Why, How, and When?

CIDR Project Team

National Disease Surveillance Centre25-27 Middle Gardiner Street

Dublin 1

ProcessesTimeline• 2000• 2001• 2000 - 2003• 2001 - ongoing• 2002• 2003• 2003• 2004

• Needs Analysis• Project Setup• Procurements• Information Governance• System Design• System Development• System Piloting• System Implementation

Needs Analysis

NDSC• The National Disease Surveillance Centre (NDSC) is Ireland’s

leading specialist centre for surveillance of communicable diseases. The centre was set up in 1998 conjointly by Ireland’s eight Health Boards and with the approval of the Minister for Health and Children.

• The aim of NDSC is to improve the health of the Irish populationby the collation, interpretation and provision of the best possible information on infectious disease. This is achieved through surveillance and independent advice, epidemiological investigation, research and training.

• The NDSC works in partnership with health service providers and sister organisations in other countries to ensure that up to date information is available to contribute to the effective control of infectious diseases

NDSC

• Medical staff– Specialists in Public Health Medicine

– Public Health Trainees/Medical Officers

– Medical Microbiologist

• Scientific staff

• IS staff

• Administrative staff

CIDR Partners

P u b lic In te rn e t / P u b lic S e c to rV P N C ID R

D a ta b a s e

D e p a rtm e n t o fP u b lic H e a lth (8 )

C lin ic a lL a b o ra to ry (~ 5 3 )

C o m m u n ityC a re O ff ic e (3 2 )

N a tio n a l D is e a s eS u rve illa n c e

C e n tre

F o o d S a fe tyA u th o rity

F o o d S a fe tyP ro m o tio n B o a rd

D e p a rtm e n t o fH e a lth a n d C h ild re n

H e a lth B o a rd

Why CIDR?• Infectious Disease Regulations 1981, amended in 1985,

1988 and 1996• Review of the Current List of Infectious Disease and of the

Process of Notification• Strategy for control of Antimicrobial Resistance in Ireland

(SARI)• New and re-emergent infectious disease / organisms,

national foodborne outbreaks, bioterrorism threats, and increasing antimicrobial resistance

• Need for timely, coherent, and consistent data locally, regionally and nationally

Needs Analysis

• NDSC hired Astron Consulting in 2000– to assist in the identification of the

information needs of NDSC and partner organisations,

– to examine solutions in place in similar organisations overseas and

– to determine whether any of these could be adopted or adapted to Irish needs

Experience in other countries

• Specifically we looked at– CoSurv from CDSC – England– E-COSS from SCIEH – Scotland– LITS+ from CDC - USA.

• Subsequently we received information from– Canada - CIPHS– Sweden – SMI-Net– Netherlands – ISIS– US (Georgia) – SENDSS– US (CDC) - NEDSS

Evaluation Criteria• The software must

– Be available and suitable for use for infectious disease surveillance in Ireland

– Be a complete product, that can be taken over and supported locally

– Be testable against the defined requirements– Meet a high proportion of the defined

requirements– Be based on modern, open, robust technology

Astron Findings

• Islands of information

• Multiple reporting

• Extensive reconciliation required

• Loss of data quality and timeliness

Astron Recommendations• No overseas solution was identified which

would fill the requirements

• The development of a new system based on a shared common data repository with clearly defined data access rights capable of collecting and associating data from a variety of sources

Project Setup

Project Organisation

Project Organisation

• Definition of roles and responsibilities including lines of accountability

• Two principal streams– Application / system design, development and

implementation

– Definition of business rules including data access rights and levels of service

CIDR Development Committee

• The CIDR Development Committee was established in 1999 as a multi-disciplinary working group to advise on the development of electronic surveillance in Ireland. The terms of reference for this committee are:– To assist and advise CIDR Project Team and other CIDR

partners on the development and introduction of a national system for electronic surveillance

– To act as an advocate and promote CIDR within his/her ownorganisation.

