Technology development and acquisition
Arguably more can be done for strategic sustainability in this area than any other, but it is also arguably the hardest. Challenges stem from uneven funding cycles, evolving technologies, jurisdictional procurement policies/constraints, the role/authority of central information technology (IT) teams and the small market niche of public health software. So what is mostly in the health department’s control to ensure sustainability?
Leverage shared services. Similar needs should drive similar solutions. Much of what surveillance and other public health programs do is similar across jurisdictions, with actual differences in processes being less common than most assume. Leveraging technologies provided by CDC, the Association of Public Health Laboratories (APHL), the Council of State and Territorial Epidemiologists (CSTE) and others is a powerful way to ensure sustainability while also enabling the health department to benefit from being part of a community of users for joint problem solving.
Consider open source. Open source software offers the opportunity for jurisdictions to share solutions to common needs and challenges. Because they have the potential to address issues of scalability and security at reduced costs, open source software should be considered as part of strategic sustainability planning. There is a wide range of open source software available globally with different levels of robustness depending on the user community. Moreover, keep in mind that a free software license doesn’t imply that there are no related costs involved or that the user will have no obligations. For example, there may be a need to contract with a vendor who can support the open source software. Be sure to weigh pros and cons like this before accessing open source software. There is also growing interest among public health agencies to move away from dependencies on commercial software, largely for reasons of improved sustainability.
Shared services: RCKMS
Jurisdictions in the United States have leveraged shared service solutions such as the Reportable Conditions Knowledge Management System (RCKMS) for decision support of reportable conditions and the APHL Informatics Messaging Services (AIMS) for enabling laboratory data exchange and creating efficiencies to share data with partners.
Cloud computing. Hosting applications and/or data in the cloud has provided viable options for a growing number of health departments. Cloud computing provides relief from the continual cycle of server acquisitions, upgrades and security patches. It also enables rapid increases in storage volumes or processing power in emergency situations (and in some cases, to untether from central IT shops). Such freedoms come at a cost, however, so a careful cost-analysis can help ensure it contributes to sustainability in the long term.
Procurement. The approach for procuring information technology should be driven by the health department’s plans for strategic sustainability. Think about the following questions as the health department embarks on data modernization projects:
- Will the health department be joining a user community in which costs for enhancements might be shared?
- Can the health department maximize the number of option years for the vendor contract to avoid time-consuming solicitation processes and possible price hikes?
- Has the health department established reasonable (i.e., affordable) service level requirements for the vendor in terms of uptime, response times, etc.?
- Is the health department asking for expensive and one-off changes to the software that will add to costs in the short- and long-term (see the next paragraph on configuring rather than customizing)?
- Is the health department paying the vendor to provide services staff could do, perhaps even better?
Staff don’t always have control over the health department’s procurement policies and procedures, but developing a relationship with procurement staff helps the procurement team understand the particular needs of public health (such as a small vendor market) and may help to gain latitude where it is most needed.
Configure rather than customize. Related to procurement, if using a vendor product, resist the urge to customize the application to the point that the health department is no longer using a standard product and therefore unable to benefit from regular updates and cost-sharing. Having a one-off software product is the most expensive and least sustainable approach to software ownership and use. Being part of a community of users that jointly identifies enhancements, agrees on the requirements and shares in the costs is far more sustainable, even if it means each jurisdiction has to give up some control.
Resource: Overview of open source
Dr. Noam Arzt, HLN Consulting, LLC, presented a primer on open source at the American Immunization Registry Association (AIRA) national meeting. This presentation includes defining a SWOT (strengths, weaknesses, opportunities and threats) analysis for proprietary and open source software, as well as strategies for success when using open source software.
Resource: Total cost of ownership analysis
Building and maintaining information systems are often associated with costs. This tool is included in the Toolkit for Planning an EHR-based Surveillance Program and can be used to provide insights into hidden costs and cost savings.