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figure 36.5 Sample of Gantt chart for Utah-RODS project. (Created with Microsoft Project 2000.)
figure 36.5 Sample of Gantt chart for Utah-RODS project. (Created with Microsoft Project 2000.)
integration and coordination of the CBBS with the existing Environmental and Public Health Surveillance strategy.
The network task group included implementing and testing the virtual private networking (VPN) and leased line networks employed, including design, equipment, procurement, configuration, installation, and testing.
Data tasks included verifying data availability, performing modifications to the data as needed, and building and testing the HL-7 interfaces.
The application task grouping entailed adapting RODS to display and analyze the Utah data, including adapting the GIS, user interface, and analytical components.
The Utah RODS project manager (Gesteland) and the Director of the RODS Laboratory (Wagner) drafted data sharing agreements to describe the technical methods for maintaining privacy for the individual and the health system, providing the legal basis for the surveillance system. The complex and time-consuming negotiations over data sharing involved IRB, information security committees, privacy officers, senior administrators, and attorneys from both health systems: the University of Pittsburgh RODS Laboratory and the Utah Department of Health. The implementation process began on December 17,2001, and the completed solution was operational within seven weeks. The decision to run the development task groups in parallel enabled the team to complete all aspects of the project within the required deadline. It took five weeks to obtain IRB approval, and data sharing agreements were signed during weeks six and seven. If the team had scheduled the technical work to begin only after obtaining legal and administrative approvals, the project would have failed.
Within three weeks, the team confirmed data availability and constructed and tested the HL-7 interfaces. Within five weeks, the team had established and tested the secure network connections. Modification of the existing RODS application was surprisingly easy because no historical or live data was available until February. All parties donating time, energy, and expertise with a commitment to success ensured the project's viability.
Each task group completed testing as soon as it could, but the team as a whole could ensure full completion across the system and with users only during the last few days of the project.
5.2. RODS as Part of an Advanced Practice Center for BioSurveillance in the Dallas-Fort Worth Metroplex
The Dallas-Fort Worth metroplex encompasses a large metropolitan area in Texas covering four counties and including a population of 4.3 million. The local health department, Tarrant County Public Health (TCPH), desired to develop biosurveillance services not only for the metroplex but also for the entire North Texas region—a population of more than eight million in 16 counties.
TCPH undertook research and internal communications to review existing biosurveillance systems. It reviewed systems that varied in terms of capability, required infrastructure, and cost.
The TCPH had funds available through a grant from National Association of City County Health Officials (NACCHO) to build an Advance Practice Center for Biosurveillance for the community. This funding was available at the same time that the Dallas-Fort Worth metroplex was eligible to participate in a U.S. Department of Homeland Security funded project called BioWatch Support Implementation and Integration Program (BWSIIP), focusing specifically on enhancing syn-dromic surveillance capabilities but with infrastructure built for more complete biosurveillance purposes.
The initial goals for the CBBS were to set up the CBBS and obtain clinical surveillance data. These goals translated into four groups of tasks: (1) planning/training/reporting, (2) application installation, (3) hospital connections, and (4) verification activities. In each group of tasks, the project managers defined tasks and assigned responsibilities. We detail further the groups of tasks in the "Development" section below.
Negotiation for adequate resources and time—TCPH first evaluated its available resources, finding and using both local and state-wide resources to develop their CBBS solution.
Contracting and Recruitment of Personnel—TCPH was fortunate to have excellent and participative IT staff and systems, cooperation of the local stakeholders, and influential hospital council and state-based resources in the form of a fiberoptic Health Alert Network. However, it had need for appropriate personnel to manage the project. TCPH chose to use some of the supplemental grant funds to hire a business-oriented project director and manager to oversee the development of the system and interact with those inside and outside the organization and, once needed, a technical project manager to coordinate acquisition of data. Within the multicounty project area, TCPH was fortunate to have several epidemiologists that were both interested and knowledgeable in using additional nontraditional data sources to provide alerts for potential disease outbreaks and utilize technologically based methods for assessment, alerting, and reporting.
The project team used a project plan, project schedule, and weekly conference calls to communicate tasks and track progress.
