Business Analysis & Process Re-design
HLN provided project management and business analysis support to the International Society for Disease Surveillance Meaningful Use Workgroup as it developed syndromic surveillance standards and guidelines to be used by the Office of the Coordinator of Health Information Technology (ONC) to clarify the public health surveillance requirements of the Center for Medicaid and Medicare Services (CMS) Meaningful Use Programs. HLN staff facilitated the work of the group and produced three key deliverables: a preliminary set of Core EHR Requirements for Syndromic Surveillance; a final set of Core Business Model and EHR Requirements for Syndromic Surveillance; and significant contributions to CDC's PHIN Messaging Guide for Syndromic Surveillance.
For a large county government agency, HLN worked to improve the transactional and reporting capabilities of a countywide coordinated case management system, a web-based information system designed by intensive case managers and epidemiologists. HLN documented the system as it existed, developed specifications for incorporating future data sets into the design, and created a roadmap that the staff could follow to iteratively implement new data sets and reporting functionality into the existing system and a new data warehouse. HLN's design includes a new Extract, Transform and Load processes and data model to support all of the business intelligence needs of the agency.
HLN completed a detailed roadmap of the data exchange and information processing steps for the maintenance and support of a statewide childhood immunization information system. This analysis focused on the data file inputs and outputs of the system. HLN documented and evaluated the current processes after reviewing available documentation (more than 180 documents, including management reports, record layouts, database schematics, e-mail correspondence, UNIX shell programs, and SQL scripts) and conducting on-site interviews. Very little formal documentation existed aside from the actual program and batch file code. Recommendations for improvement were subsequently integrated into the agencies operations practices.
Needs Assessment & System Reviews
HLN was engaged to review all aspects of an existing statewide childhood immunization information system. The focus was on the suitability of the system's technical architecture, the state's readiness for continuing a web deployment it had initiated, and the needs of the health department which has just recently become responsible for the state-wide project. HLN conducted several on-site fact-finding visits and completed a detailed needs assessment, a strategic options matrix, and a detailed review of four leading off-the-shelf registry products. HLN also made recommendations on changes in policy and marketing tactics that would be required for a successful continuation of the registry rollout. HLN collaborated with the state's marketing consultants, conducted focus groups, and performed a "mini" survey of providers that helped inform their marketing plan. Ultimately, this state acquired the study's top-rated off-the-shelf product.
For a large, urban county, HLN provided analytical and support services for an effort to build a system to identify and manage a unique list of clients being served by a known set of county services. This system represented an integrated approach whose primary goal was to unify health and human services, Justice, and Real Property Administration/Fiscal client-centered data. HLN examined existing systems, as well as future plans, and developed an interoperability strategy for linking these disparate systems together. Extensive interviews and workshops were conducted across a wide range of County offices. As the project unfolded, it became clear that health-related data would be the first to be considered, so extra attention was placed on this domain area. HLN developed a detailed system inventory covering all relevant systems in the county and collected survey data to complete the inventory database which was then left with the county at the end of the project. HLN also completed an implementation roadmap document to guide the multi-phased implementation of the system, as well as the detailed Software Requirements Specification to guide the development and issuance of a Request for Proposals to build or acquire the new system.
HLN completed a project to assess the current level of PHIN compliance and to develop a plan for achieving compliance for a state public health agency. HLN consultants engaged with a wide variety of stakeholders to identify the drivers and challenges for achieving PHIN compliance. Stakeholders were engaged through individual and small-group interviews, and presentations at various meetings and functions. HLN developed and documented a methodology for DPHS to create an overarching technical architecture. The methodology involved collecting information systems data, assessing gaps, and prioritizing opportunities. To assist with its execution, HLN customized and deployed a web-based Systems Inventory Database application, accessible on HLN's website, which was a key part of the collaboration between the HLN and client teams. The client used the technical architecture, the gap analysis, and the options and recommendations presented by HLN to move towards PHIN compliance. They received its first PHIN 2.0 certification in 2009.
Software Design & Development
HLN took a leadership role in a three-vendor project to integrate the childhood immunization and lead poisoning prevention systems in a major municipal health department. HLN worked with the executive sponsors to develop the initial conceptualization of the system, and not only developed the Oracle-based master client index but modified products across a wide variety of architectures (including client/server, web, and batch) to interface with this system. HLN now supports the operation of the new system as well as ongoing development of its products.
For a large municipal health department, HLN created a web-based Facility Profile application to support creating, managing, and communicating information about facilities used as points of distribution (PODs) for medication and supplies in the event of an emergency. The application captures detailed information about a facility, such as its address, contact information, accessibility, interior/exterior physical characteristics, establishing photos, floor plans, maps, and aerial photographs. From that data, users can create a structured electronic or paper based Preplan detailing the specific information necessary to support emergency preparedness and response operations. Both tactical data (data that is common across facilities regardless of their response function type), and strategic data (data that is specific to the kind of event the facility may support) are included in the application. The application is fully web-based, developed in Microsoft .NET and SQL Server.
HLN developed a web-based electronic health record system system specifically to support patient registration and immunization administration in immunization clinics operated by a large municipal public health agency. The state of the art system incorporates an expert decision support system that intelligently prompts the clinic staff to ask the patient the precise screening questions that are appropriate for that specific patient encounter and then recommends and contraindicates immunizations based on the answers to those questions, as well as the patient's age, gender, and immunization history. The system is integrated with the municipality's immunization information system so that both systems can benefit from data contained in the other.
Because of the highly innovative nature of the project, HLN utilized an Agile software development methodology. With this Agile methodology, HLN developed, tested, and deployed a new release of the software every five weeks. This enabled the client to continuously evaluate the software, discover new needs, redefine the requirements, and change priorities throughout the project. It also enabled the client to train the clinic staff on the software long before the deployment date and ensured a smooth transition when the EHR system finally replaced the paper driven process that the clinics had utilized for many years.
System Planning & Operations
Over a number of years, HLN migrated a major public health system for a large municipal health department first from HP-UX to IBM-AIX, and then to Linux, as the agency's hardware standards changed. Along with this migration came several changes to the network infrastructure which required careful cooperation with both the agency's network engineering and operations staff and the municipal IT organization as well. The migration to Linux significantly reduced the cost of ownership for this system and increased system performance several fold.
HLN developed a detailed system architecture for a major municipal health department as part of its support for bio-terrorism preparedness. A sophisticated set of options was required to account for a variety of scenarios possible during emergency conditions. Information security and high availability were key objectives met by the recommendations.
HLN conducted a NEDSS hosting feasibility study for a State public health agency. The state's NEDSS Base System (NBS) was hosted in an ASP environment, but the funding requirements for that hosting arrangement had changed. The study evaluated hosting alternatives, issues related to login security, and issues related to application support in a hosted environment. In order to complete the study, HLN installed and evaluated the NBS software in its own development environment, interviewed personnel from the vendor, the agency, and other NBS states, and analyzed a variety of funding and staffing models.