Benefits of Program Collaboration, Service Integration and Data Sharing

1. Benefits of Program Collaboration, Service Integration and Data Sharing

2. STD/HIV Collaboration Milestones • 1987 - STD and HIV Programs adopt unified effort to maximize PS capacity. • 1987 – PS offered to CHD HIV+ clients by STD Program DIS. • 1997 – HIV Reporting (July 1997) • 1998 - PS for HIV+ clients increased 46%. • 2002 – Policy Change- PS Offered to all HIV + Persons Tested Through C/T Sites. • 2008 – Automated HIV/STD record search capability via PRISM and HARS.

3. ************************************************************************************************************************************************************************************************** Florida’s confidentiality and security exists to protect the individual and their medical information, regardless of the disease, as part of common practice in modern public health programs.

4. Physical Security • Hardware (server) locked within Data Center Building. • Limited Access to building with monitored entrance 24/7. • Background checks and security clearance policy. • Agency/Program confidentiality and information security policies Virtual Security • Firewalls – • Active Antivirus, • Security web scanning • Behavior level monitoring • Software to ensure latest security updates • Network security that includes: • User accounts with applied security access • Software level user identification and security controls

5. Modern Web Applications/BSTD and Area STD Programs: share security levels with internal network devices, in addition to encrypted VPN tunnels and no data stored on the device (simply a view into software and data on the server). Device registered on Network VPN – Encrypted Connection Device registered on Network • Mobile Connection: • Device registration • User Authentication • Software Authentication • Window to Data – Nothing resident on Device Memory

6. Future: Health Information and Electronic Health Records Past: Silo systems and databases divided by disease Healthy Evolution – long term sustainability

7. Rationale for Integration in the Delivery and Management of STD/HIV Partner Services • 10+ Years of steady decline in federal, state and local resources • Combined resources to maximize prevention impact • Significant overlap in populations served • Significant and increasing STD/HIV co-infection • Standardization of information security policies and procedures across disease control programs • Vastly Improved performance outcomes through information exchange between STD and HIV Programs

8. Reported STD Cases by sex, among clients who had a + HIV test on, or prior to the date of their STD diagnosis. Florida, 2005-2011

9. 41.8% 35% 32.4% 34.2% 26.3% 29% 26.9% 29.2% 25% 18.9% 12.9% 9.8% Syphilis Alone Syphilis/HIV Co-infection

10. Inter-program and Technology Advances to Improve Service Delivery and Performance Outcomes • Standardization of Information Security Policies to allow for automated information exchange across Disease Control Programs. (All DOH staff accountable!!) • Reciprocal data exchange between STD/AIDS Surveillance = Reduction in NIRs and improved intelligence for HIV Partner Services • Electronic lab reporting to reduce STD Prevention and PS timeframes • Ability to conduct virtual QA/QI via PRISM

11. Inter-program and Technology Advances to Improve Service Delivery and Performance Outcomes • AIDS Surveillance monitors clients with subsequent STD infections via PRISM • Included in Annual Epi-profiles • Used as key variable to evaluate “Prevention for Positives” initiatives and to guide resource allocation • Testing and Treatment History for Incidence Surveillance • DIS collect previous testing and antiretroviral use during PS sessions. Information used by AIDS Surveillance when calculating incidence estimates

12. ELR and Data Sharing = Reduced Timeframes for HIV Partner Services ELR Expansion PRISM AIDS Surveillance STD to HARS 47 17

13. 2010 HIV Partner Services - Florida

14. Reported Adult HIV (not AIDS) Cases, Florida Through 2010 N=44,957 Through 2005 N=35,584 Data as of 12/31/2005 Data as of 06/30/2011 Note: NIRs NOT redistributed.

15. PCSI is absolutely essential for disease control programs to: • Maximize resources/increase efficiency • Standardize and improve on information security policy and procedures (Fosters mutual confidence across programs that information will remain secure. • Reach the greatest proportion of infected and exposed persons through PS, referral, link to services • Provide holistic prevention services to clients