Key requirements, given the scope of ultimate coverage, included hosting the CBBS locally at the TCPH and building it to support the entire region. The project leadership determined they wanted to share data across counties with other health departments, provide access to multiple surveillance data streams 24 hours a day seven days a week through a secure Web site, obtain local emergency department data realtime where possible, access national data, and quickly conduct sophisticated analyses. In addition, they were interested in building hot backup or disaster recovery features for their system.
The project leadership team reviewed these functional requirements against the resources available for the project. Although they had available adequate funding and excellent technical resources, CBBS development expertise was lacking in the project team. Because of this barrier, they realized that they were not equipped to build a system from scratch. Given this realization, they did not translate the functional requirements into detailed technical specifications. Instead, they chose to evaluate existing systems. Through that process they chose a system, RODS, that most closely matched the functional requirements identified, in particular local implementation, technical support, assistance with data collection from local hospitals, an available national data source (the NRDM), analysis tools, a Web-based interface, security, alerting, and reporting mechanisms. In addition, the system chosen was also open source, and the preferred data collection methodology was a real-time method. The TCPH project manager worked with the RODS implementation team to execute the project goals.
System development began once the decision makers on the project had agreed to the system components and an overall project management plan with defined milestones and deadlines. TCPH and the RODS Laboratory worked together to execute development according to the tasks identified in the project plan. The following describes major project activity groups during the development phase.
Planning/Reporting. The planning/reporting group of tasks included preparing the health department for participation in the project, assessing the available human and technical resources, identifying solutions to resource gaps, making local modifications to a sample data use agreement, and prioritizing the hospitals to be connected. Communications and updates to external entities served as milestones and kept the project on track. The project managers determined the most important and most time-consuming data set to obtain would be the emergency department chief complaints from local hospitals. To keep the process moving, they set target dates for the first batch of hospitals to be connected, the next group, as well as the succeeding groups.
Application Installation. Application installation tasks included local installation of the RODS software, which would allow the county's system to receive the data from the hospitals, addition of visualization and analytical tools to the local application once data was being received, and supplemental upgrades to the base system as new features became available. Sample tasks included discussions with the state provider of the Health Alert Network and establishment of remote management of the system application on the local server.
Hospital Connections. The hospital connections group of tasks included working with the hospitals/health systems to be connected and defining milestones for each health system, including dates of initial contact, data use agreement signing, and transmission of data. For each healthcare data provider, the team defined additional technical tasks such as assignment of the project to the IT department within the hospital, verifying data availability, obtaining a historical data set, performing any necessary modifications to and testing of the health information system interfaces, and establishing a real-time connection. This outreach activity and education process to the hospitals strengthened the relationship between the local health department and the key hospitals in the area.
Verification Activities. The validating activities group of tasks included supplemental tasks to the core goal of creating the clinically based surveillance system. Specific tasks included inclusion of the over-the-counter (OTC) data from the NRDM service, and the public health activities related to creating an advisory group for evaluating the collected biosurveillance data.
Training and Maintenance. The RODS group provided training to the technical staff in the core counties and to the larger group of system users. The goal was to transfer knowledge and create a center of excellence within the TCPH department who could then provide advice, information, resources, and support to other communities as an Advanced Practice Center supported by NACCHO. RODS provided training to the system staff to facilitate knowledge transfer; training sessions for the local technical staff, the core set of epidemiologists; and an executivelevel overview session for decision makers. The technical staff would ultimately be responsible for system operation and for subsequent upgrades. They also learned to work with hospitals to create data connections and automate data feeds from other data sources. RODS personnel provided the system users with an executive overview of Biosurveillance, the functions of the system, use of the algorithms for detecting anomalies in the data, and a user manual. Training continued through collaboration efforts and further systems development.
RODS personnel trained TCPH technical staff to include additional data sources and upgrade the system. Because it would maintain the system locally and hire trained staff specifically for the project, TCPH managed system maintenance internally.
Key factors for success included appropriate staffing of the program, coordination of local influencers for the benefit of the program, and constant collaboration between the system developers and the local health department to overcome unexpected hurdles.
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