Benefits of Program Benefits of Program Collaboration, Service Collaboration, Service

Integration and Data SharingIntegration and Data Sharing

2

STD/HIV Collaboration MilestonesSTD/HIV Collaboration Milestones

• 1987 - STD and HIV Programs adopt unified effort to maximize PS capacity.

• 1987 – PS offered to CHD HIV+ clients by STD Program DIS.

• 1997 – HIV Reporting (July 1997)

• 1998 - PS for HIV+ clients increased 46%.

• 2002 – Policy Change- PS Offered to all HIV + Persons Tested Through C/T Sites.

• 2008 – Automated HIV/STD record search capability via PRISM and HARS.

3

Data Encryption

Access Controls

State Policy and Guidelines

Physical Security

*************************************************************************************************

Florida’s confidentiality and security exists to protect the individual and their medical information, regardless of the disease, as part of common practice in modern public health programs.

4

Physical Security

Virtual Security

• Hardware (server) locked within Data Center Building.

• Limited Access to building with monitored entrance 24/7.

• Background checks and security clearance policy.

• Agency/Program confidentiality and information security policies

• Firewalls –•Active Antivirus, •Security web scanning •Behavior level monitoring •Software to ensure latest security updates• Network security that includes:

• User accounts with applied security access •Software level user identification and security controls

5

Device registered on Network

Device registered on Network

VPN – Encrypted Connection

Mobile Connection:

• Device registration

• User Authentication

• Software Authentication

• Window to Data – Nothing resident on Device Memory

Modern Web Applications/BSTD and Area STD Programs: share security levels with internal network devices, in addition to encrypted VPN tunnels and no data stored on the device (simply a view into software and data on the server).

6

Holistic Client

Centered

PCSI:Program Collaboration and

Service Integration

Systems and Information Technology Maturity Model:

Integrated Systems and Data Sharing

Future: Health Information and

Electronic Health Records

Past: Silo systems and databases divided by

disease

Healthy Evolution – long term sustainability

7

Rationale for Integration in the Delivery and Rationale for Integration in the Delivery and Management of STD/HIV Partner ServicesManagement of STD/HIV Partner Services

• 10+ Years of steady decline in federal, state and local resources

• Combined resources to maximize prevention impact

• Significant overlap in populations served

• Significant and increasing STD/HIV co-infection

• Standardization of information security policies and procedures across disease control programs

• Vastly Improved performance outcomes through information exchange between STD and HIV Programs

8

Reported STD Cases by sex, among clients who had a + HIV test on, or prior to the date of their STD

diagnosis. Florida, 2005-2011

0

500

1,000

1,500

2,000

2,500

3,000

3,500

2005 2006 2007 2008 2009 2010 2011

Female

Male

Total

9

Infectious Syphilis and HIV Co-infection Florida, 2000 to 2011

369434

505 490 509 533 506

675 703 684 66672740

64

118 164207 197 209

242

338 357

519

523

0

200

400

600

800

1,000

1,200

1,400

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

9.8%

12.9%

18.9%

26.9%29.2%

26.3%

32.4% 34.2%

35%41.8%

Syphilis Alone Syphilis/HIV Co-infection

25%

29%

10

Inter-program and Technology Advances to Improve Service Delivery and Performance

Outcomes

• Standardization of Information Security Policies to allow

for automated information exchange across Disease

Control Programs. (All DOH staff accountable!!)

• Reciprocal data exchange between STD/AIDS

Surveillance = Reduction in NIRs and improved

intelligence for HIV Partner Services

• Electronic lab reporting to reduce STD Prevention and

PS timeframes

• Ability to conduct virtual QA/QI via PRISM

11

Inter-program and Technology Advances to Inter-program and Technology Advances to Improve Service Delivery and Performance Improve Service Delivery and Performance

OutcomesOutcomes• AIDS Surveillance monitors clients with subsequent STD

infections via PRISM

– Included in Annual Epi-profiles

– Used as key variable to evaluate “Prevention for

Positives” initiatives and to guide resource allocation

• Testing and Treatment History for Incidence Surveillance

– DIS collect previous testing and antiretroviral use

during PS sessions. Information used by AIDS

Surveillance when calculating incidence estimates

12

ELRELR and Data Sharing = Reduced and Data Sharing = Reduced Timeframes for HIV Partner ServicesTimeframes for HIV Partner Services

0

10

20

30

40

50

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Number Days Specimen Collect to Assigned for Partner Services

ELR Expansion

PRISM

STD to HARS

1717

4747

AIDS Surveillance

13

2010 HIV Partner Services - Florida2010 HIV Partner Services - Florida

New HIV+ PS Interviews

743

1833

CHD Non-CHD

New and Previous + PS Interviews

1355

3029

CHD Non-CHD

14

Reported Adult HIV (not AIDS) Cases, FloridaReported Adult HIV (not AIDS) Cases, Florida

33%

8%

32%

25%

2%0%

Men Sex W/Men (MSM)

Injecting Drug Use (IDU)

MSM/IDU

Other

Heterosexual

Risk Not Reported orIdentified

41%

7%2%

32%

16%

2%

Through 2005N=35,584

Through 2010N=44,957

Note: NIRs NOT redistributed.

Data as of 06/30/2011Data as of 12/31/2005

15

PCSI is absolutely essential for PCSI is absolutely essential for disease control programs todisease control programs to::

– Maximize resources/increase efficiency

– Standardize and improve on information security

policy and procedures (Fosters mutual

confidence across programs that information will

remain secure.

– Reach the greatest proportion of infected and

exposed persons through PS, referral, link to

services

– Provide holistic prevention services to clients