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TB Notes 3, 2004

UPDATES FROM THE SURVEILLANCE, EPIDEMIOLOGY, AND OUTBREAK INVESTIGATIONS BRANCH

SUN Team Activities

Since 1998, the Tuberculosis Information Management System (TIMS) software has been in use in all states and reporting areas, allowing transfer of TB case surveillance data to CDC for reporting of national TB statistics. However, this client/server-based system is now near the end of its useful product life. Technological advances in surveillance reporting, embodied in the National Electronic Disease Surveillance System (NEDSS), are leading TB case reporting into a new era.  NEDSS is being implemented under a CDC-wide plan for surveillance-data gathering, which uses published standards and common user interfaces to operate in a real-time, Web-based environment. Recognizing the need to plan for the transition from TIMS to NEDSS, DTBE created the SUN Team.

The Sites Using NEDSS (SUN) Team was formed in February 2004 and consists of members from multiple branches within DTBE and two state reporting areas. The SUN Team supports reporting areas currently using TIMS that are preparing for transition to NEDSS by providing information, updates, and consultation. The TIMS software will be phased out in stages, and all reporting areas will transition to either the NEDSS base system (NBS) or a NEDSS-compatible system for transmitting TB surveillance data to CDC. The SUN Team also informs senior DTBE staff about technical issues and procedures for the process of successful transition of reporting areas from TIMS to the NEDSS TB Surveillance program area module (PAM) or other NEDSS-compatible systems.

The SUN Team meets biweekly and its membership includes representatives from two reporting areas, one that is going to use a NEDSS-compatible system (Florida) and one that will use the NEDSS base system (South Carolina). Primary SUN Team efforts to date have focused on the following activities:

  • Developing a coordinated DTBE work plan to support internal transition activities,
  • Working to gather information that will be useful for reporting areas and CDC staff in anticipation of the transition process, and
  • Identifying and addressing related issues that affect DTBE across multiple branches and projects.

The SUN Team’s work plan consists of five major objectives:

  • Ascertain and develop state-level transition plans,
  • Develop transition communications plan and processes,
  • Support data migration from TIMS to the NEDSS base system,
  • Ensure accurate surveillance data collection, analysis, and dissemination, and
  • Provide TIMS software maintenance assistance.

These objectives outline the activities and deliverables that will enable TB reporting areas to plan and prepare for this change and ultimately move from TIMS to NEDSS or a NEDSS-compatible system.

Over the past 3 months, the SUN Team has created tools for capturing state profile information and 1-page fact sheets for the NEDSS TB Surveillance PAM and Patient Management projects. The SUN Team has planned an informational website, designated an e-mail address (tbpam@cdc.gov) for general questions about NEDSS and the TB PAM from our stakeholders, and developed a frequently asked questions (FAQs) document, which can be requested by using the e-mail address above. During the next few months, the SUN Team will address issues about TIMS maintenance, including data migration, technical plans for mapping and housing TB surveillance data flowing from TIMS and the NEDSS Base System, and the development of NEDSS-compatible and NBS system resources.

Those interested in learning more about NEDSS can also visit the CDC NEDSS website at http://www.cdc.gov/nedss.  Detailed questions about the TB PAM can be directed to Mr. Philip Baptiste, DTBE TB PAM Project Manager, at pbaptiste@cdc.gov.

—Submitted by Todd Wilson, MS, CHES
Div of TB Elimination

The TB Program Area Module Project for National Surveillance

The Tuberculosis program area module (TB PAM) project is a software development project initiated to support the integration of the national TB surveillance system into the National Electronic Disease Surveillance System and Public Health Information Network. It also addresses the fact that the current TB data reporting software, TB Information Management System (TIMS), is approaching the end of its lifecycle for collecting, analyzing, and reporting RVCT data to CDC.

Upon its completion, the TB PAM will (1) meet the reporting needs of the national TB surveillance system, (2) assist users (state and local TB programs) in a defined and manageable transition from TIMS to NEDSS, (3) offer states a high-quality replacement option for the legacy TIMS surveillance module, and (4) enable each state using its own information system to report TB surveillance data via PHIN messaging.      

Led by DTBE, the software is being developed under a contract with Science Applications International Corporation (SAIC). Participating in the project is a steering committee of representatives from 15 state and 3 big city TB programs, the National TB Controllers Association, the National TB Nurse Consultant Coalition, the Council of State and Territorial Epidemiologists, and the Association of Public Health Laboratories. The CDC project team and the steering committee hold regular meetings to support and expand the requirements-gathering process for developing locally defined fields; processing laboratory results; and entering reports on RVCT data, system administration, and TB surveillance. 

Because of challenges in the development of a defined architectural platform for the next version of the NEDSS base system (NBS), the TB PAM project has experienced some delays. The architecture defines the broad outlines and precise mechanisms of the system. This will allow related software to be easily connected to systems and programs made by other manufacturers. The platform will define the standard around which the TB PAM will be developed. Once the platform has been defined, SAIC developers can produce the desired software, and local TB programs will be able to select compatible hardware and applications if they are developing their own TB information systems.

