A Systems Interoperability Approach to Replacing STD*MIS

By Jeff Stover, Director of Health Informatics & Integrated Surveillance Systems, Virginia Department of Health

Health systems integration is one of many approaches to improving the healthcare delivery model within the United States.  Fortunately, the bridges that have historically divided primary care and public health are quickly becoming the ties that bind in today’s healthcare environment.   As public health departments strive to be more data-driven, the inherent value of integrated data systems and data interoperability becomes more significant.

Virginia’s Division of Disease Prevention (DDP) is comprised of HIV/STD/TB/HCV surveillance and prevention programs, HIV care-related services and refugee resettlement activities.  As an integrated division, DDP had continual demands for improved data accessibility and subsequent program action.  The recent inclusion of linkage and retention to care within the Centers for Disease Control and Prevention’s  (CDC) Improving Sexually Transmitted Disease Programs through Assessment, Assurance, Policy Development, and Prevention Strategies (STD AAPPS) grant further highlights this increasing need for data inclusivity. 

In October 2011, the CDC announced discontinuation of ongoing development for the Sexually Transmitted Disease Management Information System (STD*MIS).  This required the remaining 5-8 jurisdictions still using STD*MIS to initiate planning for alternative data management solutions, including either transitioning to vendor-based products or custom-built applications for their respective STD surveillance programs.   

Replacement of STD*MIS provided an opportunity for Virginia to assess larger-scale data management operations as a means of increasing cross-program connectedness.  The DDP assessed numerous options and chose a vendor-based product based on numerous parameters, such as 1) experience with STD*MIS legacy database conversion; 2) web-based application infrastructure to allow for improved local health department accessibility; 3) improved data management stewardship and access control mechanisms; 4) allowance for creating a paperless STD surveillance system between DIS, supervisors and central office staff; 5) ELR infrastructure; and 6) modules for STD/HIV, TB, hepatitis  and HIV care services.

The DDP determined that Maven, from Consilience Software, was the most appropriate commercial-off-the-shelf system capable of serving as a division-wide interoperability system, without additional large-scale programming and build-out effort.  Project Management kick-off occurred in October 2013.   

Phase 1 of this project is based on legacy data conversion and replacement of STD*MIS.  Fortunately, Maven’s STD surveillance module also includes HIV.  Therefore, STD/HIV surveillance activities are both being modeled for Maven inclusion.  The ELR interface is also being developed for receipt, storage, review and importation of messages.  Piloting for STD surveillance and STD/HIV ELR messaging is scheduled for Fall 2014.  Phases 2 and 3 of this project are expected to begin during the summer of 2014.  Phase 2 will involve DDP data management staff creating scripts for automated transfer of HIV data to/from Maven and eHARS.  This will allow eHARS to continue as the primary HIV surveillance application, while providing Maven will updates for STD/HIV matching, analysis and reporting.  Phase 3 will involve an assessment and related data modeling needs involving various hepatitis-related programs, including general infectious disease, immunizations and DDP’s hepatitis prevention initiatives.  The aim is to provide for better assessment of hepatitis activities that occur in distinct programs.   Phases 4 and 5 will involve assessment and modeling for TB and HIV care services programs.  Both of these programs house their data in separate systems.  Scripts will be written to pull specific program data from these systems and upload it to Maven on routine schedules.  Variables will be chosen based on data deemed useful for overall program operations and planning.

Virginia’s procurement of Maven may also provide an avenue for easier data sharing across jurisdictions, as the neighboring jurisdictions of North Carolina and Washington, D.C. are also Maven sites.  As a starting point, Virginia STD and HIV staff is visiting North Carolina during the week of April 14-18, 2014 to learn from their Maven experience.

An integrated approach to STD*MIS system replacement and cross-unit integration will provide greater operational efficiency across multiple DDP programs.   For example, use of an interoperability concept has already allowed for software licensing and project management cost sharing, resulting in 40% of initially planned expenditures from non-STD funds.   Upon completion, DDP should benefit from a more cohesive data system capable of timely co-morbidity identification, improved monitoring of collective disease trends, improved analysis and reporting capacity, system accessibility by local health department staff and increased security controls.