Jon Reid, MBA, Susan Mottice, PhD, Theron Jeppson, MEd, Richard

Kurzban, Wu Xu, PhD

Developing an Open Source Developing an Open Source Asynchronous Communication Asynchronous Communication Framework for Public HealthFramework for Public Health

- PHAccess- PHAccess

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AgendaAgenda

• Problems with communication in Public Health

• Need for an Open Source Framework• Solution – PHAccess• Next Steps

3

Problems with CommunicationProblems with Communication

• 2007 SPHERE action items:– Better internal communications– Better communications with partners– Consider adding asynchronous communication

techniques

• Synchronous communication too costly and time consuming

4

Communication SurveyCommunication Survey

• Conducted Dec 2008 – Jan 2009 – The value of sharing information– Identifying barriers that exist that may

prevent them from receiving/sharing information

– Satisfaction levels with current communication processes

– Preferred communication methods for the receiving/sharing of information

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Survey Results (n=52)Survey Results (n=52)

Preferred method of communication

23%

61%

12%

2%

2%

Secure Web-Site

Phone Call

Email

Fax

Video Conference

67% 33%

Preference for staying informed on routine communicable disease issues

Own Time Personal Interaction

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Need for Open Source FrameworkNeed for Open Source Framework

• Length of time to develop and implement software

• Most software applications have redundant code (Authentication, UI)

• Hard to build user base• High cost of implementation• Users don’t want another username

and password

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Solution - PHAccessSolution - PHAccess

• Secured Web-Site• Able to host secure applications• Portal to public health information• Allows secure asynchronous

communication within public health and external users

• Single sign-on using the Utah Master Directory

• Gives autonomy to users (Web 2.0)

8

PHAccess DevelopmentPHAccess Development

• Collaboration of Public Health Workers, Clinicians, IT, Informaticists

• Used modified Agile/RAD methodology

• Built using Open Source tools and resources

• Released to local and state public health and clinical workers

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Open Source Tools UsedOpen Source Tools Used

• Linux (SUSE)• Apache 2.0• PHP v. 4.4.9• MYSQL v. 4• TinyMCE• YUI Tools 2.5• PHPMailer

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PHAccess Building BlocksPHAccess Building Blocks

Utah Master Directory

Application Level Security User Level Security

Auditing Logs

Custom Applications Core Applications

Web Services Secure Messaging File Library

Shared Calendaring Project WikiElectronic Messaging

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Application TypesApplication Types

• Core Applications– Messaging– Calendar– Contacts– Wiki– File Library– User Management– Project

Management

• Secure Applications– Issue Tracker– UT-NEDSS– Newborn Screening– Clinical Apps– ELR

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PHAccess Application FrameworkPHAccess Application Framework

Authentication User Interface

Utah Master Directory

Group Membership

Application Security

File Repository

HL7 Messaging

Application Data

Common Menu

Seamless Integration

Functions and Classes

Custom Application

Data Interfaces

Authorization

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PHAccess Application FrameworkPHAccess Application Framework

Authentication User Interface

Utah Master Directory

Group Membership

Application Security

File Repository

HL7 Messaging

Application Data

Common Menu

Seamless Integration

Functions and Classes

Custom Application

Data Interfaces

Authorization

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UMD Single Sign-onUMD Single Sign-on

Internet Clients

Proxy

PHAccess

UMD

UT-NEDSS IBIS ELR

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PHAcces Home PagePHAcces Home Page

16

Application ManagerApplication Manager

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View Application Users

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Add Users to Application

19

PHAccess Application FrameworkPHAccess Application Framework

Authentication User Interface

Utah Master Directory

Group Membership

Application Security

File Repository

HL7 Messaging

Application Data

Common Menu

Seamless Integration

Functions and Classes

Custom Application

Data Interfaces

Authorization

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Example of Data Interfaces

HL7

PHAccess

Lab LIMS Database

Secure PHI Database

Authorized User

Lab Result Application

Lab Results/Information Stored

ELR

Internet

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Case StudyCase Study

• Needed to transmit lab test results to Epi through a secure method

• Easy to manage user rights through PHAccess application manager

• Fast turn around time• Allows users to create custom

queries

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PHAccess Application FrameworkPHAccess Application Framework

Authentication User Interface

Utah Master Directory

Group Membership

Application Security

File Repository

HL7 Messaging

Application Data

Common Menu

Seamless Integration

Functions and Classes

Custom Application

Data Interfaces

Authorization

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User Interface

• Common Interface– Shared Menu, layout

• Seamless Integration– Hosted or external application– Portal of applications

• Functions/Classes– Auditing, File storage/retrieval– Secure Messaging

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Secure Mail SystemSecure Mail System

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Secure Message ProcessSecure Message Process

Send email to external email

address

Email Contains PHI?

Store secure email in

PHAccess

Send email to recipient with link to secure email

Recipient logs into PHAccess using UMD

credentials

Sender Creates Email

No

Yes

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Case Study

• PHAccess messaging used during H1N1 outbreak

• Easy group creation and management

• Send secure and insecure messages• Clinical Infection Preventionists (IP)

sending reports to state and local departments

• Reduces number of faxes and increase turn-around-time

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Wiki WorkspaceWiki Workspace

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Next StepsNext Steps

• Increase Clinical User Base– ELR– Clinical Web-Based Reporting (CMR)

• Roll out PHAccess to other agencies– EMS/Preparedness– LHD/Environmental Reporting

• Develop Open Source Community– COP– Facilitate Adoption

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For More InformationFor More Information

• Office of Public Health Informatics– http://health.utah.gov/phi/phaccess

• PHAccess Demo/Code– http://

www.rockymountaincoe.org/phaccess

• Contact– Jon Reid – jon.reid@utah.edu

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AcknowledgementsAcknowledgements

• Dr. Matthew Samore, P.I.– University of Utah, Center of Excellence

• Dr. Robert Rolfs– Utah State Epidemiologist

• This study is supported by CDC Grant No. P01 CD000284, Utah Research Center for Excellence in Public Health Informatics.