My involvement with the UT-NEDSS/TriSano™ project in Utah began in July of 2008, when Dr. Rolfs, our State Epidemiologist, approached me about leading the implementation process in Utah. The first order of business was pulling together a joint local and state implementation leadership team. Our team met and put together a plan for what we referred to as “phase 1 implementation” in Utah. The goal of phase 1 was to deploy a surveillance/case reporting/case investigation system in Utah that could replace the existing NETSS system and provide centralized, cross-jurisdictional access to case report and disease investigation data. To accomplish this, several major tasks would need to be accomplished: we would need to convert all of our paper disease investigation forms into electronic TriSano™ forms, we would need to test and formally approved these forms statewide, we would need to train state and local users on the system, and we would need to test the usability of various features of the system, including routing, searching, and data export. Implementation Teams with both state and local health department participants were established for these tasks.
Our initial training efforts focused on training individuals participating in the implementation process. A small number of individuals, limited to Utah Department of Health (UDOH) staff, were responsible for form building. These individuals worked closely with CSI staff to learn the TriSano™ form building features. Training for individuals responsible for evaluating disease forms and testing their use with case data, were more formally trained, in a classroom setting. Training consisted of an overview of the system, several case scenarios to work through, and instruction on processes to use for evaluation and testing, as well as how to document and submit feedback.
Approximately 2 months before the planned implementation date, a statewide Implementation Conference was held. The conference included nearly 100 participants, including representatives from UDOH, 11 of Utah’s 12 Local Health Departments (LHDs), Utah’s Department of Technology Services, CSI, and Novell. The conference provided stakeholders with an overview of the CSI TriSano™ development project and Utah’s implementation process, a demonstration of the system, opportunities for open discussion, and training. A three hour block of time in the afternoon was used to train approximately 50 new individuals on CSI TriSano™. For these trainings we limited class size to no more than 20 students, each with an individual computer, and had a minimum of 3 instructors. Working through case scenarios appeared to be the most effective way to challenge users to explore the features of the system. Overall, we found that new users were very comfortable navigating in CSI TriSano™. But we did notice that entering laboratory data, contact information, place exposures, and routing was initially confusing for users. These features required additional training time and hands-on experience. Overwhelmingly, users’ initial response to the system was quite positive.
Feedback from training sessions was used to create a UT-NEDSS/TriSano™ Users’ Manual. This document continues to be updated regularly and is a valuable resource to both new and experience users. The User Manual can be found on our website: https://health.utah.gov/nedss/
To support local preparation for system implementation I asked each of the LHD’s Nursing Directors to identify a UT-NEDSS/TriSano™ administrator. This administrator became their department’s liaison to UDOH for CSI TriSano™ issues. I worked with the administrators to arrange additional training sessions, to add users to the system, and to configure the system for their use. Utah has a mix of large urban health departments where more than 20 staff members may access a disease reporting and small investigation system in a day, and rural health departments where a single individual may be responsible for communicable disease reports and investigations in a hundred mile area. Understandably, the needs and work flow in these types of health departments are quite different. CSI TriSano™‘s configurable routing, queuing and user role features, allowed the system to be set up to meet each LHDs needs.
As a final preparation for statewide implementation, each of Utah’s LHDs worked with UDOH on a data entry and routing test. For several days, reported cases for each LHD were reported and entered in duplicate, once into the existing system, and once into CSI TriSano™. Cases were sent via CSI TriSano™ from UDOH to LHDs, and vice versa. Comparisons between existing systems and CSI TriSano™ demonstrated data completeness and no lost cases.
CSI TriSano™ was implemented first at one LHD in Utah, and then statewide several days later. The implementation has been an overwhelming success. We have without doubt accomplished, even surpassed, our goal of replacing our NETSS system with multi-jurisdictional system for reporting and investigating communicable diseases. The system has been stable and the staff at CSI have been extremely responsive to our questions and needs. We have a user technical support system, accessed through Utah’s Remedy HelpLine System, that is managed at UDOH, but integrates support from CSI. The system is used to answer users’ questions about the system, to report system errors, and for users to provide input on future development. Users’ questions are largely handled by UDOH staff, system errors are triaged to CSI and addressed in biweekly maintenance releases, and user feedback for system modifications and improvements are triaged to the development team.
