Nevada State EpiTrax Launch
Photo by Adrien Drj
If COVID-19 has taught us anything, it is that the public health landscape can change quickly, and we need a disease surveillance system that is adaptable to support our ever-evolving climate.
Having access to surveillance data for purposes of contact tracing, following trends, and monitoring evolving disease conditions allows health departments to be agile in response. This is a critical component in providing communities with a robust public health infrastructure.
For all these reasons and many more, the State of Nevada embarked on a journey to migrate away from their surveillance system, NBS, to the open-source EpiTrax system created by the Utah Department of Health. Ultimately, the Nevada decisionmakers made this change because they needed to be on one state-wide system and wanted autonomy to customize the system.
Nevada had been exploring this change for a while but due to unforeseen problems the window of time for implementation was incredibly narrow. In the first four months of End Point’s partnership with Nevada, the team was able to accomplish what was believed to be impossible in so short a time.
The Four Month Sprint
Some of the major milestones on the way to the new EpiTrax system included the following:
Building Out Custom Forms
EpiTrax is composed of core and form fields. Core fields are consistent across all conditions. Form fields allow jurisdictions to customize the data system to collect data specific to the needs of their area or the reporting requirements of their funders.
In Nevada, we framed these forms to collect the data outlined in the Message Mapping Guide set forth by the CDC. Collecting form data is the first step in configuring the system to use the NMI module which allows for seamless reporting.
Configuring the System
EpiTrax is an intuitive system that is highly configurable. For example, EpiTrax will show specific fields by condition or condition type, allowing an investigator working on a COVID record to only see vaccines and treatments for COVID which reduces time and error in data entry.
These parameters need to be defined and set up in the system for a large number of items. End Point was able to provide templates and examples from other states and having a framework for this documentation was vital.
Testing the System
Testing sounds easy: “You just log in and make sure the functionality is there.” However, to adequately test a new environment with multiple jurisdictions and a variety of user groups takes time, attention, and follow-through.
Nevada worked with End Point to bring in users from across the state to test both the functionality of the system and disease-specific variables. Then the test failures were discussed daily and the programmers provided options and support for resolving problems. After modifications were made to the environment the second round of testing was implemented.
Given the tight window of time to launch EpiTrax we were building (testing) the ship as we were sailing it and this was only possible given the commitment of everyone on the team.
You cannot launch a statewide system without training the end users, answering questions, and providing a mechanism for ongoing support. End Point provided countless trainings ranging from general use to administrative functionality of the system, and also provided Nevada with a user manual template that they were able to build on and grow to fit their needs.
Electronic Messaging Staging Area (EMSA)
EMSA is an application that processes lab messages and delivers them into EpiTrax. The delivery of these messages is what creates the record for investigation in EpiTrax. Since this was a new process and system to Nevada, End Point worked with the Nevada team to configure the various vocabularies and rules.
On September 12 EpiTrax officially launched in Nevada. End Point staff were there both in person and with a consistent virtual presence to work through user concerns, login issues, and workflow questions.
The customization and scope of EpiTrax are crucial components in allowing Nevada to optimize work processes, streamline the multiple data systems being used into one cohesive system, and greatly reduce redundancy.
While switching systems can seem like a daunting and time-consuming task, so is continuing to operate in crisis mode with a system that stops your team from being dynamic. Any change for the better involving hundreds of people and a lot of data is going to take time, normally much longer than 4 months.
The partnership between Nevada and End Point during this fast-paced launch has better positioned the state to use their data to support well-coordinated public health responses to emerging diseases or outbreaks.