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	"In this Information Age, public health agencies have a central role to play in collecting and interpreting healthcare data and disseminating it to the public. It's a very large part of what we do," says Dr. David Dassey, Deputy Chief of the Los Angeles County Department of Health Services Acute Communicable Disease Control (ACDC) Unit. ACDC is responsible for tracking communicable disease (CD) cases and outbreaks throughout Los Angeles County – at 4083 sq miles with a population of approximately 10 million. "We are responsible for 40% of the CD reporting in the state," says Dr. Dassey, "and our monthly volume probably exceeds the volume of cases smaller states see in a year." The network for gathering and tracking CD information includes ACDC's 25 professional staff, the Morbidity Central Reporting Unit, 12 district health offices, and hundreds of health care professionals, health facilities, and laboratories. With a substantial portion of the population under the care of HMO's and a large number of major reference laboratories and health care institutions within its jurisdiction, ACDC is constantly concerned with improving the lines of communication with these reporting sources. "Passive communication just doesn't cut it," says Dr. Dassey, "you have to find ways to make the system pro-active if you're going to do the job right." To develop a more pro-active approach to CD tracking and reporting, ACDC had to consider a significant overhaul of the old CD reporting system, AVSS (Automated Vital Statistics System) and its existing data collection and management solutions. Under AVSS the work flow process of disease reporting was decentralized and involved both manual and automated input. District-based public health registrars (22 public health registrars located at 12 different sites) served as the initial point of contact for most CD case reports. "We had a tremendous problem with quality control, timeliness and accuracy of the information," notes Dr. Dassey. "Public health registrars could only view the data they had entered at their own sites, we couldn't identify duplicate entries among sites, and, if information associated with one district's case came in to a different district office, the system was too rigid to be able to deal with it." In 1995, as part of its efforts to detect newly emerging infectious diseases, the Centers for Disease Control and Prevention (CDC) awarded a cooperative agreement to ACDC. One of the relevant objectives of the cooperative agreement was to improve and speed-up CD data collection and processing. "The CDC recognized that a number of state and local governments had developed 'homegrown' systems for managing their CD data, and there was value in getting these systems to a common standard that would allow them to share information," says Irene Culver, Project Manager for ACDC's Enhanced Surveillance Project, "that's when we realized we could upgrade AVSS to something that would really do the job at the same time we complied with the CDC's mandate." Visual Confidential Morbidity Report (Visual CMR) was born. Once ACDC received the CDC funds, it began searching for a capable developer to work with, and found Woodland Hills-based Atlas Development Corporation. Atlas is a software consulting firm experienced in building healthcare applications. "We spent a lot of time in the design phase, working closely with Atlas to get what we needed," says Culver, who manages the development effort for DHS. Culver and her group also worked with public health nurses, registrar supervisors, and environmental health inspectors to ensure DHS knew what the end-users wanted. The end product, which features a Graphical User Interface (GUI), is very user friendly and "our people really like the system," notes Culver. "I think getting the stakeholders involved at the outset has really promoted adoption." Visual CMR now enables centralized data entry operations in one office (Morbidity Central Reporting Unit) that coordinates all incoming disease, outbreak, and food borne illness reports via toll free hotline or toll free faxline. District Public Health Registrars, Morbidity Unit, Environmental Health’s Food and Milk Unit, and ACDC are now all linked via Los Angeles County Department of Health Services Wide Area Network (WAN) to help facilitate electronic communication. "This networked functionality makes it easier to get a global view of system activity, caseworker productivity and other information essential to management of the disease reporting process" says Culver. It hasn't all been easy. "Getting disease data to flow automatically with as little provider work as possible is key to a successful reporting system" according to Dr. Dassey. For example, ACDC will soon test the feasibility of electronic laboratory-based reporting using LabWorks, a module Atlas markets to clinical labs nationwide. With the LabWorks interface, laboratories will be able to electronically report lab test results with communicable disease-related information directly into Visual CMR. Other innovations are in the works, such as a case reporting form for doctors and health facilities that will be submitted to a secure web site via the Internet. As Dr. Dassey puts it: "It was hard work, but it was worth it. Visual CMR has improved our reporting and tracking capabilities immeasurably, and, thanks to the work we did with Atlas at the outset, we've got a really solid foundation for the future." Culver notes, "Visual CMR has allowed us to improve local reporting and achieve the CDC objectives. We are very proud of our success and feel confident in our ability to achieve the future goals of the CDC, thanks to Visual CMR." Back to top Home | CMR HTML Demo | Contact Us