An Oregon model for development of public health surveillance applications: Epidemiologists in the driver's seat

Since 1998 the Oregon Public Health Division (OPHD) has employed off-the-shelf software to develop, expand, and refine a communicable disease surveillance application for dynamic work environments and interoperability with enterprise solutions. Because data are critical to disease surveillance and epidemiologic investigation, OPHD epidemiologists have trained themselves with this software product to be fluent in creating multi-table relational databases, field calculations, layouts for data, reporting , customized data exports, including valid NETSS and HL7 2.5 messages, and scripts for recurrent complex tasks. We desired simplicity and flexibility and have avoided complexity that would hinder our epidemiologists’ abilities to maintain and modify the database. We sacrificed bells and whistles, including a web interface. The costs have come primarily in time required by our epidemiologists to learn database skills including development conventions and documentation so that they could modify the database to suit their needs without breaking it. In 2008 we are at the crossroads of complexity and simplicity in our development. We recently contracted with a professional developer to integrate and enhance our communicable disease surveillance application with our HIV, STD, TB, and electronic laboratory reporting (ELR) systems and to enable remote data entry and visualization by Oregon’s local public health agencies. We will present features of past and current iterations of our communicable disease surveillance application, demonstrating how it is becoming more complex and how we must adapt our own skill sets to understand and maintain it, lest we be hoist with our own petard. We will focus on ease of use, rapid development, the data model, HL7 composing, and the code behind the interface. Finally, we will offer a sneak preview of enhancements to come.