– Includes members from public health, laboratories, information services, national agencies, environmental health and general practice

CIDR Project Team• Established on a full-time basis in June

2001– Derval Igoe

• Specialist in Public Health Medicine, CIDR Project Manager

– John Brazil• NDSC IT Manager

– Emma Baldwin• Administrative Support

CIDR Project / Operations Team

• Subsequently joined by– Colm Grogan

• Senior Surveillance Scientist

– Gillian Cullen• Surveillance Scientist

– Liam O’Connor• IT Officer

– John Foy• IT Officer

CIDR Project Board• CIDR Project Board are the Business System

Owners and provide overall direction and management for the CIDR project. – It approves all major plans for the project within the budget

allocated to CIDR capital development by NDSC Board.– It authorises deviations from the agreed plans, within budget.– It seeks to ensure that the required resources are available

for and committed to the project.

• Members are nominees of partner Health Boards and Agency Chief Executive Officers

Procurements

Procurement

• Supported by Central Purchasing Department, Eastern Health Shared Services

• Competitive Tendering• EU Procurement Procedures

– Open– Restricted

Procurement of Consultancy Support

To assist NDSC to– Issue a Request for Proposals (RFP) for system design– Select a suitable system designer– Issue a Request for Proposals (RFP) for system

development– Work with the developer to agree the system– Carry out a user acceptance test when system developed– Implement the system

– EU Procurement via ‘open’ procedure, contract value €200,000

Designing, Developing and Implementing a New System

Separate procurements for – Design of the System and– Development / Implementation /

Maintenance

Primarily because of uncertainties regarding the scale of system and the likely cost

Design Procurement• EU procurement utilising the ‘open’ procedure in

2001• Twenty four proposals

– 23/24 based on thin client (browser) / web services– 1/24 based on client – server

• Responses evaluated by evaluation committee including NDSC and partner members

• DMR (now Fujitsu Consulting) selected– Contract value €150,000– Contract duration 6 months

Development Procurement - 1

• EU procurement utilising the ‘restricted’ procedure in 2002

• Request for ‘Expressions of Interest’• Fourteen companies responded• Responses evaluated by evaluation

committee including NDSC and partner members

• An invitation to tender, including the technical design documentation, was extended to five companies

Development Procurement - 2

• Three proposals were received• Information sessions were held separately

with with each proposer• Proposals evaluated by evaluation committee

including NDSC and partner members• Fujitsu Consulting were selected as the

development / implementation partner• Contract value (including infrastructure and

reporting solution) €2 million, duration 9 months

Information Governance

Information Governance

• Appropriate data sharing

– Defined access rights

– Policies and procedures

– Audit

– IS 17799 – Information Security management

– Institutional multi-disciplinary information

governance committees

What’s Happening in Ireland?

• National CIDR Business Rules Committee– Regional and Agency Business Rules

Committees

• To define / agree – Access Rights

– Levels of Service

Business Rules

Overseas Information Governance Initiatives

• HIPAA

– US, Health Information Portability and

Accountability Act 1996.

• NHS Information Authority

– UK, adopting BS7799 (equivalent to IS 17799).

System Design

System Design

• Business Process Analysis

• System Dynamics

• Software Architecture

• Technology Architecture

• Persistent Information Architecture (Data Model)

• Reporting Framework

Clinical orreferencelaboratory

CIDR administration

CIDRtranslationmodule

Filename: P251S_Appendix 02 - Processes.vsd Current date:23 May, 2003Page 1Processes National Disease Surveillance Centre: Computerised Invectious Disease Reporting System (CIDR) - System Design Pagename: LIMS Integration

File of relevanttest results to

translation module

Translate codesfrom local to CIDR

standard

Reformat datato CIDR standard

Load datato CIDR

Presenttranslation records

for validation

Reportexceptions

to CIDR admin

Patient match notconsidered at this point

Method(test type)not found?

Searchfor clinician

Matchfound?

Yes

Yes

Most dynamic and liableto produce exceptions

Method onCIDR?

No

Yes

Authorise

Organismnot found?

Onganism onCIDR?

Create newCIDR code

Yes

NoResubmit

exceptions fortranslation

Organism will not be an outputfrom every Lab system

Update translationmapping rules(for all labs)

Yes

Cliniciannot found?

