2008 Model Practice Application (Public)

WebEOC Utilization for Seasonal Influenza Reporting

Dallas County Health and Human Services

Goal: To have all schools, within each Independent School District in Dallas County (14), report: a) total absences, b) absences due to ILI This reporting would be accomplished via WebEOC by the 20092010 influenza season. Objective: To have all schools, within each Independent School District in Dallas County (14), trained on all facets of WebEOC reporting. a) To have 33% of schools trained on WebEOC by May 2009. b) To have 66% of schools trained on WebEOC by August 2009. c) To have 100% of schools trained on WebEOC by October 2009.

Disease surveillance and reporting are critical components of any public health program. The work plan for DCHHS specifically addresses large categories related to overall disease detection: Target Capability 2A: Information Gathering and Recognition of Indicators and Warning Target; Capability 4A: Health Intelligence Integration and Analysis; Target Capability 5A: Epidemiological Surveillance and Investigation. The project relevancy is more a matter of enhancing an existing practice. Many of our districts report their absentee data during flu season using a variety of reporting methods (weekly vs. monthly, fax vs. email, etc). DISD remains enthusiastic about reporting its data and being able to view it afterwards by date or area. This project can become more relevant as more of the WebEOC program is utilized to integrate, report, and analyze the data. This project seeks to incorporate all reporting into one format with the ability to display the data from different perspectives depending on the need. Districts may view their data on a comprehensive list display or it could choose to view the data by school for a more specific and detailed data. Upon final review of this project, DCHHS will have all schools report absentee data on a daily basis during flu season. Should this occur, DCHHS could incorporate absentee thresholds by school and actually have real time absentee data the moment it is submitted. Should a school exceed its threshold, WebEOC would identify that school and highlight its outcome for follow-up by a DCHHS epidemiologist or ISD employee. This project becomes even more relevant given the future uncertainty regarding a potential pandemic. Since schools already act as a sentinel for the spread of influenza, monitoring seasonal flu outbreaks (particularly their severity) by incorporating WebEOC into the reporting structure would allow for a more efficient and timelier indication of an outbreak. WebEOC has traditionally been used in the field of emergency management for crisis resource sharing and intelligence aggregation. This innovative use of WebEOC actually attempts to incorporate it into a different discipline but goes even further by utilizing it during a nonemergency situation. As used by DCHHS for this pilot project, it attempts to collect surveillance reports from ISDs by breaking down the data into subdistricts. As more of the technology is used, the data can be entered by each individual school and then segmented into different display boards based upon the audience. WebEOC can also be used with GIS mapping systems to further refine the data along geospatial lines of analysis. As the project unfolds over time and as partners become more aware of the advantages to its use, WebEOC becomes even more effective for DCHHS in terms of real time disease surveillance. For example, a daily reporting of absentee data by a school could alert the health department to any particular anomaly affecting that particular school. WebEOC can be structured to incorporate a school’s threshold, to mark when that school exceeds that absentee threshold, and this would alert a DCHHS epidemiologist to seek out the cause. From the perspective of central administration in a district, seeing which schools are reporting high absences will also become a real time notification, should they choose to use the system in this fashion. Typically, the influenza reporting process has involved email, faxes, or telephones. There has been no correlating electronic support or reporting system that benefits the districts themselves. They, as a courtesy, gather and report the data using the methods listed above and in those methods, there was no real time benefit to them for doing so. This system, if used to its fullest, will actually be of benefit to districts since it could provide an electronic absentee reporting system for them. From a public health perspective, DCHHS benefits from having the data reported in one format, in an electronic

DCHHS is the lead agency for disease surveillance and this project seeks to improve the reporting process for both the health department and the constituent school districts in Dallas County. As the lead for this project, DCHHS assumes responsibility for WebEOC board development, training of DCHHS and ISD staff, receipt of the data and the subsequent analysis. The stakeholders (the ISDs in Dallas County) are responsible for the actual data collection and the reporting into the WebEOC system. DCHHS maintains working relationships with all of the school districts in Dallas County and those districts have been excellent partners in traditional disease surveillance as well as active participants in the SNS program. In fact, those SNS relationships are spelled out in great detail in the Memorandums of Understanding that have been executed between DCHHS and the school districts in Dallas County. With that history of collaboration, DCHHS consulted with DISD on the specifics of the WebEOC pilot project to ensure their cooperation. To date, they have reported 15 times since flu season began. In order to maintain effective relationships, DCHHS has agreed to be available for needed training (onsite at the district), to provide regular updates and communication, and to provide a comprehensive influenza report to them on a weekly basis.

1. WebEOC Board Development 2. DCHHS Staff Training 3. ISD staff training 4. Beta test of data entry & report mechanisms 5. Pilot began with 20072008 flu season. 6. Utilized existing WebEOC system (DCHHS) and the staff time for a pandemic influenza planner and an epidemiologist. Funding Source: 1. Pan Flu and CDC Public Health Preparedness funds for staff members identified above. 2. WebEOC was funded through the CRI funding stream.

DCHHS developed an initial WebEOC board to capture influenza reporting data in order to demonstrate the potential of a user-friendly interface. The board was further refined and then an organizing system was built into the WebEOC architecture to reflect the various subareas organized by DISD to consolidate their reporting. DISD was approached to discuss their current methods for ascertaining total absences during the flu season, tracking absences due to ILI and their current reporting methods. WebEOC, as a reporting tool, was introduced and DISD agreed to test the mechanism. DISD staff were trained to report using WebEOC and have been using the system for the 2007-2008 influenza season. The WebEOC system can display reporting data for both DISD and DCHHS depending on how the data needs to be organized. Currently, DISD is able to view data by reporting period (currently weekly) and by learning area (subdistrict). At present, during the pilot project, DISD collects the data from each of their schools which are organized by learning areas. These learning areas submit the total data to central administration for reporting to DCHHS through the WebEOC system. At the time of this submission, DCHHS and DISD have used WebEOC to report on 15 weeks of student absentee data.

The WebEOC system has been in place within DCHHS for three years, is a part of the disaster communications protocols, and is the backbone of the public health / emergency medical response system for Dallas County. DISD is an enthusiastic supporter to date of this reporting mechanism and it is still not used to its fullest analytical / display capabilities. Given the progress to date, Irving Independent School District has signaled their intention to participate during the 2008-2009 flu season and DCHHS believes that others will be ready as well. DCHHS is going through further training on WebEOC in order to refine the system even further. In addition, DCHHS has sought and won grant funds (pending) to make further refinements existing reporting boards and display boards and to create reporting and display boards for every school in Dallas County in time for the 2008-2009 flu season. Once the system refinements are in place and training has been conducted, the long-term resources need to maintain the system will basically entail the cost of the WebEOC system. The DCHHS epidemiology team will be able to access the data at will for analytical purposes. In addition, DCHHS will continue to bring training to ISD personnel as needed to ensure the continuity of reporting. However, given the simplicity of the web based, reporting form, the training sessions will not require a great deal of staff time on the part of either DCHHS staff or ISD staff.

1. Successfully organized Dallas Independent School District to conduct weekly reporting of absences and ILI absences. DISD is the largest school district in Dallas County. 2. Successfully piloted the use of WebEOC boards specifically for DISD use for both reporting and displaying data. 3. Additional stakeholders trained and operationally familiar with using WebEOC software, which could also be used during an SNSPOD response. DCHHS has also developed POD boards for those school facilities that would serve in an SNS response and having trained staff members within each district familiar with WebEOC is an additional bonus.