Project Collaboration Research Initiative (PCRI) May 2006 Gary Feldman MD and Karen Smith MD Presented by Karen Smith,

1. Project Collaboration Research Initiative (PCRI) May 2006 Gary Feldman MD and Karen Smith MD Presented by Karen Smith, MD, MPH and Roger Rosenberg, Project Director

2. PCRI is a Partnership • HOAC – Health Officers Association of California • CCLHO – California Conference of Local Health Officers • Cal DHS – California Department of Health Services • UC CIDP – University of California, Berkeley Center for Infectious Diseases Preparedness

3. Project Information Lab/Company/Group: Health Officers Association of California (HOAC) Collaboration Project Principal Investigator: Gary Feldman, MD, and Karen Smith MD Government COR: Jan Patterson Government Project Officer: Gabe Caganap Contract Instrument: Grant Period of Performance: 01 Apr 2005 – 30 Apr 2006 Contract Specialist: Nita Bourne Date Initiated: 01April 2005 EDMS# : 2685 Contract #: W81XWH0510362

4. Project Description: Hypotheses • Health officers of California can use state-of-the-art collaboration and conferencing software to enhance planning for and response to threats of bioterrorism, pandemics and other widely distributed public health disasters. • Health departments in California can use the software to improve coordinated, rapid response the threats within each of their jurisdictions.

5. Project Description: System Requirements • Conferencing must include shared viewing and editing of documents as well as full duplex audio. • Multiple means of access must be available in case of loss of power/phone. • Virtual Private Network level security is essential to ensure that decisions and documents under discussion remain secure. • System must provide an “audit trail” of activities, discussions

6. Health Officers will log into a customized portal with a unique ID and password.

7. Upon successful login Notification Banner – for emergent situation Main Menu provides access to all portal features Instant list of available meetings Chat instantly with whoever is on-line or jump into an ad-hoc meeting List of active announcement or news relevant to the HOAC community

8. Users can schedule a collaboration meeting and invite authorized users. Select audio/video and recording options.

9. Users can chat to anyone that is on-line. From the chat window they can invite to that person to a collaboration meeting

10. A fully functional Forum allow users to create offline discussions regarding topics of interest. Full searching capabilities allow users to find topics. Users can respond to main discussion threads for other users to review.

11. A full library function for uploading and downloading documents including the ability to subscribe to specific categories or collections of documents. Full search capabilities allow users to find documents based on a particular topic.

12. Audio controls and who is talking status Once a collaboration meeting starts Full whiteboard capabilities for collaborative drawing or reviewing pictures in real-time List of participating users and who is talking at any time Ability to upload presentations, share any program in your computer or visit any web site together. Create real-time polls.

13. Project Description: Future Implications • Effective response to a widespread, serious public health threat requires health officers to collaborate in real time. As a result of PCRI Officials will be able to: • Share data: maps, photos, radiographs, charts • Draft: strategies, policies, press releases • Update continuously as the situation unfolds. • Availability of and familiarity with conferencing software will allow use in routine meetings generating cost savings due to decreased need to travel.

14. Projected Outcomes • Deliverables • Conferencing protocols • Reports of drills and exercises utilizing software with increasing participation by health officers with increasing competence, efficiency and effectiveness • Reports • Quarterly and annual

15. Potential Benefits • Health officers will collaborate more efficiently and share relevant information on a real-time basis • This means of collaboration will become increasingly natural and easy to the point it will be the routine • The technology will facilitate routine meetings and lessen the need to travel saving money. The software will store meeting contents and become the record of the meeting • As a tool for designing and deploying exercises in bioterrorism, WMD and natural public health disasters, PCRI will facilitate readiness across California.