No

No

Note re Lab steps completedRegister data(Check for patient match)Barcode samplesStart testingReview results, add narrative/judgement as necessaryTECHNICAL AUTHORISATION (VALIDATION):Review test performed vs request form (forcompleteness and reasonableness).Positive? May prompt additional testingP => MEDICAL AUTHORISATION - Escalate to ClinicalMicrobiologist (or Pathologist or Lab Manager - dependson local practice) where necessary... additional testing may be requestedSend results back to Clinician

No

No

Proceed from CLF or RLD(as appropriate) on Core

Transaction Process

See Master File Maintenance

LIMS Integration will contain details of referencenumbers used by each lab in referencing Clinicianslinked to CIDR clinician ID.

If no match results user searches based on clinicianname and practice address. If GP found, GP recordupdated to include Lab's reference number for thatclinician.

Exceptions?

Yes

Extraction routinesto get to this point (a

file of relevant testresults) will be lab

dependent

Possibility to turn off this check.Where system doesn't find matchingGP, GP from Lab written to CIDR. Willbe used in creating new GP understep MO14 in core process

Business Process Analysis

Key Concepts in CIDR

• Multiple REPORTs relate to a given event in a given individual

• An EVENT is the same episode of disease in an individual i.e. within a given timeframe

• CIDR is a PERSON-based system

• An OUTBREAK relates to multiple instances of disease in individuals within a given location/timeframe

Dataflows in CIDRGP / Clinician

Clinical Laboratory

Reference Laboratory

Public Health

NDSCDoHCFSAI FSPB

EUWHO

CIDR

System Components

Data Layer

CID

R D

ata

Rep

osito

ry

Data

Translation

Pres

enta

tion

Laye

r

Clie

nts

LaboratoryInformation

System

Laboratories

Public Health

NDSCB

row

ser S

ervi

ce

Manual Data Entry

Bro

wse

r Ser

vice

Reports

CIDR DataEntry and

EventCreation by

Public Health

laboratory resultsappropriate referenceLaboratory includingData validation by

List

ener

Business Workflow

Data Access

Bus

ines

s Lo

gic

App

licat

ion

Laye

r

DataPersistance

CIDRReporting and

Analysis

System Dynamics

Prototype 5

Prototype 4

Prototype 3

Prototype 2Prototype 1

GP

Labs

Steps Data EntryNotification PatientMatch

EventCreation

OutbreakAdmin. Follow-up

Data Entry

Data Entry PatientMatch

EventCreation

OutbreakAdmin. Follow-upDPH

Use of Prototypes

• Valuable tool in clarifying requirements

• Tangible proof of development for communication to stakeholders

• Potentially more expensive in the short-term, less expensive in the long term if it contributes to meetings users needs / expectations

CIDR Technical Architecture

• n – tier Architecture– User Services – Directory Services– Business Façade– Business Rules– Data Access– Data Persistence

CIDR Core System

User Services Layer

Business Façade Layer

Data Access Layer

TechnologyInfrastructure

Pres

enta

tion

Sub-

syst

emB

usin

ess

Sub-

syst

emD

ata

Sub-

syst

em

Business Rules Layer

Data Persistence Layer

Directory Services Layer

WebServer

DirectoryServer

ApplicationServer

DatabaseServer

Software ArchitectureWeb

Forms Code Behind

InternetInformation

Server(Web

Server)

HTTP

HTTPS

ADSI

SMTP

UDA

ODBC

Windows2000

AdvancedServer

Windows2000

AdvancedServer

InternetInformation

Server(Application

Server)

SQL Server2000

(RDBMS) Windows2000

AdvancedServer

StoredProcedures

SystemFramework

Data Access

BusinessRule(s)

BusinessFaçade

ADO.NET

ActiveDirectory

OperatingSystemCommunicationBasic SoftwareTechnical

Interface FaçadeUtilityApplication

Windows2000

AdvancedServer

LDAP

X.500

Use

r Ser

vice

s La

yer

Bus

ines

sFa

çade

Dire

ctor

ySe

rvic

esB

usin

ess

Rul

es

JDBC

Dat

aA

cces

sD

ata

Pers

iste

nce

HTTP

HTTPS

SOAP

SOAP

.NETFramework

ASP.NET

SQL Server2000

(Warehouse)

Application Technology Infrastructure

.NETFramework

WebServices

Core System

• Microsoft Solution– .NET

– IIS

– SQL Server 2000

• Web Services, XML, SOAP, 128 bit SSL

• Standards-based (de facto)

