Communicable Disease Surveillance and Communication System, a.k.a. The Health and Human Services Communication Portal (H

State: MI Type: Model Practice Year: 2010

The communicable disease surveillance and communication system addresses school-based disease reporting, surveillance, crisis communication, and response. With a student population of over 220,000, school reporting provides an important opportunity for disease surveillance in Oakland County. Timely reports of communicable disease activity in schools has the potential to reflect illness patterns in the community as it is occurring and increases the success of early educational messaging and response efforts. An analysis of schools revealed barriers to reporting communicable disease activity to Oakland County Health Division (OCHD). The cumbersome process of submitting hard copy reports resulted in low reporting rates by schools. Ultimately, this led to incomplete analyses of communicable disease activity in the county which inhibited effective response efforts and resulted in lost opportunities for relevant communication with schools and parents. As a result schools were often unaware of public health issues and were inconsistent with their communication to parents. The overall practice goal was to improve communicable disease reporting and risk/crisis communication with schools in Oakland County. The two primary objectives for this project are: Increase the number of schools who submit weekly electronic communicable disease reports more than 75% of the time. Improve the method to disseminate risk and crisis communication messages to school partners and stakeholders. Development of a reporting and communication system that is easy to use would increase the total number of schools reporting on a regular basis. This would facilitate a timely response to identify public health issues and disease. Disseminating messaging through a secure communication system to predetermined user roles, such as school contacts, principals and superintendents ensures the distribution of consistent information among all schools, administrators, and parents. At 20 weeks post implementation the number of schools who provide weekly electronic communicable disease reports more than 75% of the time has increased. During the 2009 H1N1 pandemic the portal was successfully used. With increased reporting capabilities in the hands of the schools, OCHD was able to monitor the initial influx of influenza like illness. This data provided OCHD a warning sign and indication as to the severity of the pandemic in Oakland County. This led to increased preparation and a more rapid response effort including the monumental task of vaccinating the high- risk population. Additionally, based on the level of use and response to the HHSCP, this communication method is now an integral part of the OCHD redundant communication strategy. It has significantly improved communication, allowing for consistent, immediate messaging that is continuously available, making it invaluable to OCHD and our community partners/stakeholders.
The HHSCP system addresses school-based disease reporting and surveillance as well as crisis communication and response. Schools are crucial in disease prevention and control efforts through participation in the reporting process. The Michigan Department of Community Health mandates that all primary or secondary schools, child daycare centers, or camps shall report, within 24 hours of suspecting, both of the following to the appropriate local health department: • The occurrence among those in attendance of any of the reportable communicable diseases • The unusual occurrence, outbreak, or epidemic among those in attendance of any disease, infection, or condition With such a large student population, disease surveillance is necessary to maintain the well-being of students, school staff, families and surrounding communities. School reporting is the primary method Oakland County Health Division (OCHD) uses to gather data regarding communicable disease incidence in educational institutions. It is imperative that schools report communicable disease occurrence when notified, to analyze illness patterns within the community and ensure a timely communication and response effort. Risk and crisis communications are an essential component of disease surveillance. Limitations to existing communication methods required the Health Division to rely on media and other community partners/stakeholders to disseminate public information. Existing communication systems such as e-mail and the Michigan Health Alert Network (MIHAN) are sub-standard. E-mail restricts file size and the number of recipients. Attached documents are static and can become obsolete. MIHAN has restricted access based on emergency preparedness roles. It is also insufficient in allowing local public health agencies to gather community data for disease surveillance. In the summer of 2007, an assessment was conducted with schools to identify barriers and challenges in reporting communicable disease activity to OCHD. It was