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BACKGROUND: The migration from siloed legacy disease surveillance systems to integrated surveillance systems have become a priority for many public health agencies. An integrated surveillance system has many benefits such as improving data quality, providing timely reporting, reducing redundancy and improving decision support. However, high costs, inadequate resources and infrastructure may prohibit public health agencies from achieving surveillance integration. The Southern Nevada Health District (SNHD) successfully used open source tools to achieve surveillance integration across disparate public health legacy systems including sexually transmitted disease (STD), HIV/AIDS and tuberculosis (TB) using an open source solution called Trisano. Integration of these systems is important because separate systems may lead to untimely identification of co-infected cases. Timely identification of co-infected cases will assist SNHD disease investigators with prioritizing effective treatment interventions, and taking advantage of surveillance functions, skills and resources to address the problems of the target populations.
METHODS: Trisano, adopted in 2010 by SNHD is a NEDSS-compatible system developed by the Utah Department of Health for all reportable diseases including STD, HIV/AIDS and TB. Mirth Connect, an open source HL7 messaging integration engine was implemented to process, standardize, transform, validate and normalize all incoming electronic laboratory results. SNHD also developed several applications to handle the CDC and State data submission.
RESULTS: In 2010 Trisano was initially used for case management and reporting of communicable diseases except STD, HIV and TB. Subsequently STD, HIV and TB disease surveillance was migrated into Trisano from STD*MIS, HIV*MIS and Excel spreadsheets in 2014. A total of 80,031 STD and 9,967 HIV legacy investigation cases were imported to Trisano along with their field records, interview records, risk factors, lab tests and contacts. TB legacy data will be imported during the first quarter of 2015. Since the migration to Trisano a total of 15,792 cases of STD, HIV or TB have been initiated and/or investigated. Further, a total of 1,648 cases were identified in Trisano to be co-infected. Of these cases 1,640 were co-infected with STD/HIV and 8 were co-infected with STD/HIV/TB. After Mirth ELR processing, 83,081 ELRs have been transferred to Trisano for disease investigation in 2014, and 5,675 of them were used for co-infection investigation.
CONCLUSIONS: The integrated Trisano system by identifying co-infected cases timely has led to changes in program policies and more effective public health interventions. Other benefits include streamlining ELR reporting, improving data quality and the harmonization of disease surveillance across different programs.