To successfully manage the challenges of architectural platform design being encountered during this process, we are using the rational unified process (RUP). The RUP is an iterative software development process covering the entire software development lifecycle. It divides the development cycle into a sequence of four phases: inception, elaboration, construction, and transition. This process has enabled us to confront and reduce the risks to successful software development as soon as possible, and focus on realistic objectives related to the development of the TB PAM.

The inception phase, consisting of the TB PAM planning activities, was completed in fall 2003, and the requirements-gathering process (the elaboration phase) was completed in late spring 2004. The construction and testing of the TB PAM was started in summer 2004. By fall 2004, DTBE will have contacted staff of each state TB program to determine how they plan to report RVCT data to DTBE following the transition to PHIN/NEDSS and to help plan the transition from TIMS to PHIN/NEDSS.

We plan to hold a Web-based conference call in fall 2004 to assist in educating state TB programs about the transition process, and about options such as messaging via PHIN for states using PHIN/NEDSS-compatible information systems. We expect to deploy the TB PAM no later than spring 2005 to begin its transition and integration into PHIN/NEDSS. However, the actual release date is dependent on the release and deployment schedule of the next version of the NBS.

—Reported by Philip M.J. Baptiste, MEd
Div of TB Elimination

National TB Surveillance System Update: Public Use Data Set Implementation

Over the past few years, DTBE has received numerous requests from states as well as other stakeholders to establish an online, query-based public use data set for the national TB surveillance system. These requests, coupled with a new CDC/ATSDR data release policy issued in April 2003, have propelled the development of a public use data set, now referred to as the Online Tuberculosis Information System (OTIS).

OTIS will make national TB surveillance system data available to the general public. It will contain information from the Report of Verified Case of Tuberculosis (RVCT) forms submitted to CDC by the 50 states, the District of Columbia, and Puerto Rico. Data on OTIS will be aggregated and modified as needed to block breaches of confidentiality and prevent disclosure of any patient’s identity. OTIS is intended to complement, not replicate, the annual TB surveillance report (Reported TB in the United States, www.cdc.gov/nchstp/tb/surv/Surv.htm) by providing a convenient and comprehensive way to analyze national TB surveillance data. Rather than presenting a series of data tables, OTIS will enable users to focus their queries and perform ad hoc cross-tabulations on variables of interest. When initially implemented, OTIS will include data submitted to CDC from 1993 through 2003. It will be updated each year.

Since the initiation of this process, DTBE has worked closely with state and local data providers to ensure that OTIS is designed to meet their needs, as well as fulfill the requirements of CDC/ATSDR policy. On October 9, 2003, the Surveillance team sent an e-mail to state, local, and big city TB programs, as well as to the National TB Controllers Association (NTCA) and the National Association of City and County Health Officials (NACCHO), requesting volunteers to assist DTBE in the development of the public use data set. These volunteers, representing 22 states and two cities, joined DTBE staff from three branches in establishing the OTIS Steering Committee. From late fall 2003 through winter 2004, DTBE worked with the OTIS Steering Committee to develop the TB Surveillance System Data Release Policy. This contains the elements required by CDC/ATSDR policy, including a list of variables for inclusion in OTIS, the rules necessary to protect the confidentiality of a patient reported with TB (e.g., rules for data aggregation), and a description of the data and its limitations (e.g., the technical notes). The OTIS Steering Committee has provided invaluable input and feedback during the process. In addition, TB programs not represented on the OTIS Steering Committee have been given the opportunity to review the draft policy and provide feedback.

Once the TB policy completes CDC clearance, DTBE will request that each state TB program sign it, indicating whether or not they want their data to be included in OTIS. DTBE anticipates that the TB policy will be sent to states for signature in fall 2004. Following an additional step for validation of the online database, it is planned that OTIS will be available in early 2005.

Once OTIS is fully implemented, DTBE anticipates the following outcomes:

  • Increased use of national TB surveillance data by a range of stakeholders, giving researchers and public health officials an additional tool for monitoring TB trends, focusing TB program priorities, and evaluating progress toward TB elimination;
  • Increased efficiency for stakeholders whose time is spent submitting data requests and awaiting responses; and
  • Decreased resources expended by the TB Surveillance Team in responding to data requests, enabling transfer of resources to other important efforts such as building surveillance-evaluation capacity at the local and state levels, ensuring a high level of data quality for all system levels, and ensuring a smooth transition to the reporting  of TB surveillance data via the Public Health Information Network and the National Electronic Disease Surveillance System.

By achieving these outcomes, OTIS will serve as an important tool in national efforts to eliminate TB in the United States. If you have any comments or questions about OTIS, please contact Lori Armstrong, Project Officer.

—Reported by Jodi Keyserling
Div of TB Elimination

Note: Jodi Keyserling, a Public Health Prevention Specialist, left DTBE for her new PHPS assignment in Sacramento, California, in September 2004. Lori Armstrong will remain the project officer and primary contact for this project at larmstrong@cdc.gov or (404) 639-8860.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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