Outbreak Management and Notifiable Disease Surveillance System Integration: Merlin and the Merlin Outbreak Module Janet Hamilton, MPH Communicable Disease Surveillance & Reporting Manager Florida Department of Health Bureau of Epidemiology Janet_J_Hamilton@doh.state.fl.us PHIN August 28, 2008

Outline What is the Merlin Outbreak Module? Why develop the Merlin Outbreak Module? Key design considerations Evaluation, PHIN Outbreak Management Functional Self Assessment Tool

Background Merlin: Florida Department of Health’s (FDOH) statewide secure web-based disease reporting and epidemiologic analysis system Operational 1/1/2001  Outbreak module: added to the system in 2004 Developed prior to release of the PHIN Outbreak Management standards 

What is the Merlin Outbreak Module? The Merlin Outbreak Module is a tool for documenting and analyzing outbreaks and unusual disease occurrences investigated by county health department epidemiology programs and the state health office.

Why Develop the Merlin Outbreak Module? Facilitate more complete outbreak reporting Provide a tool to CHDs to guide and train staff in outbreak investigation and epidemiology Keep outbreak data collection in the statewide central database Provide a drop-in surveillance tool using the statewide central database Provide a simple way for state staff to assist counties manage outbreaks

Key Design Considerations Highly integrated: ready exchange of records from surveillance application to outbreak module Easy navigation and data entry, mirrors surveillance application Multiple simultaneous users, statewide, different user roles

Merlin Database Outbreak Module Surveillance Module Reportable Diseases Profile Outbreak Definition Case People Environmental Samples People Settings People People Frequencies Risk Factor Analysis

Merlin Home Page Display EpiCom posts or link to system; EpiCom: FDOH outbreak communications and emergency notification system

Linking cases between the outbreak module and reporting module

Key Design Considerations Flexible: easy to design and implement questionnaires Create and display relationships (case and contact, settings) Useful for large and small outbreaks Outbreak summary and analysis features (line list, epi curve, etc.), data export

Evaluation Evaluated using the PHIN Outbreak Management Functional Self Assessment Tool Several gaps were identified, including: Action items: User defined tasks and follow up events Integration with the central electronic laboratory database Laboratory specimen collection tracking Ability to create and save questionnaire templates

Closing the gaps: Action items Action items: User defined tasks and follow up events

Closing the gaps: Lab Results View pending laboratory results associated with the outbreak Search state central FDOH electronic laboratory database Import electronically received laboratory results that are related to an outbreak, and attach them to outbreak associated cases, for both notifiable and non-notifiable diseases.  Electronic laboratory specimen tracking Users to link the laboratory specimen collection record with results and the subject.

Closing the gaps: Lab Results View pending laboratory results associated with the outbreak

Closing the gaps: Import Lab Results Attach to cases Add to outbreak Import and start a new case

Closing the gaps: Survey Questionnaire templates Facilitate data summary and analysis across outbreaks or sites.  Questionnaires can be stored for future use.

Closing the gaps: Survey Library “Choose Template” allows user to browse the library of templates

Conclusions Evaluation using the PHIN Outbreak Management Functional Self Assessment Tool was helpful System interoperability can improve disease investigators’ access to key data and eliminate duplicate data entry.  Integration of the outbreak module with electronic laboratory reporting and the rest of Merlin enables public health information exchange between outbreak response activities and traditional public health surveillance. The intersection of traditional surveillance methods with new technological capabilities allows a focus on end users of the system.

Acknowledgements Richard Hopkins Christie Luce Travis McLane Bernhard Schmid Kim Wiley Stu Gash Juan Gutierrez Greg Baker Lalit Heda Tom Stankus Paul Lindeman