Ontario Public Health Unit Environmental Health Information System Survey

Transcription

1 Ontario Public Health Unit Environmental Health Information System Survey Suchita Jain, Public Health Officer, alpha //00

2 Table of Contents Executive Summary... Introduction... 5 Objectives... 5 Methodology... 5 Results... Program Areas... Challenges... 9 Future priorities... Conclusion and Recommendations... Appendix : In Depth Analysis of Data Collection Tools Used by Health Units for Environmental Health Program Areas... 5 Program Area : Food Safety... 5 Program Area : Small drinking water inspections: a) Transitional-small drinking water systems... Program Area : Small drinking water inspections: b) small drinking water systems... 7 Program Area : Tobacco inspection... 8 Program Area 5: Day nursery and nursing home inspections... 9 Program Area : PSSI... 0 Program Area 7: Rabies Investigation... Program Area 8: Cold chain Inspections... Program area 9: Injury Prevention Inspections (IPI)... Program Area 0: Part 8... Program Area : Health Hazard Investigation... 5 Program Area : Local by-law enforcement... Program Area : WNV related investigations... 7

3 Executive Summary In June 00 a survey was sent to all health units environmental health departments to evaluate the data collection tools (Environmental Health Information Systems (EHISs), other software programs, and/or paper) being used by health units to collect information for various environmental health programs and business functions. The survey also evaluated the challenges and the priorities in terms of implementing and enhancing EHISs. Overall, 7 of the health units that completed the survey use Hedgehog for inspection data collection; health unit uses Amanda/THEIS; health unit uses a Siebel designed system; and health units use Health Space. Though health units have implemented EHISs, they are still using 5 different data collection tools (EHISs, software programs and/or paper) to collect inspection data, depending on the program area. Furthermore, health units are using between and different combinations of data collection tools (EHISs, software programs and/or paper) to collect data for program areas. For business functions, up to different data collection tools (EHISs, software programs and/or paper) are used to collect data depending on the business function. Furthermore, health units are using between 8 and 8 different combinations of data collection tools (EHISs, software programs and/or paper) to collect data on business functions. Though the majority of health units are using the same EHIS (Hedgehog) to collect data on environmental health programs, the survey results suggest that there is no coordinated way the EHISs are being used. There were many combinations of how health units are using the EHIS in combination with other software programs and/or paper for data collection. In addition, there is variation in the program modules that have been implemented by the health units. While no health unit is using Hedgehog for all program areas, a module for each program area has been developed by at least one health unit. Recommendations: I) Process Oversight ) An EHIS working group should be established to set priorities and direction on the future development, maintenance and enhancement of EHISs in Ontario. The objectives could include: To bring MOHLTC and Ontario Public Health Units together to work collaboratively on developing common data elements and definitions; standardizing a minimum data set; developing risk assessment tools; and developing common reporting tools To have a forum to share knowledge and resources on environmental health information systems Work together to facilitate the identification of future needs of environmental health information systems (upgrades, new equipment, new systems) facilitating secure funding pools and negotiating vendor agreements, as needed to meet future needs

4 II) EHISs ) Health units are currently using multiple data collection tools (EHISs, software programs and/or paper) to collect data on program areas and business functions. Health units should work towards having a comprehensive EHIS that can capture data on all program areas and business functions. ) Support further evaluation of EHIS software (s) being used by health units in order to work towards an integrated EHIS that could be used by all health units in Ontario. The goal should be to have a comprehensive system that can capture a core set of consistent data across Ontario with the flexibility for health units to customize the system as required. III) Standards and guidelines ) There is no clear overall picture of data standards, definitions, and reporting requirements available for Ontario environmental health programs for health units. The EHIS working group should work with the MOHLTC to conduct a review of reporting systems, standards, policies and data definitions that are available. The review should outline the strengths and gaps that are in the system(s) and provide evidence based recommendations to improve standards, data definitions and reporting requirements. ) For program areas where there are no reporting standards and/or definition the EHIS working group should focus on working with the MOHLTC to develop and communicate evidence based reporting standards, guidelines and data definitions. This should be a high priority as the process will guide health units in the development of program modules for their EHIS; it will decrease the budget and resources required to develop program modules from scratch; it will help in providing the MOHLTC with accurate and comparable data; and it will decrease the number of software programs required for data collection and reporting. In addition, the process will provide the MOHLTC and health units with a better understanding of how environmental health programs in Ontario are meeting their goals.

