West Nile Virus Response Plan

APPENDIX K
Health Information Infrastructure
Details of Action Plan

  1. Standardize Document Interchange Between NYSDOH and LHUs.

    2. Distribute document interchange standards. Detailed standards have been developed. In summary:

    • All documents to the counties from the NYSDOH will be distributed through the Health Information Network (HIN). This ensures word processing compatibility, assures delivery, allows precise access control, and assures confidentiality in transport via encryption and at the destination via HIN security agreements (DOHMEM 96-10). Documents sent by NYSDOH staff for posting should be sent to WNVPostings on Lotus Notes. LHUs will be able to send information for HIN postings using a file upload application. Documents sent for posting should be in either MS Word 97 or in HTML format. When a document is posted on the HIN, e-mail may be used to notify the LHUs that the file has been posted.

    • Confidential information will be exchanged electronically using secure mechanisms on the HIN.

    • The standard word processing format is MS Word 97. Ad hoc communications containing information considered to be non-confidential may be sent via e-mail, but should be plain text, saving MS word attachments for specific applications with known target audiences.

    • All files will be checked for viruses before distributing to others.

    The WNV data group and the Quality Assurance subcommittee of the New York State Association of County Health Officials' Automation Steering Committee have endorsed these standards.

  2. Standardize Information Linkage, Data Sharing and Data Visualization Between Health Jurisdictions and Related State/Federal Agencies.

    • A Geographic Information System (GIS) is essential to the surveillance effort. Since many LHUs have separate GISs, it is important to establish standards for data interchange between them. Protocols for GIS data interchange were developed at the 09-Feb-2000 data workgroup meeting. The standard for geocoding will be NAD83. LHUs will be able to enter and correct geocoding information on electronic surveillance forms. Data entry and serialization of cases, birds, mosquitoes will be on HIN electronic forms. In order to allow local health to avoid double entry and locally process and geocode data, batch serialized records will be downloadable from the HIN for import into local GIS (or other analytical systems). An upload function will be provided on the HIN that will allow local health to submit corrected geocoded information in batch.

    • Data interchange will be required for electronic lab reporting of WNV tests on Human, Bird/mammal and Mosquito surveillance as described in the activity plans for these specific surveillance systems. Standards and electronic methods to implement this capability have been developed previously by NYSDOH to support other electronic laboratory reporting systems. These will be adapted to assure compatibility with WNV lab reporting by Wadsworth Center and other external laboratories that could be involved in the reporting process.

    • Data interchange with NYCDOHMH and CDC will be required for Surveillance data and lab results. NYSDOH is collaborating with both agencies to develop a common core data standard to enable this interchange to occur. These standards will be completed to an extent that will enable NYCDOHMH and NYSDOH to interchange data systems.

    • Standardized reports and data queries for the three surveillance systems will be provided to local health on the HIN. LHUs with local analytical capability will need to download data specific to their county to enable customized local analyses. This capability already exists in the electronic disease reporting system and will be made available for Bird/Mammal and Mosquito surveillance systems.

    • The NYSDOH, in cooperation with the LHUs, will develop patient confidentiality protocols. In addition, NYSDOH and its partners will establish non-disclosure and, where appropriate, data sharing agreements for surveillance and laboratory data.

  3. Establish Secure Electronic Meetings and Ad Hoc File Exchanges Between NYSDOH and LHUs.

    • Use secure file exchange for sending/receiving confidential information. Secure file exchange is available now to all HIN and HPN users. Training in the use of the HIN is ongoing for staff of the LHUs. In addition, training materials are available.

    • The NYSDOH has developed secure electronic meeting rooms with the following requirements:

      • uses existing HIN/HPN web and encryption infrastructure,

      • provides access controlled discussion groups,

      • allows ad hoc file postings to the discussing group by its members,

      • can be customized to individual discussion group needs,

      • interactive notification when new postings are made to the discussion group,

      • ease of training - in common use on the internet,

      • uses existing HIN authentication/access control system.

  4. Integrate Electronic Tracking, Surveillance and Lab Reporting into Central Databases for Humans, Birds/Vertebrates, and Mosquitoes.

    1. Standardize on the existing centralized electronic human disease case reporting system on the HIN for statewide WNV surveillance.

      2. NYSDOH has an existing centralized electronic case reporting system on the HIN which:

      • includes the common core form (DC103) and related supplemental forms, including encephalitis;

      • includes sophisticated access rules and edit checks;

      • already provides reports, form-based data entry and batch upload/download of data;

      • supports NETSS reporting to CDC;

      • is in use by counties, including Westchester and Nassau;

      • provides standardized location codes and batch automated geocoding;

      • has a training infrastructure and training tool on the HIN;

      • has access procedures and protocols;

      • has an existing centralized database, field elements and data structure;

      • minimizes record duplication;

      • has quality assurance protocols;

      • has production level operations support, including backup with vaulted offsite storage, automated failure notification and multiple access pathways.

      The core form is completed and standardized. With this system, even if paper reports are received, the basic core and supplemental data may be entered and made available to the LHU for follow-up and completion. Laboratory reporting by Wadsworth Center will be accomplished using file upload in defined formats. The system will support human case reporting as well as specimen and sample tracking. Information interchange with NYCDOHMH will be accomplished by batch file exchanges in defined formats.

      Currently, NYSDOH staff are working on the development of these systems. Workflow processes and data dictionaries have been defined and are undergoing review. Methods for file upload of laboratory results to the HIN are under development with Wadsworth Center and NYCDOHMH. The existing disease case reporting system has built in downloads, queries and summary reports which counties may use to access their data. During the 1999 outbreak, additional data reporting methods were developed to allow rapid dissemination of line listing reports and other information to specific local health staff. NYSDOH will use these existing systems to provide data reports back to LHUs.

    2. Standardize on the existing HIN infrastructure to implement centralized and integrated electronic reporting for Bird/mammal and Mosquito Surveillance.

      3. Details on work flow, data flow and Wadsworth Center lab result reporting have been worked out, and work has been completed on the electronic reporting application for human and dead bird surveillance. A test version of the mosquito surveillance system is operational. We anticipate completion of all related systems on the HIN by May 1, 2000. Electronic lab reporting will be accomplished by file upload using defined data formats. Interchange with NYCDOHMH will be accomplished by interactive electronic forms and batch file interchange using define file formats.

  5. Insure Input on Standards, Adequate Health Information Network (HIN) Access and Training for those Staff Involved in WNV Activities at State and Local Health Departments.

    6. Access and training needs have been defined for LHUs, NYCDOHMH, other health jurisdictions and related state and federal agencies through a survey. The survey:

    • determined if the agency is MS word 97 compatible;

    • requested input on data standards;

    • requested a list of individuals requiring access to discussion groups;

    • requested a list of individuals requiring access to electronic data entry forms for each surveillance system;

    • requested a list of individuals requiring access to data reports from each surveillance system and the level of access needed;

    • determined the training needs of agency staff;

    • obtained input on data interchange and confidentiality protocols, based on protocols developed above, with other counties.