revealed that within the course of that school year over 12,000 reports were completed by hand and submitted to the OCHD Communicable Disease Unit. The hard copy reports were either mailed or faxed. For the 2006-07 school year 121 public schools and 26 private/charter schools returned weekly reports at least 75% of the time. The assessment indicated the process to submit and record communicable disease activity was labor intensive, cumbersome and untimely for schools and OCHD. The process to submit and record communicable disease activity was inefficient because it required school and Health Division personnel to record the same data. Many times school personnel would submit duplicate reports with contradictory information that resulted in OCHD staff spending hours calling schools as well as reviewing and merging data. Most importantly, this slowed down the ability to quickly assess the County for communicable diseases activity and provide relevant communication and response to schools and community partners. OCHD has a history of effective crisis response and communication utilizing traditional methods with schools and the community. Past events that demonstrate a strong reliance on OCHD response and communication efforts include dealing with a rabid pony situation at a popular local petting zoo, frequented by families and school age children and a regional blackout in 2003. The school assessment, as well as the lessons learned from these events, indicated a need to strengthen disease reporting and risk communication strategies particularly among schools and community partners/stakeholders. The use of technology to enhance and improve efficiencies was identified as a necessity for both reporting and communication functions. The following needs were identified: • Public health and response messages in schools • Channels of communication with schools and community partners/stakeholders 
Agency Community RolesIn Oakland County, OCHD is responsible for monitoring the community for communicable disease activity and providing effective risk/crisis communication to the public. Oakland County Health Division has over 30 programs/services that focus on preventing the spread of disease; ensuring a safe and clean environment; promoting and encouraging healthy behaviors; preparing for emergencies; surveillance of disease threats; and ensuring accessibility of health services. The Health Division identifies real public health issues affecting the community and addresses these needs with cost effective solutions. OCHD programs benefit every Oakland County resident and countless visitors. As the public health authority, OCHD recognized a need to conduct an assessment with schools to address the barriers to reporting communicable disease activity. Results indicated the desire for an efficient way to report communicable disease activity and strengthen communication methods. This motivated OCHD to develop a comprehensive Web-based system for community partners/stakeholders. This one-stop-shop model addressed a multitude of public health issues. These include automating and simplifying the process to report communicable disease activity, a mechanism to disseminate risk/crisis communication and a centralized location to collect and store community resources accessible to all OCHD units. As is common practice in implementing new technology, it is essential to gain support of potential users. During the planning phase, a team of local school district superintendents formed a focus group to discuss administrative uses for the portal, such as high level reporting, as well as the benefits of a “one-stop-shop” for credible, up-to-date public health information. OCHD obtained acceptance from schools by collaborating with them during the planning and testing phases. For example, OCHD involved a local school district to pilot the system for feedback on functionality prior to implementation. Trainings to use the HHSCP were available to schools and early learning centers beginning in June 2009. A vast majority of public, private, charter schools and early learning centers took advantage of this opportunity. To date, 471 educational institutions have been trained: • 325 public schools • 78 early learning centers • 61 private schools • seven charter schools Costs and ExpendituresOCHD formulated the concept and provided business requirements to Oakland County Information Technology for the development of the HHSCP. In 2008, development of the HHSCP began. Within one year the system was tested and deployed for use by OCHD, school districts and additional community partners/stakeholders. To facilitate implementation of the HHSCP, OCHD offered more than 100 classroom style trainings for more than 550 school/early learning center personnel in 386 schools and early learning centers. The original development costs of the HHSCP, totaled $97,600. This included the following services provided by Oakland County Information Technology (OCIT): • Detailed requirements gathering • Database design and development • System programming and development • Testing with OCIT programmers and User Support • Project Management • Hardware (SQL Server 2005, Business Objects XI Web Intelligence, Netegrity Site Minder) • Deployment to production environment The second generation of the HHSCP equaled an additional $73,200.This included enhancements identified by school districts as well as the addition of the communication capabilities. In-kind costs included support time by OCHD personnel during the requirements gathering, testing and implementation phases. This included staff time from the Planning and Evaluation Unit, Communicable Disease Unit and Emergency Preparedness Unit. These costs equaled approximately $50,000. In total project expenditures equaled $221,000. The initial funding source for the original development effort was provided from Oakland County Finance Administrative Leadership Committee. OCHD utilized 800 technology hours allocated to the project from the Oakland County Information Technology Master Plan. Additional development costs were funded by the Oakland County Health Division Cities Readiness Initiative (CRI) grant dollars. ImplementationBased on the history of low communicable disease reporting rates by schools, a study to identify barriers and challenges was conducted by a graduate student in the Health Division, Communicable Disease Unit. Results of this analysis indicated schools felt reporting was cumbersome, time-consuming and unimportant. In addition, schools identified a need for improved communication with the Health Division. Based on this feedback, it was determined a new practice for communicable disease reporting and public health information sharing was needed. The concept of automating communicable disease reporting for schools was approved by the Oakland County Finance Administrative Leadership Committee. Following a review of existing technology, it was determined that a custom application, developed in partnership with Oakland County Information Technology, would best meet the business and technology requirements. The Oakland County Finance Administrative Leadership Committee allocated 800 OCIT project hours for the development, testing, and implementation of the HHSCP. Concurrently, to meet national emergency preparedness indicators, the Health Division identified the necessity to store and share documents/information with schools and community partners/stakeholders. This created a second generation of the HHSCP, which included risk/crisis communication capabilities and a centralized location for document storage. Federal grant dollars funded 600 OCIT project hours to develop the second generation of the HHSCP. Approximately one year after project approval, system development began and was unveiled for testing in the same year. Prior to implementation, the OCHD Communicable Disease Unit and a proactive local school district piloted the portal. To ensure the portal was a functional solution for schools, the Health Division met with the school district to receive feedback. Based on this feedback, enhancements to the portal were made. Concurrently while in the testing phase of the HHSCP, the first wave of the H1N1 pandemic surfaced in Oakland County. Health care partners were granted limited access to the portal for timely response and communication efforts during this crisis and beyond. This enabled the Health Division to enhance its redundant communication strategies by providing consistent, credible communications to our partners in health care. To promote the HHSCP, Health Division staff presented at local conferences and meetings to community partners/stakeholders. These avenues were used to emphasize the advantages and importance of schools, early learning centers, hospitals and private providers utilizing the portal. The message also stressed the significance of collaboration with multiple community partners by delivering consistent, credible communications via the portal. To promote implementation of the portal, a letter was sent to school personnel, administrators and early learning center directors emphasizing the following: • Illness patterns in school age children is an important indicator of communicable disease activity in the community • Disease prevention and control efforts depend on a schools and early learning center participation in the reporting process • Importance of timely submission of communicable disease cases that occur among students and staff • Electronic reporting is quicker than paper reporting, it saves money and is easier to complete. • HHSCP allows for timely two way communication In order to support portal implementation, OCHD offered extensive training for all school/early learning staff. Each public, private/charter school and early learning center was offered an opportunity for training by OCHD staff at their designated location to ensure maximum convenience. In addition, four scheduled trainings were offered at OCHD. In all, OCHD offered more than 100 classroom type trainings for more than 500 school/early learning center personnel in 386 schools and early learning centers.