16. Military Relevance • The ability of disparate group of health officers to learn to use this technology in an effective manner to collaborate in routine and emergent situations and use it in a creative fashion to design and deploy major cross-jurisdiction exercises, then this approach should be equally useful in a wide variety of military situations. • If the military is deployed where there is no public health structure, it assumes responsibility for the public health of its troops and the population under its jurisdiction. This tool should be equally effective for military “public health officials”

17. Research/Development Plan • Three phases • Phase I: build and connects a VPN intranet connecting the combined board members of the CCLHO/HOAC in 19 counties throughout the state and test the usability of the middleware/collaboration software. (Beta testing of software indicated need for a change to the Interwise Platform)

18. Research/Development Plan • Three phases • Phase II: • connect 350 users in California counties and begin to investigate the efficacy of the over-all system for drills, exercises and ‘real-time’ responses to terrorism and natural disaster. • collaboration software enhanced with ‘modular’ web portals for each county and an overall portal for the entire state. The portals function as a reception and information desk providing ‘presence detection’ of participants and instant accessibility to members who are not currently participating. • Sustainable work rooms and data storage are provided. • Other enhancements include calendars of events that are available to all, news banners of current topics, both by state and by county. • At least one major affiliate group, e.g. the California Association of Local Public Health Lab Directors will be allowed access to the system

19. Phase II • Phase II build out will accommodate users on a state-wide basis including approximately 40 counties. • Interwise servers on line by May 25th • T1s installed May 22nd • Nortel CS1000 PBX installed by June 9th • Test and Acceptance June 5 – 6 • Total system ready June 14th

20. Phase II timeline

21. Research/Development Plan • Three phases • Phase III – connect approximately 3,500 users (all counties including Los Angeles) and other crucial worker groups such as the Public Health Nurses. Capacity is available for connectivity to traditional first responders, National Security Assets.

22. Research/Development Plan • Drills and exercises – Phases II and III • Progressively complex • Simple log on communications drills (inter-jurisdictional) • Tabletop exercises – informal, discussions with document sharing (inter and intra-jurisdictional) • Functional exercises – fully simulated emergencies (inter or intra-jurisdictional) • Intra-jurisdictional special applications • “special projects” within a single jurisdiction, e.g. connecting PH department operations center with hospitals, EOCs, etc

23. Research/Development Plan • Routine use: increase HO familiarity and comfort with software through routine use • Regular Board meetings • Exercise planning meetings • Will incorporate document sharing, etc • Inter-jurisdictional collaboration in real time

24. Successes to Date • Phase I proved that useful work could be completed using collaborative technology. • Beta test analysis through use of testing metrics, user interviews and questionnaires indicated the need for a software platform change. Several systems evaluated, Interwise chosen. • Project has enhanced HOAC’s visibility with related health organizations and first responders.

25. Successes to Date • Training provided to HOAC Board of Directors • Training includes installation, software features and etiquette of internet mediated collaboration • Use of the software to conduct meetings • HOAC Board of Directors • Project planning meetings • System infrastructure in place in 19 counties throughout California, State Health Officer’s office and at the CCLHO office (State Dept. of Health Services) in Sacramento

26. Challenges • Overcoming resistance of Health Officers to take time necessary to learn to use conferencing tools • Funding inadequate to build out the system as initially envisioned • During beta testing in Phase I, there was insufficient user acceptance of the existing collaborative platform necessitating a review of alternative platforms, adoption of a new system, and a delay in role out.

27. Quality Assurance/Regulatory Issues • None identified

28. Contract Funding **$838,000 available in FY05 pending

29. Project Funding - Execution Current BudgetExpended Funds% $838,000 $808,000 2%

30. Project Coordination Currently, no military or civilian agencies are formally participating in Project Collaboration. California National Guard Incident Command Center, and elements of the 18th Airborne Corps and JITC (Joint Information Technology Command) are aware of our progress as are the FBI and NSA.

31. Cost Analysis/Cost Savings Calculation of per user fee between both Interwise and IWS

32. Cost Analysis/Cost Savings

33. Comparison • Although other applications of collaboration software are being pursued by others, we are not aware of any other similar work.

34. Intellectual Property Status • Existing vendor agreements allow HOAC to utilize all aspects of the collaboration platform and the network to accomplish the Physician Health Officer mission • No further needed Confidentiality Agreements or Patents have been identified • There are no assignments or obligation to assign rights to current or future patents/applications • No invention disclosures submitted

35. Publications • No publications have been written on the HOAC Project Collaboration Research Initiative at this time

36. Take Home Message State-of-the-art conferencing software and associated training allows public health officers and their health departments to better collaborate in planning for and responding to a wide variety of local and regional public health threats.