Development of a Statewide Central Outbreak Documentation System in Florida for Increased Situational Awareness

BACKGROUND: The Florida Department of Health (FDOH) has developed comprehensive reportable disease and syndromic surveillance systems that are implemented statewide by all 67 county health departments (CHDs).  Outbreak records, however, were maintained independently by CHDs without a single searchable statewide system.  In response to the CDC Public Health Emergency Preparedness (PHEP) capability-based performance measures on public health surveillance and epidemiological investigations, a statewide centralized system for capturing outbreak metadata was proposed.  The web-based Central Outbreak Documentation System (CODS) was developed to meet the PHEP cooperative agreement requirements, to improve documentation about disease outbreaks occurring throughout the state, and to increase situational awareness.                                                                     

METHODS: A multidisciplinary leadership team was assembled and the process for operationalizing the loosely defined PHEP metrics conceived; including determining the procedure for gathering outbreak data and clearly defining the minimum information required for an outbreak report to be considered complete. The CODS team drafted a set of high-level requirements for a web-based system and created a manual outbreak reporting template for use by CHDs involved in the pilot project since August 2011.  Site visits to 15 CHDs and conference calls with 5 CHDs yielded detailed business requirements from an end-user perspective forming the basis for the new system to be tested by the pilot CHDs before statewide deployment in spring 2013.

RESULTS: During the initial year of data collection (pilot phase), the percentage of infectious disease outbreak investigations that generated reports was 97%, with 40% of those reports containing all the minimal data elements.  Based on stakeholder feedback, design of web-based CODS contains several user-friendly features including automatic calculations of PHEP performance measures for reporting by using system-generated algorithms to determine outbreaks, investigations, reports, and minimal elements.  Lessons learned from roll-out of the web-based system will be presented.

CONCLUSIONS: Including end users in the development process generated invaluable input into the functional requirements used by system designers.  Goals include being a beneficial tool for local and state level epidemiologists by reducing duplicative data entry, standardizing recordkeeping, decreasing time burdens by auto-generating health alert posts and reports, and improving timeliness of response efforts.  The development of a centralized location for all outbreak metadata will allow FDOH to meet PHEP grant assessment needs while increasing situational awareness and improving outbreak documentation.  CODS could even form the basis for other states’ outbreak reporting systems.  Review of baseline data suggests further training on outbreak reporting is recommended prior to statewide implementation.