Connecticut Concussion Tracker (CT)2 October 9, 2014 Joanne Conover, Ph.D., Associate Professor Department of Physiology and Neurobiology University of Connecticut 75 N. Eagleville Road, U-3156 Storrs, CT 06269-3156 860 486 8338 joanne.conover@uconn.edu Steven A. Demurjian, Ph.D., Professor Computer Science & Engineering Department 371 Fairfield Road, U-4155 Storrs, CT 06269-4155 860 486 3719 steve@engr.uconn.edu Thomas P. Agresta, M.D., M.B.I, Professor Department of Family Medicine – Medical Informatics University of Connecticut Health Center 263 Farmington Avenue Farmington, CT 06030-6029 860 679 3198 agresta@uchc.edu © Copyright 2014, 2015, J. Conover, S. Demurjian, and T. Agresta, University of Connecticut.

Objectives of (CT)2 Suite of Applications for Concussion Tracking in support of new CT Law HB5113 Mobile and Web Versions Single system for all CT Schools Nurses, Trainers, Coaches, Principals, etc. Provide Additional Policy/Regulatory Capability Data Collection: Causes, Symptoms, Follow-up, Return to Class/Participation Track Students from K to 12 Establish Longitudinal Repository Advanced Reporting Capabilities for both Schools and State Deleted: Central Location for Storage Hosted at UConn OpenEMR – Electronic Medical Record Free & Open Source Certified by Office of National Coordinator for Health IT

Initial Screens *

Selecting State/City/Town/Region/District/School

List of All Students/User and Summary

Remaining Summary Screens

Basic Student Info and Cause of Injury

Basic Student Info and Cause of Injury *

Symptoms within 48 hrs *

Following up with Student *

Returning to Learn and/or Play

Reporting Capabilities Ability to examine data by variety of factors Age Gender Symptoms Duration Sport Football, Soccer, Basketball, Hockey, etc. Days lost Region/School Longitudinal Analysis Tracking trends over time Under Current Development by M. Morton, CSE4701 Intro to Databases, Honors Project Graphs: Breaking out total concussions by sports (would look different if you did it by gender). See concussion rates change over time, for example, football concussions might be decreasing while concussion rates in soccer may be on the rise.

Sample Reports You see trends such as: More concussions occurring in school during middle school years, and the most sports related concussions occurring in HS. Younger players have more concussions in games, but older players have more concussions in practices. Total number of sports concussions peaks at age 14-16. Why?

Sample Reports You see trends such as: More concussions occurring in school during middle school years, and the most sports related concussions occurring in HS. Younger players have more concussions in games, but older players have more concussions in practices. Total number of sports concussions peaks at age 14-16. Why?

Sample Reports You see trends such as: More concussions occurring in school during middle school years, and the most sports related concussions occurring in HS. Younger players have more concussions in games, but older players have more concussions in practices. Total number of sports concussions peaks at age 14-16. Why?

Next Steps for (CT)2 Establishing (CT)2 Team Involved UConn/UCHC Personnel Department of Education Representatives Identify Schools to Participate in Early Stages Requirements Gathering for Security Access Survey schools - who enters or accesses data Design security/role based access User Centric-Design and Implementation Session Reports, user interface, content modifications Deploy Test Version by Dec. 1, 2014 to gather input Objectives: Put into Hands of Potential Users Admin, Nurses, Coaches, ADs, etc. Adjust UI and Process

Current (CT)2 Team Physiology and Neurobiology Dr. J. Conover/Ms. R. Acabchuk (PhD student) Computer Science & Engineering Dr. S. Demurjian, Ms. X. Shao (PhD student), Joshua Diffenderfer (MS Student), M. Morton (Ugrad) Kinesiology Dr. Lindsay Distefano Nursing and Public Engagement Dr. Carol Polifroni School Nurse Ms. L. Demurjian, RN, MBA, Nurse Medical Doctor & Medical Informatics Dr. Tom Agresta, MD, MBI

Interactions with Uconn Athletic Training Identify Collaborators from UConn AT Potential Usage of (CT)2 by UConn AT Taking the App into the Field User Interface and Usability Testing Sharing the App with Members at Schools Nurses, Coaches, Trainers, etc. Suggestions for Changes/Enhancements What are Other Potential Collaborations?

Next Steps for (CT)2 Deploy Wider-Scale Pilot Version Develop Pilot rollout and evaluation strategy Pilot Version Very soon Android application Secure Data Exchange and Encryption in Database UI Design, Performance, and Load Testing Wide Range of Schools – Urban, Suburban, Rural, Public, Private, etc. Identify Stakeholders and Obtain Feedback Plan Later Increments Statewide Deployment in Fall 2017 (Very Optimistic) Add iOS version Add Canned and Ad-hoc Reporting Add additional data capture screens to facilitate more robust reports (total participation in each sport, out of school sports participation – other as requested)

Connecticut Concussion Tracker Vision

Other Relevant Issues for (CT)2 Data Retrieval Security Requirements Role-Based Authentication/Access Control Identity Management  Data Storage Requirements 

Data Retrieval  Enabling schools to self-evaluate and identify areas for improvement De-identified incident level data available for canned and ad hoc reports by authorized school users. De-identified aggregate & comparative reports available for canned and ad hoc reports by authorized school & state users. Who has access to what type of reports would be determined in concert with Department of Education during project period

Security Requirements for (CT)2 Encryption: All Communication (mobile app or web version) FERPA Compliance: Insure Concussion Records are Available to Parents/Students HIPAA Compliance: Electronic Medical Records to establish a Backend Repository Mobile App No Data left on Phone Encrypted Transmission Web App https No Cookies Backend Storage All HIPAA Fields Encrypted Take Advantage of EMR Secured Report Environment

Role-Based Authentication/Access Control Assigning and Maintaining User Privileges: Who will have access to various features such as view data, update/delete record and close incident? Who will create, assign & manage Admin accounts? Who will assign and maintain user roles? Plans for turnover. Generic Security Levels: Security Administrator Simple User Advanced User Identifying Potential Users: Principal, Nurse, Athletic Trainer, Coaches, Administrators, Athletic Director

Identity Management Student ID Maintenance Consider requirement of tracking multiple incidents for individual students longitudinally If so, student identification be tracked across schools Long term goals Track diabetes, asthma, allergies, other health issues Integration with student health record for complete healthcare record Is the goal to statistically analyze data or to also manage student health? Is it an incident tracking system only? If so, non-clinical. If clinical, then ICD-10 codes for EMR. SSN is best for tracking person. Else, use probabilistic matching software.

Data Storage Requirements Review/finalize App specifications, security, system admin, student ID management, data storage Items to be determined Intellectual property: work UConn Tech Trans Potential expansion – other states or CT colleges Server location options: Initial development and staging at UConn Potential hosting of production at UConn (hosting expense for HIPAA compliance, etc.) Transfer production to State servers Support staff Software maintenance Yearly updates/improvements