Fairfax County Health Department transforms data exchange and workplace culture
A FOCUS ON PEOPLE AND INNOVATION HELPS KEEP THE COMMUNITY HEALTHY
promising practices
Set up standing meetings to build relationships with leaders and staff. Understand their perspectives, goals and processes before offering a solution.
Centralize informatics requests to prioritize them strategically; a project management tools can help track risks and progress.
When hiring, look for people who want to learn different skills. Learning informatics and IT can be done on the job.
Celebrate the small wins. Small proof-of-concept projects can build trust and show leaders and colleagues the power of data modernization.
“When we looked at systems, interoperability was key. We asked: How do we make it work with other existing systems or future systems that we anticipate bringing to our agency?” says Noel Clarin, informatics and IT manager. The team began improving other systems, including Fairfax County’s lab information management system. Then, in 2023, Fairfax County began working with the Virginia Department of Health on a Fast Healthcare Interoperability Resources (FHIR) pilot project to access vital records from the state more efficiently. Along with these initiatives, the informatics and IT team recognized they needed a central source for data, and hypothesized a data warehouse could be the answer.
A COVID-19 community testing clinic. During the pandemic, the Fairfax County health department implemented a new EHR which connected to lab orders and state systems.
Implementing a data warehouse
Prior to the creation of the data warehouse, Fairfax County relied on disparate systems and downloads of comma-separated values (CSV) files that were transformed or cleaned manually by the user in the health department, and then pulled into the user’s analytical system such as R Studio, SAS or Microsoft Power BI. In contrast, a data warehouse would allow team members to pull the data directly into an analytical system without the extra steps of transforming it or saving it to their individual computers. The warehouse also represents “a single source of data truth,” according to Pooja Tewari, Council of State and Territorial Epidemiologists Applied Public Health Informatics Fellow. As a fellow, Tewari observed the informatics and IT team launch the data warehouse. She explains that health department staff wanted to be able to query data that was already transformed, which is why a data warehouse was preferred over a solution like a data lake.
Alida Laney, public health data manager at Fairfax County, led the implementation of the data warehouse. She says scalability was a factor in choosing Microsoft Azure for the warehouse platform, and that scalability is often thought of as vertical only, meaning processing power can be added or scaled down as needed. However, the Azure platform allows vertical—and horizontal scalability. “Horizontal means we can add new databases at any time, just by going through the user interface. So, the startup time and cost are minimal.” She says its capacity allows the team to add storage, or even spin off to a data lake. “It was made to work with what you already have, and you can move it to create what you want it to do, without restarting and reimplementing hardware and software. It all moves seamlessly.
Impact of the data warehouse
Currently, Fairfax County’s data warehouse includes data sources such as electronic health records, lab orders and results, disease surveillance data from the state, immunization records, and vital records. An immediate use case of how the data warehouse will help improve public health involves identifying non-reported congenital syphilis cases. Through the data warehouse and a daily data exchange of birth records via FHIR, the team will be able to match syphilis cases to mothers’ names in birth records. Ben Klekamp, epidemiology manager for Fairfax County, says the matching of the mother’s name adds another surveillance layer, and “will help our investigators confirm a case to ensure the child receives the treatment they need.”
Tewari says the new data warehouse can also lead to health equity. “With the improved informatics infrastructure, we can use data to drive action. And that could consist of improving internal case management, setting program priorities, creating sustainable data analyses, and looking at disease burden across program areas.”
The data warehouse allows the team to easily build data dashboards for different audiences. Tewari gives the example of a dashboard that is available for public view, which could help the community feel empowered to make decisions and engage in different preventative measures. She also says another dashboard could be created for community providers to have actionable data and offer preventative measures to their patients who are identified as having the greatest need. “The data warehouse can allow for the ability to analyze and disseminate public health data. And through these dashboards, it promotes health equity, and it demonstrates a commitment to addressing public health problems and disparities in a collaborative manner.”
Coordinating data efforts with the state
According to Klekamp, in the past, public health data modernization resulted from responding to emergencies, which can often break down political, operational, and financial barriers. That allowed public health to move quickly and do things rapidly. “Unfortunately, though, these efforts may not always be done in a way that is thought through, and they do not serve a greater purpose…or solve a larger data modernization effort.”
Klekamp says in non-emergency times, data modernization efforts “come from a shared goal.” A recent example involved transferring rabies animal testing results from the local to state level. Fairfax County has its own locally operated public health lab, and the lab performs animal rabies testing on site. The data were stored locally, “and then once in a while, every quarter, every six months or something like that, we would send a static file down to the state, and then they would sit there and manually enter that data into their system.” This process was a burden for Fairfax County to remember to send the file and for the state to manually enter data.