Client Requirements

• Modern PC with Standard Browser Software

(IE 6 or better)

• Connection to Internet or Government Virtual

Private Network

• IS support

– Software / Hardware

– Security / Confidentiality

Security Requirements

• Core– Firewalls (external and internal), authentication

server, intrusion detection, active directory, separated web, application, and database servers)

• Transmission– 128-bit Secure Sockets

• Client / User– Unique Username / Password / Authentication

token

Standard Terminologies, Codes and Structured Data

• HL7– HeBE Messaging subgroup recommending HL7v2.4/XML

• Diseases / Organisms / Lab Tests– SNOMED / LOINC (terminologies recommended by US

Centers of Disease Control and Prevention for for electronic reporting of results to public health agencies)

• Patient Demographics– GPIT dataset

• Addresses– Geodirectory address model

System Development

Technology Infrastructure

• Production Environment• Development Environment• Test / Training Environment

• Connectivity

Government Virtual Private NetworkeGovernment

Network

AgencyNetwork

10Mb Ethernetconnection carrying"eGov-Hosting" VPN

WAN link toeircom BIP

Agency's FirewallEthernet connection toAgency's privatenetwork

Managed3640/3725router

10Mb Ethernetconnections for "eGov-Services", "eGov-InterAgency", "eGov-Dialin" and AgencyPrivate VPNs