5 Introduction In 008, the Ministry of Health and Long-term Care (MOHLTC) requested alpha to help implement environmental health information systems (EHISs) in Ontario. At this time a survey was sent to all health units to evaluate the various data collection tools (EHISs, software programs, and/or paper) being used to collect data for various environmental health programs. A software vendor and hardware vendor RFP process was completed and licences for Hedgehog were offered to all health units along with the hardware required for implementation. Some health units continued using or introduced other EHISs, including Health Space, Amanda and Siebel. In June 00 a survey was sent to all health units to evaluate the data collection tools (EHISs, other software programs, and/or paper) being used by health units to collect information for various environmental health programs and business functions. The survey also evaluated the challenges and the priorities in terms of implementing and enhancing EHISs. This report only focuses on the results from the environmental health program areas. A full report that includes the results for business functions can be found on the alpha website. Objectives The objectives of the survey conducted in 00 include: ) To gain an understanding of data collection tools (EHISs, software programs and/or paper), if any, being used by Ontario health units for environmental health program areas and business functions. ) To identify the challenges that the health units face in implementing and maintaining EHISs. ) To identify the EHIS priorities of the health units. The main goal of the EHIS is for a health unit to have one comprehensive EHIS that can collect appropriate inspection data for all program areas. Furthermore, the data collected among health units should have common definitions so that it is comparable at a provincial level. The results of the survey will help inform and drive the work of the Environmental Health Information Systems Working Group. The purpose of this working group is to set priorities and direction on the future development, maintenance and enhancement of environmental health information systems in Ontario. Methodology In June 00, a survey was sent via to all health unit environmental health Directors/Managers. The survey asked health units to identify all the data collection tools (EHIS, software programs and/or paper) being used to collect data on program areas and business functions. Section of the survey asked about the challenges in developing and implementing EHIS environmental health program modules for data collection. Section focused on health unit EHIS priorities. 5

6 # of programs Results Responses to the survey were received from of the health units. The results are summarized in three sections: a) the data collection tools (EHIS, software programs and/paper) used for various environmental health program areas; b) the challenges that health units face in the implementation and enhancement of the EHISs; and c) the EHIS priorities of the health units. Note: a complete report (including the results of business functions) is available on the alpha website) In total 7 health units reported using HH, health unit uses Amanda, health unit uses Siebel and health units use HS as their main EHIS system. Note: many health units use these EHISs in collaborations with other software and/or paper depending on the program. Program Areas Health units were asked about environmental health program areas. Table summarises the number of health units data collection tools (EHIS, software programs and/or paper) used to collect data for the program areas. Depending on the program area, up to five different data collection tools (EHIS, software programs and/or paper) were used to collect data. There was a lot of variation in the combinations of data collection tools (EHISs, software programs and/or paper) used for data collection within each program area. Appendix provides an in depth breakdown of data collection tool combinations for each program area by number of health units using that combination. Overall, between and different combinations of data collection tools were used by health units depending on the program area. There were also some program areas where a large proportion of health units reported not using any data collection tool. Table shows the number of combinations of data collection tools used by program area. In addition, it shows the number of health units that do not collect data on a particular program area. In terms of the EHISs specifically, Health Space (HS) was not used for out of the program areas; Siebel was not used in program areas; and Amanda was not used for 5 program areas. Overall, Hedge Hog was used by at least user in all program areas. Table : The number of data collection tools (EHISs, software programs, and/or paper) used by health units to collect data on various environmental health program areas: Program area Number of data collection tools being used by health units.0 Food Safety Inspections # of HUs 7