The Fairfax County informatics and IT team and the Virginia Department of Health worked together to find a solution. The rabies data were stored on a Microsoft Dynamics database, and the informatics and IT team created their own Microsoft Power App, which automatically formatted the data into the structure that the state requested. Laney explains, “It moves on a timeline. It is timed weekly, and it moves seamlessly, to create the file, and then we use Rhapsody, an integration engine. This helps move that data securely to the state, in the format they’re requesting, so now people don’t have to hand-enter the data…and the state uploads it into the state surveillance system.”
Fairfax County laboratory scientist Nancy Yeomans preparing a microplate for TP-PA testing.
(Photo credit: Will Schermerhorn)
Communications strategies
The informatics team required buy-in for their interoperability initiatives from many different leaders, including Fairfax County executives, division leaders, department leaders in Fairfax County as well as state health officials. Clarin says there is no secret formula to getting buy-in from so many different leaders, but “what has helped for us has been a lot of communication and engagement with each of these different leaders. I think it is important to understand that each of us plays a different role within public health, and within our own agency, and within the county, and it helps to get a good understanding of the different perspectives that each of these leaders has.”
He says their team has worked hard at building relationships with these different influencers and partners, as well as gaining an understanding of their needs and goals within their own division or environment. The questions his team asks are: “How do we align all our goals together to really look at a strategic vision? And how do we make technology work for us, to move towards that vision?”
The informatics team increased their opportunities to communicate, setting up standing division and program meetings. Clarin says his team’s efforts “resulted in opening doors” and making it clear they were available for brainstorming or questions.
Laney says in the meetings they try to understand their colleagues’ pain points and needs before offering a technological solution. Meeting with colleagues helps her learn how much the staff was doing for each program and the passion they have for the work. It also helps her understand how much time they’re spending gathering data, transforming data, and doing statistical analysis, which drives policy and outreach. She says these conversations were a good way to understand the work of programs, telling colleagues, “Let us take this pain point, that could be solved with technology, out of your process so that you have more time to do the work you need to do, like creating policies and planning outreach and/or support for your program.”
Workplace culture changes
The interoperability initiatives allowed Fairfax County to implement new solutions and technology, which allowed for more efficient work processes. “It also built trust and a relationship with our individual programs, because they started to see how informatics and IT could work for them and what it could do for public health,” says Clarin.
Klekamp explains that he’s seen big changes during his 12 years of working in public health. When he first started working, there was no dedicated informatics staff. Epidemiologists often had to figure out informatics solutions on their own. He says the mindset was, “What are we going to do, as epi’s, because nobody else is coming to help us out?” (He notes that this can still be a reality for many health departments.)
Now he says epidemiologists are more strategic about how the data are being processed and are more closely aligned with IT and informatics. “Instead of just jumping in and trying to implement a solution on their own, epi’s gather requirements and work with IT and informatics staff to understand the best path forward.” He adds, “Now we have personal relationships with the people that can help us get the data, move the data, transform the data, and then that way, we can take the data and do things with it.”
Project management and process mapping
Along with increased communications, the informatics team worked on organizing and prioritizing informatics requests. During COVID, the interaction between different programs and the effects on each other’s technologies became more evident. So, they centralized requests, assessing them strategically on how the technology request may affect other programs. According to Clarin, the informatics team would ask: “Who needs to be at the table when deciding this change? And then, working together to implement that change, how do we train users? How do we educate them, and then, how will we maintain it afterwards?” One way the informatics and IT team understands the work of their colleagues is to use the visual power of process mapping. These visual diagrams help program staff better understand work processes and bottlenecks and help the informatics team find efficiencies and decide on solutions.
Download COVID-19 process map example
During the pandemic, the Fairfax County informatics and IT team met with the case, contact and wellness teams to map out their processes for tracking and following up with COVID-19 cases and contacts in the community. The mapping revealed that much of the process involved multiple notifications, and time spent sharing information in Excel sheets and emails. The IT team created an application, a central data repository to support the necessary data collection for the Health Department. This also allowed the teams to look up information for their case/contact on demand and provided the capability of automatic notifications. This quickly streamlined the entire process. The application was also built to be “disease-agnostic” so it can be quickly adapted for a future outbreak if needed. (Proprietary information removed from example.)
Download care coordination process example
This process map example shows an example workflow for care coordination teams in Fairfax County. In this case, the Health Intervention Team (HIT) wanted the help of the IT and informatics team to document a complex workflow. They didn’t require a technical solution from the mapping—rather, they needed a holistic view of the entire process that would serve as a knowledge and communications tool for the care staff. The yellow starburst symbol on the process map represents a pop-up window that displays additional information. (Proprietary information removed from example.)