The overall practice goal was to improve communicable disease reporting and risk/crisis communication within Oakland County.Increase the number of schools who submit weekly communicable disease reports more than 75% of the time. The expectation was to: • Announce the implementation of the HHSCP to all 488 public/private/charter schools and 500 early learning centers prior to the end of the 2008–2009 school year • Provide training options on HHSCP for public/private/charter schools and early learning centers • Maintain support and training options to schools/early learning centers • Encourage on-going weekly reporting from all schools• Prior to the end of the 2008–2009 school year, OCHD notified over 1000 schools/early learning centers regarding the HHSCP • To date OCHD has trained 486 schools/early learning centers Utilizing the HHSCP, data collection occurs on a continuous basis by OCHD staff. The data is submitted electronically by participating schools via the portal. Schools and early learning centers may also submit reports by fax or mail. Data that is collected consists of the following: • School demographics(district, name, type, address, phone, fax) • Last time user logged in and saved/submitted a page • Reporting week (MMWR week verses school session week) • School start and end date (or year round) • School in session for the week • Daily/weekly communicable disease reporting(quantity, type, history) The reporting tool allows OCHD administrative users to create “ad-hoc” and pre-existing reports to quickly return time sensitive or historical data for analysis.Data collection began at the start of the 2009–2010 school year. Schools are expected to submit communicable disease activity for their designated facility on a weekly basis. This includes submitting reports when there is no communicable disease activity and when school is not in session during the school year. To provide OCHD with timely information, schools are strongly encouraged to report disease activity on a daily basis.OCHD administrative staff have access to data and reports for quick retrieval of critical information. The results assist OCHD in tracking disease trends in the community. Lessons OCHD has learned to date: • At times, parents provide inadequate information when notifying schools of child illness which is a barrier to accurate reporting • The number of schools that consistently report communicable disease activity on a weekly basis has increased • The immediate availability and accuracy of the data reported by schools has resulted in timely surveillance and a more rapid response by public health • Reporting is more consistent for those schools that attended a classroom style training • Reporting decreases prior to and after busy times in the school year (i.e. Christmas break). Based on findings, modifications include an option for schools to report unspecified illnesses, system generated reminders, regular updates for high level administrators/directors, and follow-up face-to-face or Web-based training options.At 20 weeks post implementation we have increased the number of schools who provide weekly electronic communicable disease reports more than 75% of the time. Number that reported more than 75% of the time: Baseline: 2006- 2007 School Year Public: 121 out of 353 (34.3%) Private/Charter: 26 out of 135 (19.3%) Current: 2009 – 2010 School Year Public: 184 out of 348 (53.3%) Private/Charter: 42 out of 193 (21.7%) During the 2009 H1N1 pandemic the portal was successfully used. With increased reporting capabilities in the hands of the schools, OCHD was able to monitor the initial influx of influenza like illness. This data provided OCHD a warning sign and indication as to the severity of the pandemic in Oakland County. This led to increased preparation and a more rapid response effort including the monumental task of vaccinating the high- risk population. Improve the
With the internal and external business environments of the Health Division in a state of continuous evolution, technology and information systems will continue to play a critical role in the delivery of efficient services. By developing the HHSCP as a customized solution, OCHD now has a flexible, compatible, and integrated piece of technology that will continue to be utilized by community partners/stakeholders and other county departments. As trends and disease patterns evolve, OCHD has adapted to changing demands and recognizes the usefulness of advanced, redundant communication. Based on an assessment of the HHSPC following the 2009 H1N1 pandemic,stakeholders/ community partners have expressed commitment to maintaining a centralized location to obtain consistent, credible communications for local public health concerns. The following comments have been made regarding the HHSCP: • “Communicable disease activity is more readily accessible and reliable”…Oakland County Epidemiologist • “I like the fact that the information is available anytime”…Oakland Schools Administrator• “It’s so convenient”….school secretary • “It cuts down my workload”…OCHD employee • “On the "green" side of things we have saved so much paper”…school staff • “It truly is a one-stop-shop”…school administrator Internally the County recognizes the need to outline an overall approach for the selection, use, and support of technology that aligns with County resources, business needs, and processes. As part of the County bi-annual Information Technology Master Plan, technical hours and information technology support are dedicated to the sustainability of the projects developed in partnership with OCIT. Therefore, this county-wide approach to develop projects based on standards, consistency, and compatibility allows sharing and cost-effective use of technology enhancing the sustainability of the system. The following are strategies to ensure the use and sustainability of the HHSCP: • Provide continuous communication reminders to stakeholders/community partners • Maintain the portal as a consistent, credible source for public health information • Provide additional trainings via the web and classroom setting to foster timely, accurate communicable disease reporting • Eliminate acceptance of hard copy communicable disease occurrence reporting • Expand the capability for partners to share documents and resources in secure environment • Develop a discussion tool that allows partners to communicate and share their ideas with each other via the portal • Initiate a focus group comprised of stakeholder/community partners for further enhancements to the portal • Expand functionality for additional programs and users