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U.S. Department of Health and Human Services

  

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TB Notes 4, 2003

The TB Patient Management Project

The TB Patient Management Project is a DTBE-sponsored effort to collaborate with representatives from the National TB Controllers Association (NTCA) to assist in developing a solution for local and state health departments that need an information system to support the multitude of TB patient management activities. While all TB reporting jurisdictions use the TB Information Management System (TIMS) to report TB cases to the CDC TB Surveillance System, most programs have not implemented the patient management functions in this software application. The programs that have implemented the patient management functions rely very heavily on them and have incorporated the use of these data for management and clinical reporting.

Since the introduction of TIMS in 1993, many local and state programs have developed their own patient management systems; some have focused on a specific TB control activity (i.e., contact investigation) while a few have developed a comprehensive application. Even today, many local and state programs lack any information system capability to support patient management activities. While a recognized output of a patient management system is the mandated reporting requirements to CDC (RVCT, ARPE), it has been recognized that local and state programs need systems to assist in patient and program evaluation and management activities, information that is not reported to DTBE.

There are several challenges to this project. First, while our TB community relies on published guidelines for TB control and prevention activities (ATS/CDC guidelines), the management of TB patients is a local process and as such is influenced by local practices. This creates a challenge to those involved in information system (IS) development trying to identify TB patient management processes that are common across programs. Second, TB programs vary in their infrastructure. Some state programs are in charge of providing TB care to patients in their jurisdiction, while other states provide oversight and guidance to county-run programs in their jurisdiction. This impacts access to data and the need for confidentiality. Third, programs need systems that are interoperable so that a program can simply modify a system rather than restart the application development process. Interoperability includes the ability to interface with CDC’s National Electronic Disease Surveillance System (NEDSS) and its program area modules, which will support the collection of surveillance data from state systems so that programs can reduce the amount of duplicate data entry. Lastly, while public health programs have recently received an infusion of funds to support local bioterrorism information system infrastructure development, many public health programs do not have dedicated funds to support TB information system development, support, and maintenance.

To address these challenges, DTBE staff (representatives from Field Services and Evaluation Branch and the Information Technology and Statistics Branch) have partnered with an internationally recognized information system development company, Scientific Applications International Corporation (www.saic.com), along with Scientific Technologies Corporation (a subcontractor recognized for its work with local and state public health departments) to advance public health practice through information technology. With the involvement of contractor support, along with the use of industry-standard information system development technologies and processes, DTBE is committed to supporting two major outcomes from this project:

  1. Document the functional requirements and identify core TB patient management practices and program evaluation activities across programs
  2. Use this information to develop evaluation criteria to assess and evaluate various existing information system options.

The result will be a recommendation to DTBE, NTCA, and other stakeholders.

Project schedule/activities
A great deal of the ground work was accomplished by the NTCA Information Technology Working Group, who began in 2001 to identify core patient management data elements. With this invaluable contribution, the project team has launched several additional activities:

  • Collaboration with the TB Surveillance NEDSS effort and other CDC NEDSS program area module initiatives (leads: STD, NIP)
  • NTCA joint analysis and design meetings in Washington, DC, in June 2003, in Atlanta in August 2003, and via a Webinar (Web seminar) in October 2003
  • CDC joint analysis and design meeting in Atlanta in July 2003
  • Field visits to select programs to validate program management and evaluation activities (state of South Carolina; city of Denver, CO; San Mateo County, CA; state of New Mexico; Austin-Travis County, TX; New York City; Chicago, Il; and Shelby County, AL)

The project team completed the documentation of core patient management requirements by September 2003. A draft set of information systems evaluation criteria were available by November 2003, with pilot testing of the criteria beginning in December 2003. The project team will be identifying and selecting existing systems between November and December 2003. Beginning in January 2004, SAIC’s team will begin evaluating selected systems. The project team expects to deliver a preliminary recommendation to NTCA by June 2004 and a final recommendation addressing estimated costs for modifications and support by September 2004.

Concluding thoughts

  • Two important features of this endeavor will be identifying common TB patient management and program evaluation functions, and using industry-standard information technology methods
  • Project conclusion will not result in software development, but rather the evaluation of existing systems
  • A recommendation outlining the selection of feasible systems, along with an assessment of necessary modifications and support needs, will be developed

The project team recognizes Stuart McMullen (currently Senior Public Health Advisor assigned to the Los Angeles County TB Control Program) for his administration of the project during its inception phase while he was stationed in Atlanta.

For more information about this project, please contact Subroto Banerji at (404) 639-8065 or via e-mail at sbanerji@cdc.gov

—Reported by Subroto Banerji, MPH
Div of TB Elimination

 


Released October 2008
Centers for Disease Control and Prevention
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