BACKGROUND: Health departments exchange data with a variety of sources, using both traditional (e.g. fax or email) and more modern and secure methods (e.g. automated HL7 messaging). Without sufficient understanding of data flow and a proper data management system, activities like data entry, case investigation, and tracking efforts may be inadequate or duplicated. Additionally, staff turnover and lack of documentation may lead to inactive data connections, which could present a vulnerability for the department. Proper understanding of the data infrastructure remains essential to productivity, cost savings, and security.
METHODS: We conducted exploratory interviews with key employees throughout the health department to discover and investigate the current data connections that link the St. Louis County Department of Public Health (DPH) systems, specifically the county clinic electronic health record system (EHR), to external systems. Our perspective was patient level data flow. Can a patient’s health data be completely tracked from the moment that patient enters a clinic to all of the locations and waypoints it passes through from there? What are the final resting or storage place(s)? We created a visualization to map the data systems that interact with the DPH EHR using an open source mapping tool.
RESULTS: The interviews enlightened us to a variety of data sources and connections previously known only to a few employees at DPH. We are exploring ways in which DPH can more fully utilize these connections and resources while other, now defunct connections may need to be closed or deactivated. The data visualization portrayed unidirectional and bidirectional data flow, including both manual and automated systems of communication.
CONCLUSIONS: In order to successfully implement informatics projects, it is imperative to first understand and document critical factors such as where data reside, who has access to it and at what stages, how often it is accessed, where it flows to and from, and how personnel or divisions within the organization utilize it. The data flow visualization map will be considered a living document, reviewed on a regular basis. Information from this project will help to inform creation of data dashboards and lay the foundation for enhanced surveillance systems within DPH. Future directions also include conducting a survey to assess utility for employees and collect feedback to improve the document’s usefulness.