7 # of programs # of programs # of programs # of programs # of programs # of programs # of programs Program area Number of data collection tools being used by health units.0 Small Drinking Water Inspections: a) Transitional-Small Drinking Water Systems n/a # of HUs.0 Small Drinking Water Inspections: b) Small Drinking Water Systems n/a # of HUs.0 Tobacco Inspections n/a 5 0 # of HUs 5.0 Day Nursery & Nursing Home Inspections n/a.0 Personal Services Settings Inspections n/a # of HUs 5 # of HUs 7.0 Rabies Investigation 5 n/a 0 # of HUs 8.0 Cold Chain Maintenance Inspections 5 n/a # of HUs 7

8 # of Programs # of Programs # of Programs # of Programs Program area Number of data collection tools being used by health units 9.0 Injury Prevention Inspections n/a # of HUs 0. Part 8 9 n/a # of HUs. Health Hazard Investigations. Local By-law Enforcement # of Programs n/a n/a 8 # of HUs # of HUs. WNV related n/a # of HUs Table : Number of combinations of data collection tools (EHIS, software programs and/or paper) used for data collection by program area. As well, the health units that did not report using any data collection tool in a specific program area. Note: environmental health departments were surveyed and some of the programs listed may be carried out by a department other than environmental health in specific health units. Program area Combinations of data collection tools.0 Food safety inspections Small drinking water inspections: a) transitional-small drinking water systems.0 Small drinking water inspections: b) small drinking water systems.0 Tobacco inspections 5 # of health units not using any data collection method 8

9 Program area Combinations of data collection tools 5.0 Day nursery and nursing home inspections 0.0 PSSI Rabies Investigation 8.0 Cold chain inspections Injury prevention inspections 7 0. Part Health hazard investigation. Local by-law enforcement 5. WNV related investigation # of health units not using any data collection method Challenges Health units were asked to describe the challenges they face in developing and implementing program modules within their EHIS. Challenges identified include: a) Ministry requirements: Health units find it very difficult to have an overall picture of how they are meeting environmental health goals in Ontario due to the inconsistent MOHLTC standards and reporting requirements. For many of the environmental health programs there is a lack of direction and clearly defined reporting requirements. Some reporting standards are generally outlined in the Ontario Public Health Standards (OPHS), however, specific reporting requirements are not documented for all program areas. Other environmental health programs are not outlined in the OPHS at all and do not have any documented standards. Finally, for some programs the MOHLTC has developed direct reporting systems that have inherent reporting standards built in to the system. In this case the standards may or may not be formally documented. The current state of reporting standards by program areas is summarized in Table. Table : Summary of Ontario MOHLTC reporting standards by program area Program Area OPHS reporting requirements.0 Food Safety a) Inspection activity reporting system: BOH shall record inspection data pertaining to food premises under its jurisdiction and provide information to the ministry as required; b) Annual food safety audit reports: BOH shall provide data annually to the ministry through a food safety audit report c) the BOH has a disclosure policy for the public Reference: Food Safety Protocol (008); Environmental Health Program Standards.0 Small drinking Inspections of SDWS: 9

10 Program Area water system (SDWS) OPHS reporting requirements a) Drinking water : - BOH will conduct a site-specific visit of the SDWS; use the RCAT tool in accordance with ministry instructions; assign a risk category; issue a written directive; follow-up and issue a new directive Reporting: - BOH will record inspection data pertaining to drinking water systems and provide information as required by ministry - BOH will report all adverse drinking water notifications in a timely manner and as directed by the ministry including as a minimum: date issued, date rescinded and corrective actions taken b)recreational water: The BOH shall record inspection data and provide information to the ministry as required. c)beach Management : The BOH shall record monitoring data pertaining to public beaches and provide information as required by the ministry.0 Tobacco inspections.0 Day Nursery and Nursing Home Inspections 5.0 Personnel Services Settings Inspections References: Drinking water protocol; Beach Management Protocol; Recreational Water Protocol; Environmental Health Program Standards Smoke-Free Ontario Tobacco Compliance Protocol: PHUs will collect data and maintain a record of every inspection and reinspection. The Tobacco Vendor inspection form (developed by MHP) will be filled for every inspection. The data will be sent to MHP as per established schedule. Reference: Smoke-free Ontario Act Tobacco Compliance Protocol The BOH shall : a) maintain a record of all inspections conducted; b) the BOH will report outbreaks of infectious diseases through iphis; c) the BOH will review data for trends BOH shall provide data as required to the ministry Reference: Infection Prevention and Control in Licensed Day Nurseries Protocol; Risk Assessment and Inspection of Facilities Protocol a)boh reports occurrence of significance prior to media release; b) report cases of reportable disease through iphis or any other specified reporting mechanism References: Infection Prevention and Control in Personal Services Settings Protocol 0

