**Utah\'s Indicator-Based Information System for Public Health**

**System Description**

**02-19-2003**

[Abstract]{.underline}

The Utah Department of Health currently has a web-based data
dissemination system, called the Indicator-Based Information System for
Public Health (IBIS-PH). IBIS may be accessed at the following URL:
<http://health.utah.gov/ibis-ph>. The system is meant to provide broad
dissemination of information deemed necessary or useful for public
education and public health program and policy decision-making.

IBIS-PH includes the following functions:

-   [Indicator Reporting and Visualization System
    (IBIS-IRV)]{.underline}. IBIS-IRV provides web reports of
    standardized views (including graphs and public health context) for
    public health indicators, such as Healthy People 2010 national
    health objectives, communicable diseases, risk factors, and chronic
    diseases. Indicator web reports are generated dynamically from
    stored data (providing for easier report maintenance). Data from
    individual indicators may also be strung together into \"set
    reports.\"

-   [Data Query System (IBIS-Q)]{.underline}. IBIS-Q provides a
    user-friendly web interface allowing custom queries of public health
    data sets, such as death, birth, hospital, emergency department,
    BRFSS, and population data.

-   [Indicator Development and Administration Interface
    (IBIS-Admin)]{.underline}. IBIS-Admin employs a user-friendly GUI
    that allows subject-matter experts to create and modify indicator
    data stored on the IBIS-IRV system. It also allows for system
    administration functions, such as granting user privileges and
    standardizing report elements, such as the way data sources are
    presented, etc.

-   IBIS-PH also provides access to static pages, such as published
    reports (.pdf files), and information on public health, such as the
    role of government in public health practice and the local public
    health system.

Primary responsibility for IBIS currently rests in the Utah Department
of Health, Office of Public Health Assessment, Lois M. Haggard, Ph.D.,
Director. The project has been supported by the Utah Department of
Health, HRSA MCHB, and most recently, the CDC Assessment Initiative
Project. The Assessment Initiative funding will support Utah and other
states wishing to adopt the technology.

[Background and System Purpose]{.underline}

The Utah Department of Health has developed a web-based data
dissemination system, called the Indicator-Based Information System for
Public Health (IBIS-PH). IBIS-PH may be accessed at the following URL:
<http://health.utah.gov/ibis-ph>. IBIS-PH is based on previous systems
funded by the Assessment Initiative (in 1994) and HRSA, MCHB (in 1997).
IBIS-PH is currently beginning its third and final year of a Cooperative
Agreement with HRSA, Maternal and Child Health Bureau, \"Data
Utilization and Enhancement Cooperative Agreement Program for State
Information Systems\" (#6U93 MC 00172-03-01). Utah was recently awarded
funding from the CDC, Cooperative Agreement to Support State Assessment
Initiatives\" (#U82/CCU822377-01).

The system is meant to provide broad dissemination of information deemed
necessary or useful for public education and public health program and
policy decision-making. IBIS-PH makes the most commonly-requested
information the fastest and easiest to access. Demand for public health
information may be conceptualized as an inverted pyramid.

**Figure 1: Public Health Information Demand Paradigm: Provide Easiest**

**Access to Information on the Most Frequently-Asked Questions**

Links on the IBIS-PH homepage provide access to published reports (.pdf
files online), and background information on public health, such as the
role of government in public health practice and the local public health
system. The homepage and background pages are static html pages that
will require only occasional updating. A user survey may also be
accessed from the homepage. Users are encouraged to provide feedback to
the system staff using the on-line survey. The survey is a simple JSP
with Java servlets that supply data to the Oracle database.

[Indicator Reporting and Visualization System (IBIS-IRV)]{.underline}

IBIS-IRV is accessed from the homepage by clicking on the \"View Health
Indicators\" link. It provides web reports of standardized views,
including graphs, numeric tables, data definitions, and public health
contextual information for health indicators, such as Healthy People
2010 national health objectives, communicable diseases, risk factors and
CSTE Chronic Disease Indicators. IBIS-IRV may be used in anticipation of
frequently-requested information. It may also be used to \"push\"
information to the public on topics deemed important for public
awareness.

The indicator web reports are created dynamically from a central data
repository that stores both numeric and text data. That is, a web report
does not exist until a user request initiates it. Data from the database
are presented to the user according to standardized report templates.
IBIS-IRV currently uses Actuate e-reporting Software to assemble
information from the database into an html report page that is sent to
the user\'s browser. A flowchart of the current system, using Actuate,
may be found in Attachment 1., at the end of this document. The Actuate
web reporting application has limitations and is unable to provide the
utility we require. An alternate solution has been defined. Even so the
system does currently operate using Actuate.

