silo” mentality, but slowly coming together Front line county health department staff (epidemiologists & public health nurses) usually have job duties that span the program areas Must continually switch between applications – remembering user name and password for each

Purpose & Goals To bring together all department surveillance systems County health department staff wear a variety of hats To make the transition between systems appear seamless Using single-sign-on (SSO) capabilities To expand electronic reporting capabilities to external partners (practitioners) To link the users that are submitting data with the data Users can generate reports and graphs

SUB APPLICATION County Flu Activity – Counties report flu activity in their areas; similar to state assigned code as reported weekly to CDC Respiratory epidemiologist develops a state activity code State code is sent to CDC Internal application – all users are DOH county staff

SUB APPLICATION: COUNTY FLU ACTIVITY

SUB APPLICATION Pneumonia & Influenza Mortality Reporting Vital Statistics staff scan death certificates and enter the number of people (by age) whose death was attributable to pneumonia and/or influenza Reports and graphs are viewable by county health department staff and Bureau of Epidemiology staff Internal application – all users are DOH county staff

SUB APPLICATION: PNEUMONIA & INFLUENZA MORTALITY

SUB APPLICATION: PNEUMONIA & INFLUENZA MORTALITY

SUB APPLICATION: PNEUMONIA & INFLUENZA MORTALITY

SUB APPLICATION: Respiratory Laboratory Test Result Reporting Modeled after NREVSS Includes capacity to submit for all or any of the following: RSV, influenza, parainfluenza and adenoviruses Hospitals enter the number of tests performed and number of positive results each week Reports are viewable by hospital staff, county health department staff, and Bureau of Epidemiology staff Chance to partner with Children’s Medical Services Internal and external application – end users are hospital staff and DOH staff

RESPIRATORY SYNCYTIAL VIRUS

SUB APPLICATION Electronic Case Reporting Infection Control Practitioners from participating hospitals can enter a case electronically Information being transmitted is confidential and must be protected Information is sent via secure socket layer (SSL) and is pulled into the Merlin reportable disease surveillance application via a web service call Hospitals have access to the information they have submitted for audit purposes External application – end users are hospital staff

Epi Gateway Architecture Ad hoc Surveillance Sub Applications Integration Program Area Surveillance Systems Other Surveillance Systems Interface Epi Gateway

Integration & Interface become transparent by using: Architecture Integration & Interface become transparent by using: Single Sign On Similar look and feel Users experience: Minimally impacted when switching from one application to another

System Security Written primarily in .net environment Utilizes a SQL database Database is located separate from web server and sits behind the DOH firewall Entire application is scanned before Change Control will allow code to be altered in the production system Uses a template for each DOH application Must mitigate vulnerabilities or accept risk

Future Considerations Establish links to: Other surveillance systems Environmental health systems Syndromic surveillance systems Other valuable resources NEDSS-AVR, Data Warehouse Provide tools for: Electronic Laboratory Reporting Small labs can report a single case electronically Established precedent for bring confidential information from an outside source into the DOH network

Next Steps Evaluate effectiveness Plan and execute expansion

Contact Information Christie Luce Florida Department of Health Bureau of Epidemiology 850-245-4444 ext 2450 Christie_Luce@doh.state.fl.us