11 Program Area.0 Cold Chain Inspections 7.0 Rabies Investigation OPHS reporting requirements BOH should conduct a routine annual inspection. The BOH should complete the current vaccine cold chain maintenance inspection report form and report results to ministry. Reference: Vaccine Storage and Handling Protocol The BOH shall report individuals receiving PEP through iphis. They must comply with the minimum data elements identified in: a) Regulation 59 under the HPPA; b) disease specific user guide published by the ministry; and c) bulletins and directives issued by the ministry Reference: Rabies Prevention and Control Protocol; Rabies Prevention and Control 8.0 Injury Prevention Inspection 9.0 Part 8 none 0.0 Health Hazard BOH to provide data as required by the ministry Investigations Nothing specific. Somewhat integrated into Environmental Health Program Standards Reference: Risk Assessment and Inspection of Facilities Protocol; Environmental Health Program Standards.0 WNV related There is a West Nile Virus Preparedness and Prevention Plan. Cases of WNV are reported through a mosquito surveillance system (FTTP site) weekly. Human cases may be reported through iphis. Reference: West Nile Virus Preparedness and Prevention Plan (00).0 Local by-law None Health units identified further challenges including: i. where there are no specific detailed reporting standards and definitions, it is very challenging for health units to develop program modules; ii. For some program areas, there have been ad hoc changes in MOHLTC reporting requirements. For example, health units complete an annual food safety audit for the MOHLTC. Depending on provincial information needs, the MOHLTC may make ad hoc changes to the audit which makes it challenging for health units to provide the required data. This has an impact on existing modules and new module development. In addition, ad hoc changes impact on the integrity of historical data. iii. Health units find it challenging to use MOHLTC reporting systems. To meet some requirements, health units have to extract data manually from their EHIS in order to report the data as an Excel

12 iv. or Word file. In other cases where data can be sent directly, the MOHLTC systems do not always function efficiently causing frustration for environmental health staff. Finally, there are multiple systems for a number of program areas resulting in public health inspectors entering data more than once. For example, a health unit may enter data while in the field into a health unit specific EHIS (e.g., Hedgehog), and then need to re-enter the data into a MOHLTC-supplied system (e.g., RCAT) in order to capture a comprehensive data set and generate health unit and MOHLTC reports. b) Lack of IT/IS support Health units find it challenging to implement and maintain EHISs due to insufficient allocation of information technology (IT) and information systems (IS) resources. Some health units have chosen to reallocate public health inspectors to work in IT support roles. This has impacted on the quality and timeliness of inspections. In addition, lack of dedicated IT support has impacted on the timeliness of further EHIS module development and implementation. Health units also find it challenging to maintain a budget to upgrade hardware and existing EHIS modules, as well as implement new modules. Future priorities The most commonly reported priorities for the health units included: a) program module development, implementation and/or enhancement; b) integration of systems; and c) guidelines and standards a) Program module development implementation and/or enhancement different programmatic priorities were identified. The most commonly identified priorities were related to enhancement or implementation of food safety; small drinking water systems; and recreational pools and splash pad inspection modules for data collection. b) Integration of various systems Health units would like to prioritize the need for integrating various systems. First, health units would like their EHISs to be comprehensive to collect data for all program areas and business functions. Currently health units use up to five different data collection tools (EHIS, software programs, and/or paper) to collect data on program areas and up to different data collection tools (EHIS, software programs, and/or paper) for business functions (see Table and Table ). Second, health units identified the need to move towards having one comprehensive EHIS for Ontario that could house data for all program areas and business functions. c) Guidelines and standards Health units would like to work with MOHLTC to develop evidence based standards and data definitions for all environmental health program areas for Ontario. For each program area a process map should be developed that includes: standards, data definitions, guidance documents, protocols and reporting requirements.

