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TB Notes 1, 2002

Report from the Computer and Statistics Branch

Summary of the NTCA and CDC TIMS Summit

The following is a summary of the Tuberculosis Information Management System (TIMS) summit convened and attended by members of the National TB Controllers Association (NTCA) and CDC/DTBE staff on November 6 and 7, 2001, in Atlanta, Georgia. Jose Becerra, MD, MPH, of CDC and Randall Reves, MD, of the NTCA served as co-moderators of the summit.

Background: To design and develop the TIMS patient management module, CDC conducted a thorough joint application development process in 1993/94 that included input from TB controllers. Throughout the development of TIMS, TB controllers have been concerned about the ability of the TIMS patient management module to fill the needs of TB control programs. The mismatch between this expectation and the actual product has been a cause of great concern among TB controllers, complicated by staff turnover (both at headquarters and in the field), and by the serious defects that plagued the first versions of TIMS. An Information Technology Working Group of the NTCA was formed to work with DTBE on addressing the need for patient management systems that could enhance TB control as well as addressing public health reporting requirements. As a result of fruitful discussions generated at a session organized by the Information Technology Working Group at the June NTCA meeting, a subsequent meeting was sponsored by CDC/DTBE in Atlanta in November. The TB control professionals of the NTCA and CDC who attended the TIMS summit meeting did so for several reasons: to review the modules that have been developed by various local programs; to determine which modules, or components of modules, are the most successful and adaptable to other programs; to prepare for the technology of the future via discussions about the National Electronic Disease Surveillance System (NEDSS); and to eventually present jointly with CDC a robust and usable product.

Meeting summary: Jose Becerra, MD, MPH, chief of the Computer and Statistics Branch of DTBE, presented a review of CDC's current activities regarding TIMS. He indicated that representatives of the NTCA and of CDC are exploring short-term options to make TIMS, as is, more useful to those low-incidence areas that may need it (e.g., exporting data into MS Access for reports customization and linkages with other databases).

Dr. Becerra then described CDC's priorities for future activities: "For those areas with their own systems, we want, first, to make sure that our TIMS import utility is more widely tested before we put it in full production mode; and second, to start to work on defining a common business process model and a core data dictionary for TB case management." He pointed out that California has produced useful documentation, including a first attempt to correspond to the NEDSS conceptual data model, and that Alabama is already very close (90%) to completing a Web-enabled system that includes HIV/AIDS, STD, and TB data elements and seems to comply with current NEDSS standards. He introduced Carol Berglund as the CDC point of contact and, in collaboration with NTCA, a facilitator for this case management task. He stated that a subject-matter expert on TB case management will be provided by NTCA and the Field Services Branch of DTBE (editor's note/update: Stuart McMullen has agreed to serve in this capacity). He also introduced Dave Elmore as DTBE's technical lead for the transition from TIMS to the NEDSS-TB program area module (PAM). According to Dr. Becerra, the TIMS surveillance module will be the first module worked on in NEDSS; the development of a case management module will be considered later. DTBE staff will meet with NEDSS project staff for a joint application development (JAD) session at an undetermined date.

Randall Reves, MD, of the Denver Public Health Department, presented the NTCA's perspective regarding TIMS. He began by stating that there is a long-overdue need for a TB patient management system for many programs and that far too many programs have been attempting the task on their own, patching together many different and often duplicative "quick fixes" in order to better and more efficiently accomplish the job of patient care and TB control.

He went on to state that it had been unrealistic to expect TIMS to be able to adequately address all patient care and TB control issues for every program, and that a NEDSS version developed in Atlanta might be inadequate as well. He pointed out that the presentations by the summit participants from Alabama, Wisconsin, Florida, Oklahoma, New Mexico, and California had provided excellent demonstrations of how TB controllers should have been working toward their objectives all along: starting at the very basic level - what TB controllers must do to get their jobs done - and making that set of requirements drive the information system. He cited as a good example the way in which the contact investigation data management system had been developed in Alabama, integrating those complex data into the overall TB and public health data management system in the state (including such documentation as DNA fingerprints).

Dr. Reves continued by saying that there are many common elements in what TB controllers do, and that there is a willingness and need to work together to improve TB control data management systems for those who are not as far along in the process. One group of persons at the meeting worked on a comparison of the data dictionaries that are being developed by a number of TB control programs as a first step toward defining those elements common to all programs. He stated, "We are working toward providing TB programs with a menu of systems that have already been developed, with the pros and cons of each, so that programs will not have to 'reinvent' what other programs have already developed for patient and program management - whether they involve the use of TIMS in more efficient ways, or other systems that will provide the data on reporting but not by direct TIMS entry (once the import function is working). These activities need to be fostered." He went on to state that some of these common elements being developed will be of local or state concern, but others will no doubt become part of the NEDSS system, which will eliminate some of the need for dual data entry. Another group of TB controllers attending the meeting spent some time working with CDC staff on this issue.

For further information on the TIMS summit, please contact Dr. Jose Becerra at (404) 639-8122, Dr. Randall Reves at (303) 436-7297, or Dennis Minnice at (312) 746-5987.

Reported by Jose Becerra, MD, MPH
Division of TB Elimination
Randall Reves, MD
Denver Public Health Department
and Dennis Minnice, MPH
Director, TB Program
Chicago Department of Public Health


Released October 2008
Centers for Disease Control and Prevention
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