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TB Notes 1, 2000
Introduction
Where We've Been and Where We're Going: Perspectives from CDC's Partners in TB Control
Changes I've Seen
TB Control in New York City: A Recent History
Not by DOT Alone
Baltimore at the New Millennium
From Crickets to Condoms and Beyond
The Denver TB Program: Opportunity, Creativity, Persistence, and Luck
National Jewish: The 100-Year War Against TB
Earthquakes, Population Growth, and TB in Los Angeles County
TB in Alaska
CDC and the American Lung Association/ American Thoracic Society: an Enduring Public/Private Partnership
The Unusual Suspects
The Model TB Prevention and Control Centers: History and Purpose
My Perspective on TB Control over the Past Two to Three Decades
History of the IUATLD
Thoughts about the Future of TB Control in the United States
Where We've Been and Where We're Going: Perspectives from CDC
Early History of the CDC TB Division, 1944-1985
CDC Funding for TB Prevention and Control
Managed Care and TB Control - A New Era
Early Research Activities of the TB Control Division
The First TB Drug Clinical Trials
Current TB Drug Trials: The Tuberculosis Trials Consortium (TBTC)
TB Communications and Education
TB Control in the Information Age
Field Services Activities
TB's Public Health Heroes
Infection Control Issues
A Decade of Notable TB Outbreaks: A Selected Review
International Activities
The Role of CDC's Division of Quarantine in the Fight Against TB in the U.S.
The STOP TB Initiative, A Global Partnership
Seize the Moment - Personal Reflections
 
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This is an archived document. The links are no longer being updated.

TB Notes 1, 2000

TB Control in the Information Age

by Jose Becerra, MD, MPH
Chief, Computer and Statistics Branch

"TRS is a computer-based system devised to furnish current information on clinical management of patients and up-to-date statistical summary reports for public health administrative purposes."
- Tuberculosis Branch, State and Community Services Division, National Communicable Disease Center, Sept. 1969.

Thus was recorded one of the first iterations of an electronic information management system for the purpose of tracking the epidemiology and clinical management of TB in the United States. The Tuberculosis Record Service (TRS), a mainframe system using punch cards and computer tapes for data processing, was a predecessor of the DOS-based SURVS-TB (Software for Expanded Tuberculosis Surveillance). SURVS-TB, a microcomputer system depending on mailed diskettes for data transfer, and the Tuberculosis Database System (TBDS), a patient management recordkeeping system, were used until 1998 when the Tuberculosis Information Management System (TIMS) was implemented. Regardless of names and versions, TB information management systems pursue the same general objective: the use of meaningful data, that is, intelligence-added data, to perform organizational work and monitor outcomes.

Image 1: Logo of the Tuberculosis Information Management System (TIMS)

TIMS is an integrated client-server application in Windows, meaning that many users ("clients") may simultaneously access a fully relational database residing in a secure server within a computer network, using the Microsoft Windows graphics user interface. TIMS has replaced the mailing of diskettes with dedicated modem communications for data transfer purposes. Furthermore, TIMS allows the generation of surveillance data from the patient management module integrated within TIMS. Soon, TIMS will also be able to import surveillance data from other systems to completely eliminate the need for double data entry.

However, when TIMS was originally designed, the Internet revolution that nowadays dominates the informatics world was just beginning. The World-Wide Web model, wherein interactive and secure data transactions are conducted using a common viewer or "browser," regardless of the original platform in which an application is developed, poses new opportunities and challenges to the future of TIMS. Among these challenges are 1) the speed with which information technology is being adopted (and abandoned); and 2) the call for fully "integrated" information systems.

The transition of TIMS into a Web-enabled application will eventually occur. We can envision a local department of health, with a low-end ("thin") computer and a browser, logging in to a state or regional server to securely send in interactively validated TB data or to browse the results of some descriptive trend analyses. We can also envision a health maintenance organization uploading data on a batch of TB suspects and contacts to be worked up by local health department staff. These data would be subsequently sent to CDC without personal identifiers, using a commonly agreed-upon format. However, the speed with which information technology is changing many times hinders the wise selection of platforms, software development tools, and practices that permit the design of durable and reliable Web-based surveillance systems.

Image 2: A picture of a woman standing in front of a file drawer. Old TB record keeping system.

The word integration is trendy nowadays. However, integration is a value-laden term that may mean consolidation to some, as in block grants, while it may mean coordination of efforts to others. TIMS might be considered an integrated system: it integrates patient management with surveillance data. And TIMS will become fully integrated with other information management systems once its data import utilities are completed and a new version is released complying with public health, clinical, and laboratory informatics standards now in development as part of the CDC-wide surveillance integration efforts. The future of TIMS hinges on the assumption that TB will remain a categorically funded program, possibly integrated with other disease-prevention efforts in a patient-centered health care delivery model, but ultimately accountable for its funding. Therefore, TIMS will reflect this funding accountability by protecting TB data integrity and its proper use for program evaluation purposes.

Our organizational mission is to promote health and quality of life by preventing, controlling, and eventually eliminating TB from the United States. Our National Strategic Plan calls for a reduction of the TB case rate to less than one per million population by the year 2010. Therefore, we need to leverage information technology to manage, analyze, and synthesize practical knowledge at the local, state, national, and international level to facilitate the organizational work that will move us closer to that organizational objective.

Data are processed; information is managed; knowledge empowers. Information becomes knowledge, and thus power, when systematically structured and functionally organized for a specific purpose. But there is one crucial premise in this line of reasoning: the existence of an organizational will. An organizational will requires commitment to accomplish a mission, and that commitment begins with a will to know. Once that organizational will is present, and it certainly is present in the TB prevention community, TIMS is and will be ready to facilitate the organizational work that will move us closer to achieve our organizational objectives for the year 2000 and beyond.

 


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

Please send comments/suggestions/requests to: hsttbwebteam@cdc.gov, or to
CDC/Division of Tuberculosis Elimination
Communications, Education, and Behavioral Studies Branch
1600 Clifton Rd., NE - Mailstop E-10, Atlanta, GA 30333