1. 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
PHIN
August 28, 2008

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

3. 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 

4. 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.

5. 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

6. 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

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

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

9. Linking cases between the outbreak module and reporting module

10. 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

11. 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

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

13. 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.

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

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

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

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

20. 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.

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