Search continues for case-management tool

NTCA group to vet candidates

It sounds a bit like an assignment from Mission: Impossible. A working group from the National TB Controllers Association (NTCA) is planning to meet in Atlanta next month, with the hopes of finding some decent case-management software for state programs to use.

Subcommittee members, along with practically everyone else in the TB world, agree there’s an urgent need for such a thing — and that TB programs needed it yesterday. But several on the subcommittee also doubt that ideal solutions will be ready until some indeterminate point in the future.

Last June in Baltimore, where this year’s annual NTCA conference was held, TB controllers turned down a chance to see Oriole third baseman Cal Ripken, instead turning out en masse for a night meeting on the subject. New Mexico, Florida, Alabama, and California took turns at the meeting touting the merits of case management systems they’d already developed or that were under construction.

The upshot was a resolution to take a harder look at the four states’ projects, and maybe some other entries as well, to see if any existing programs fit the bill for states looking for a short-term solution.

"We’re going to try to come up with some examples of best practices and then see which selection might work as an interim fix, without requiring a lot of expense in terms of training and support," says Dennis Minnice, a member of the subcommittee and Chicago’s TB program director. Such a fix, he says, would have to be flexible enough that other states could tweak it to meet their needs.

Plus, such a system wouldn’t take too much technical support to get it up and running and then keep it going, says Philip A. LoBue, MD, subcommittee member and assistant clinical professor of medicine at the University of California - San Diego Medical Center.

"Support is really the main obstacle," LoBue says. "Let’s say I have a program and I give it to you. You’ve got to install it, see if it works, and figure out what to do if it crashes. We haven’t seen how we’re going to deal with that."

For the long term, there’s a bigger task at hand, Minnice says. "We’ve got to determine some uniformly agreed-upon standards; we need to bring a better focus to the subject," he says.

Agreeing on what data to collect won’t be a simple task, adds LoBue. "The types of populations we deal with vary considerably," he says. "In some instances — contact investigation, for example — the science isn’t well-defined, either." The result is that one program collects one set of data, while a second collects another.

That’s one reason LoBue likes the idea of a system that’s web-based, he points out. "That would cut down on the need to buy a lot of [hardware], since multiple users could access it with only a computer."

In the ideal world, certainly, a case management tool wouldn’t make states to do tedious double-entry of data and would interface smoothly with TIMMS, the Center for Disease Control and Prevention’s TB surveillance instrument, say LoBue and Minnice.

The CDC’s one-way patch

The CDC’s TB software department has, in fact, developed a "patch" — a sort of software interface — that will enable programs to pull surveillance data out of TIMMS and put it into their case-management programs, says Jose Becerra, MD, MPH, chief of the computer and statistics branch at the CDC’s Division of TB Elimination. But even with the patch in place, the process usually won’t work the other way around, Becerra adds.

"That’s because TIMMS has 350-plus rules, and the rules need to be built into the case management system before TIMMS can accept the data," he explains. Kansas’ TB control program has been working with Becerra to get its data to conform with the demanding TIMMS parameters, and the program is almost there, he adds.

So why can’t states just use the Kansas package? No good, explains Becerra: "Each system does case management a different way. You need a system that’s flexible enough to be customized."

Both Florida and California seem headed toward integration of surveillance systems for a number of public-health disease entities. New Mexico and Florida are aiming at web-based systems, too, allowing for transmission of digitized chest X-rays or scanner-ready computerized tomography at the speed of an eyeblink.

Trying to eliminate double-entry

Florida’s system is bent on eliminating double-entry, says Graydon Shepherd, the state’s TB program director. "We’re still doing some double entry, but we’re making progress toward making the systems talk to each other," Shepherd says.

The Los Alamos National Laboratory brainiacs who’ve written OpenEMed, New Mexico’s case management contestant, swear they can also accomplish two-way talk with TIMMS, so that "data entered into the case-management system are automatically populated into TIMMS, and vice versa," says Gary Simpson, MD, PhD, another subcommittee member and the state’s head TB honcho.

Of course, Simpson and Shepherd both concede, the states’ respective systems need more money — and more time.