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Health Department Effort Receives National Recognition

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Software, envisioned by the Larimer County Department of Health and Environment and developed by County Information Technology and Health Department staff, has received the designation of “Bright Idea” by the Harvard Kennedy School of Government’s Ash Center for Democratic Governance and Innovation.
Two software applications were developed by a team of Larimer County programmers and a core group of Health Department staff, with project assistance and management provided by the Health & Human Services Business Analyst Team.:
  • PHEWR (Public Health Event Web Registration), is an online registration and scheduling tool that supports the efficient staging of large health interventions, such as vaccination clinics, mass dispensing of medications, etc.  
  • ETHOS (Electronic Tool for Health—Open Source) is a management system supporting local health departments, including cashiering for environmental health and community health services, clinic scheduling, and medical record modules.
The open source software was developed to improve public health services for Larimer County residents and to benefit all public health agencies that choose to use them. With open source software, local health departments never have to worry that a commercial software vendor will go out of business or compel expensive upgrades, since everyone “owns” and shares the software and any improvements. The goal is to build a community of public health programmers, developers, and innovators—in Colorado and across the country—who support and improve each others’ work, allowing their agencies to spend less on commercial licensing and more on improving public health. The current implementations constitute the first few steps toward that goal.
Public Health Event Web Registration (PHEWR)
Conceiving and implementing the PHEWR system began in 2009 when the Health Department was planning for mass immunization clinics in response to the H1N1 (“swine”) flu pandemic . Anticipating the long lines and high demand experienced when vaccine supplies are short, Health Department director Dr. Adrienne LeBailly envisioned creating a system that would allow those wanting to attend the large clinics to register online to be immunized at a convenient time, assuring that clients met eligibility criteria and completed paperwork in advance, and that there would be minimal wait times with enough vaccine available for each clinic.
PHEWR proved its effectiveness in its initial two uses. While other regions struggled with long lines and frustrated patients, Larimer County received state-wide accolades in 2010 for its well-run H1N1 clinics. 99.6% of residents who received vaccines expressed satisfaction with their H1N1 clinic experience. The National Association of County and City Health Officials (NACCHO) recognized this achievement by honoring the Larimer County Department of Health and Environment with a Model Practice Award.
PHEWR was quickly put to the test again in 2010. Shortly after the 2009-2010 flu season, an outbreak of meningococcal disease resulted in the deaths of four county residents, including a Colorado State University student. The U.S. Centers for Diseases Control (CDC) and the state health department recommended an immediate mass vaccination effort targeting CSU students and staff, giving the local Health Department and CSU only seven days to prepare. With the use of PHEWR, 10,168 college students and CSU staff were pre-registered, scheduled, and vaccinated at two clinics, with an average time of 8 minutes from entering the clinic site to walking out the door. This successful use was presented at the 2011 National Immunization Conference in Washington, D.C.
ETHOS (Electronic Tools for Health—Open Source)
In 2008, Larimer County’s Health Department had begun gathering functional requirements and researching options for replacing a commercial cashiering and management system, in partnership with other Front Range county health agencies that had similar needs. The options considered included
  • joint purchasing of commercial software to reduce costs,
  • adopting existing open-source implementations of electronic health record (EHR) systems ,
  • public-private partnerships in software development, and
  • internal software development. 
A feasibility and return-on-investment analysis favored the last option as best meeting the department’s needs and controlling costs. Again, the director stressed that the software should be open source and shared freely with other public health agencies, especially now that nursing services in small counties with limited resources were becoming full public health agencies.
The scheduling module of ETHOS was launched in February 2011, followed by the Cashiering module in April. The clinic’s Medical Record module went live at the County’s three health office sites in June 2011. Benefits have included moving from a hand-written scheduler to an electronic version and the ability to better track charges within the cashiering module. Additionally, clinical staff can share information with referral agencies easily, use an alert system to avoid medical errors, and gather and document patient health information more thoroughly.
The comprehensive nature of both applications, combined with the open source licensure, make PHEWR and ETHOS unique in the world of public health, allowing other local health agencies to avoid purchasing an expensive application from a vendor or duplicating effort unnecessarily using scarce in-house resources. Larimer County is currently working with other Colorado counties on the implementation of ETHOS and PHEWR.
 “Both software applications were designed so that they can be managed by local staff with limited technical expertise, making it more realistic for public health departments with few Information Technology resources,” said LeBailly.  “We’re very proud of both applications, but especially proud of the in-house staff whose intelligence, focus, hard work and vision were responsible for such a positive outcome.”
The Bright Ideas initiative shines a light on noteworthy and promising government programs and practices so that government leaders, public servants, and other individuals can learn about and adopt initiatives that work. Select past recipients of the designation have gone on to receive the Innovations in American Government Award. 
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