Challenges
One of the challenges for Fairfax County has been bringing different entities and people to the idea of data modernization initiatives. Laney says, “We have program-level folks we’ve got to bring in. We’ve got enterprise information technology. We have leadership. We have policy. We have laws that we have to abide by, especially for security. And we also have our state health department too, that we must interact with and work with for data modernization.” She says an important challenge was addressing security, “making sure that we’re following the letter of the law to protect the information that we have. So, that was top priority, and we worked with our enterprise IT folks to build in all the security that we needed to ensure that all our data were kept safe.”
Small wins and learning to adapt
Clarin says a factor that has helped with obstacles, particularly to build buy-in or collaboration, is looking for “small wins, where some of these new ideas work.” Laney says these little wins also help leaders and staff members see the value of data modernization. She says, “We can give data on the efficiencies that have now been built into the staff, so they can focus on other areas, like policy work and outreach, instead of downloading and transforming files.”
She thinks small proof-of-concept projects can help get staff on board. “Showing someone who is not in informatics, and is not in IT, who maybe doesn’t understand the back end of how this, all of this is coming together, having something concrete to show them, that helps them in their work, really builds excitement and trust.”
Clarin says an adaptable attitude is important. “There is always going to be a need to pivot and there will always be obstacles. As you go down this path of data modernization or implementing new technologies, there’s not one way to do things … being flexible and being able to pivot is going to be key.”
Tewari agrees that adaptability is important and that learning informatics skills is achievable. At conferences, she often asks about the educational background of people she meets, and usually finds out that informatics skills are learned on the job. “I think that’s validating, because people might be afraid to try it if they’re just like, ‘Oh, I didn’t do my education in this.’” In her own fellowship, she has taken advantage of training and even learned programming languages to help implement some of the data modernization initiatives. other areas, like policy work and outreach, instead of downloading and transforming files.”
Power of the people
For Fairfax County, the biggest factor in their success is the people. “We are fortunate to have leaders who support our efforts, our goals, and individual projects. And we have users that want to change and want to adapt,” says Clarin.
He adds that technology shouldn’t be the one solution that solves everything. “Technology is what should support the people and support the processes that are in place, and when we can align the people and the processes and put in a piece of technology that supports it, and provides efficiencies, I think that’s where we find wins with our programs, and they can see the value of how it all comes together. And it’s seeing the tangible effects of having it all in place.”
Leaders optimistic about data modernization efforts
The Fairfax County Health Department is hopeful about the changes they are seeing from data modernization initiatives. Klekamp says data modernization helps local health department staff work from data to inform their decisions instead of relying on perceptions. He says when you work in a community for a long time, “assumptions about the community start to kind of take hold.” In certain locations, he says, “there are a lot of historical, and sometimes very negative things about what happened in that area to those individuals in that area. But I think it’s really important to use data to confirm or dispel those perceptions.”
These efforts also help ensure that public health professionals are spending their time on what’s most important. “The data modernization effort is making sure that we don’t spend our time and our resources sitting there just managing data all day long. It’s about freeing up staff time, so we can get into the community more.” says Klekamp.
Clarin says data modernization allows their health department to think differently. He adds he has been fortunate to work with people who are willing to “push the envelope,” examine their program processes, change, and adapt when needed. “You know, in order for us to modernize, we have to step outside of the box. We have to think differently and approach things in a different way to find those new opportunities.”
key takeaways
- A data warehouse makes combining data easier, offering potential solutions to complex public health issues.
- A data warehouse contains cleaned and categorized data. These data can be sourced for analytical reporting, potentially saving staff the extra steps of transforming the data first.
- Technological solutions should be offered only after understanding work processes, goals, pain points and perspectives. Conducting process mapping and requirements gathering at the start of a new project results in a more stable and sustainable solution at the end.
- Successfully implementing data modernization comes from a foundation of shared goals and partnership-building.
“Technology is what should support the people and support the processes that are in place, and when we can align the people and the processes and put in a piece of technology that supports it, and provides efficiencies, I think that’s where we find wins with our programs, and they can see the value of how it all comes together.” - Noel Clarin
Sources
1. Centers for Disease Control and Prevention. Advancing Interoperability for Public Health. https://www.cdc.gov/
2. Amazon Web Services. What’s the Difference Between a Data Warehouse, Data Lake, and Data Mart? https://aws.amazon.com/compare/the-difference-between-a-data-warehouse-data-lake-and-data-mart/
3. Microsoft Azure. What is a data warehouse? https://azure.microsoft.com/en-us/resources/cloud-computing-dictionary/what-is-a-data-warehouse/