Data Model

OrganismToEvents

0,n

0,1

CommunityCareAreaToPendNotifier

0,n

0,1

CIDRrecordToEnhancedDataValues0,n

0,1

PendNotifierToPendNotifierDetail0,n

0,1

HealthBoardToEvent

0,n

0,1

CIDRDataStructToCIDRDataCode0,n

0,1

OrganismToOrganismAttribute

0,n

0,1

EventToCIDRalert

0,n

0,1

OutBreakToCIDRalert 0,n0,1

PatientToPatientDetails0,n

0,1

SusceptTestToGroupSusceptTest

0,n

0,1

LabDiagTestToGroupSusceptTest0,n0,1

PendNotifierToPendNotifierGroup0,n

0,1

CIDRrecordToPendNotifierGroup

0,n

0,1

DiseaseToCIDRDataStructItem

0,n

0,1

CCAToPendPatient

0,n

0,1

HealhBoardToPendPatient

0,n

0,1

LabToCIDRuser0,n

0,1

LabDiagTestToRawLabDiagtest

0,n

0,1

LabDiagTestToMethod

0,n

0,1

MethodCodeToMethod

0,n

0,1

PendPatientToPendPatientDetail

0,n

0,1

PendingPatientToCIDRrecord

0,n

0,1

NotifierToNotifierDetails0,n 0,1

PatientToCIDRrecord

0,n

0,1

HospitalToCIDRrecord

0,n

0,1

LabToCIDRrecord0,n

0,1

CIDRrecordToLabDiagTest

0,n

0,1

OrganismToCIDRrecord

0,n

0,1

CIDRrecordToNotifierGroup

0,n

0,1

NotifierToNotifierEvent

0,n

0,1

EventToNotiferGroup0,n

0,1

DiseaseToCIDRrecord

0,n

0,1DiseasesToEvents

0,n

0,1

PatientToEvents0,n

0,1

CommunityCareAreaToPatient

0,n

0,1

HealthboardToPatient

0,n

0,1

HealthAuthorityToHealthBoard

0,n

0,1

HealthBoardToCommunityCareArea0,n0,1

HealthBoardToCIDRuser0,n 0,1

HospitalToEvents

0,n

0,1LabToEvents

0,n

0,1

CommunityCareAreaToNotifier

0,n

0,1

AnitbioticTo SusceptibilityTest

0,n

0,1

OrganismToLabDIagnosticTest

0,n

0,1

HospitalToLab

0,n

0,1

CIDRDataTypeToCIDRDataStructItem

0,n

0,1

EventsToLabDiagnosticTest

0,n

0,1

CIDRDataStructItemToEnhDataVal0,n

0,1

EventsToEnhancedDataValue

0,n

0,1

OutBreakToEvent 0,n

0,1

CIDRDataStructItemToOutBrkDataVal

0,n

0,1

OutBreakToOutBreakDataVal

0,n

0,1

Diseases : 1DiseaseID <pi>

NotifiersNotifierID <pi>

OrganismsOrganismID <pi>

AntibioticsAnitbioticID <pi>

HospitalsHospitalID <pi>

HealthAuthoritiesHealthAuthorityID <pi>

HealthBoards : 1HealthBoardID <pi>

CommunityCareAreasCommunityCareAreaID <pi>

CIDRusersCIDRUserID <pi>

OutBreaks : 1OutBreakID <pi>

SusceptibilityTestsSusceptibilityTestID <pi>

LabDiagnosticTestsLabDiagnosticTestID <pi>

TestMethodCodesTestMethodCodeID <pi>

CIDRDataTypesCIDRDataTypeID <pi>

CIDRDataStructureItemsCIDRDataStructureItemID <pi>

EnhancedDataValuesEventDataValueID <pi>

OutBreakDataValuesOutBreakDataValueID <pi>

PendingPatientsPendingPatientID <pi>

NotifierDetailsNotifierDetailID <pi>

TestMethodsLabTestMethodID <pi>

PendingPatientDetailsPendingPatientDetails <pi>

Labs : 1LabID <pi>

PendingNotifierDetailsPendingNotifierDetailID <pi>

PendingNotifiersPendingNotifierID <pi>

Diseases : 2DiseaseID <pi>

EventToCIDRrecord0,n

0,1

Labs : 2LabID <pi>

NotifierGroupsNotifierGroupID <pi>

PendingNotifierGroupsPendingNotifierGroupID <pi>

RawLabDiagnosticTestsRawLabDiagnosticTestID <pi>

CIDRalertsCIDRalertID <pi>

GroupSusceptibilityTestsGroupSusceptibilityTestsID <pi>

CIDRrecords : 1CIDRrecordID <pi>

PatientDetailsPatientDetailID <pi>

PatientsPatientID <pi>

OutBreaks : 2OutBreakID <pi>

OrganismAttributesOrganismAttributesID <pi>

HealthBoards : 2HealthBoardID <pi>

CIDRDataCodesCIDRDataCodesID <pi>

EventsEventID <pi>

CIDRrecords : 2CIDRrecordID <pi>

OrganisationToCIDRUser

0,n

0,1 Organisation: 1OrganisationID <pi>

Organisation: 2OrganisationID <pi>

0,n

Reporting Framework

OperationalDatabase

ReportingDatabase

(Cube)

OperationalView Informational

View

Data Capture and Use Query, Reporting, and Analysis

OperationalSystems

InformationalSystems

SQL Server 2000Relational Database

With Analysis Services

CIDRApplication Business Objects

2000

When?

• CIDR Design completed – July 2002

• Procurement of CIDR System Development and

Implementation Partner – February 2003

• Development and Implementation of CIDR System –

Q24 2003

• CIDR System Pilots – Q1 2004

• CIDR System available nationally – mid 2004

CIDR Reporting

Ready and safe access to data

• Business Objects provides a method of creating useful, parameterised reports quickly, allowing access to information without putting the source data at risk, and potentially increases the efficiency of reporting processes.

Thick and Thin Clients• Thick clients

– Business Objects software installed on client machine

– Data retrieved from Server– Processed locally

• Thin clients– Standard browser interface– Data and processing on server

Who else uses Business Objects?

• Business Objects is extensively used in Breastcheck and in Tallaght Hospital.

• Business Objects is a similar product to Hummingbird, the business intelligence software used in CDSC in Colindale.

System Piloting

CIDR Pilots• Health Board

– NEHB• Department of Public Health• Community Care Offices• Clinical Microbiology Laboratories

• Reference Laboratories– MRSA Reference Lab– Pneumococcal Reference Lab– Salmonella Reference Lab– Virus Reference Lab

System Implementation

Implementation Issues

• Historic Data

• Analysis of Trends

• Roll-out

– By infectious disease programme?

– By geography?

• Health Services Restructuring

What will we get with CIDR?

• The infrastructure for a secure national public health information network– Capable of allowing the collection of data

other than that relating to infectious disease in a coherent and timely fashion

– Providing ‘best of breed’ data analysis tools such as Business Objects and, potentially, SPSS and ESRI ArcView