Indicators are indexed in multiple ways, including alphabetical,
organizational, and topical indexes. The indexing system is flexible and
can accommodate an infinite number of indexes. The multiple indexes
essentially provide \"portals\" for users coming from different
perspectives. The indexes are hierarchical, and one indicator may appear
under any number of indexes. The index page content is dynamic, based on
the indicators currently published in the system.

In addition to the reports for single indicators, reports of those
indicators may be strung together into \"set\" reports. This feature may
be used to compose first-draft versions of paper reports.

[Data Query System (IBIS-Q)]{.underline}.

IBIS-Q provides a user-friendly web interface that allows users to query
public health data sets, including mortality, birth, in-patient hospital
discharge, emergency department visits, BRFSS survey data, and
population estimates. IBIS-Q uses de-identified public datasets. Query
output may also be constrained to exclude table cells with small
numbers. The parameters for the cell suppression algorithm may be
modified according to the state\'s wishes.

A flowchart of the IBIS-Q system may be found in Attachment 2. Data
query modules currently supported include the following:

-   Mortality (1980-2001)

-   Birth (1989-2001)

-   Linked Birth and Infant Death (1989-2001)

-   Inpatient Hospital Discharge (1992-2001)

-   Emergency Department (1999 & 2000)

-   BRFSS (1998-2001)

-   Utah Health Status Survey (2001)

-   Utah Population Estimates

-   General (by county, sex, and single year of age for 1980-2030)

-   Population by race (by county, sex, five-year age groups for
    1990-2000)

-   Hispanic ethnicity (by county, sex, five-year age groups for
    1990-2000)

Data from summary tables produced by the NEDSS base system are planned
for implementation in the future. IBIS-Q also houses a knowledge
management system within its help pages that includes commonly-required
general information, such as how to age-adjust rates, ICD codes and
mortality comparability ratios, and problems with reporting small
numbers.

[Indicator Development and Administration Interface
(IBIS-Admin)]{.underline}.

IBIS-Admin allows subject-matter experts to publish indicators on the
IBIS system. It provides a graphical user interface that allows program
staff throughout the Department to develop and publish their own
indicator pages. Indicator developers user use the Admin site to modify
values in the IBIS-Admin Oracle database. Access to the IBIS-Admin site
is controlled by SiteMinder using single sign-on technology (users enter
their current NetWare password to access the system). Indicator
\"owners\" are granted rights to their indicators by the SysAdmin user,
and indicator \"owners\" may grant rights to \"editors,\" typically
program staff who provide assistance with content development and
maintenance.

Indicators under development go through the following statuses: Open,
completed, approved, and published. An indicator is created and set to
\"open\" by the SysAdmin user. The indicator owner sets the indicator to
\"completed,\" to signal to the SysAdmin user that the content is
complete and ready to publish. After the content has been reviewed for
quality assurance, the SysAdmin user sets the status to \"approved,\"
and the indicator data may then be pushed to the Public database, where
it can be viewed by the public. Once the data have been pushed to the
public site, the indicator status is changed to \"published.\" If an
indicator owner wishes to modify his or her indicator data, he or she
may set the status on the Admin database back to \"open,\" and the cycle
repeats.

[Next Steps]{.underline}

-   Replace the Actuate e-reporting system with XML data tables and XSLT
    web report templates.

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-   Design and implement a community profile report system where users
    can obtain information for a given community (geographic or
    race/ethnic community) across several indicators.

-   Implement dynamic mapping of health events.

-   Implement a system whereby numeric summary data on the IBIS-IRV
    database are automatically updated from the source data sets as
    source datasets are updated. This feature will save staff time, and
    will become crucial as the more dynamic NEDSS data are integrated
    into the system.

-   Evaluate the current system and identify necessary and desirable
    upgrades for improved utility and relevance to public health
    practitioners in Utah and elsewhere.

-   Implement changes to the current system, based on the results of the
    evaluation.

-   Package the IBIS-PH system for transfer to other states
    (install.exe, users manuals, technical documentation, etc.).

-   Market the IBIS-PH system to and successfully deploy it in
    additional states.

[Attachment 1. Utah\'s Current IBIS-PH System]{.underline}

[2. IBIS-Q, Query System Diagram]{.underline}