13 Conclusion and Recommendations Overall, 7 of the health units that completed the survey use Hedgehog for inspection data collection; health unit uses Amanda/THEIS; health unit uses a Siebel designed system; and health units use Health Space. Though health units have implemented EHISs, they are still using 5 different data collection tools (EHISs, software programs and/or paper) to collect inspection data, depending on the program area. Furthermore, health units are using between and different combinations of data collection tools (EHISs, software programs and/or paper) to collect data for program areas. The consequences of using multiple programs for data collection include: excessive time and resources required for data entry due to the duplication of entry in to various systems; and the overall complexity in analysis and management of data. Though the majority of health units are using the same EHIS (Hedgehog) to collect data on environmental health programs, the survey results suggest that there is no coordinated way the EHISs are being used. There were many combinations of how health units are using the EHIS in combination with other software programs and/or paper for data collection. In addition, there is variation in the program modules that have been implemented by the health units. While no health unit is using Hedgehog for all program areas, a module for each program area has been developed by at least one health unit. It should be noted that this survey was completed by health units environmental health departments. Responsibility for all of the environmental health program areas and business functions included in the survey may not reside in the environmental health department in all health units. The results of the survey included greater /equal to health units reported not using any data collection tool (EHIS, other software programs and/or paper) for the following program areas: cold chain maintenance inspections (), injury prevention inspections (), Part 8 (0), and local by-law enforcement (). Further exploration is needed to determine if all environmental health program areas should be included in a single EHIS regardless of the department that carries out the work. Recommendation: Process Oversight ) An EHIS working group should be established to set priorities and direction on the future development, maintenance and enhancement of EHISs in Ontario. The objectives could include: To bring MOHLTC and Ontario Public Health Units together to work collaboratively on developing common data elements and definitions; standardizing a minimum data set; developing risk assessment tools; and developing common reporting tools To have a forum to share knowledge and resources on environmental health information systems Work together to facilitate the identification of future needs of environmental health information systems (upgrades, new equipment, new systems) facilitating secure funding pools and negotiating vendor agreements, as needed to meet future needs

14 Recommendation: EHISs ) Health units are currently using multiple data collection tools (EHISs, software programs and/or paper) to collect data on program areas and business functions. Health units should work towards having a comprehensive EHIS that can capture data on all program areas and business functions. ) Support further evaluation of EHIS software (s) being used by health units in order to work towards an integrated EHIS that could be used by all health units in Ontario. The goal should be to have a comprehensive system that can capture a core set of consistent data across Ontario with the flexibility for health units to customize the system as required. Recommendations: Standards and guidelines ) There is no clear overall picture of data standards, definitions, and reporting requirements available for Ontario environmental health programs for health units. The EHIS working group should work with the MOHLTC to conduct a review of reporting systems, standards, policies and data definitions that are available. The review should outline the strengths and gaps that are in the system(s) and provide evidence based recommendations to improve standards, data definitions and reporting requirements. ) For program areas where there are no reporting standards and/or definition the EHIS working group should focus on working with the MOHLTC to develop and communicate evidence based reporting standards, guidelines and data definitions. This should be a high priority as the process will guide health units in the development of program modules for their EHIS; it will decrease the budget and resources required to develop program modules from scratch; it will help in providing the MOHLTC with accurate and comparable data; and it will decrease the number of software programs required for data collection and reporting. In addition, the process will provide the MOHLTC and health units with a better understanding of how environmental health programs in Ontario are meeting their goals.

15 # of HUs Appendix : In Depth Analysis of Data Collection Tools Used by Health Units for Environmental Health Program Areas Program Area : Food Safety Figure : Number of health units using various data collection tools (EHISs, software programs and/or paper) to collect data on Food Safety Number of health units using various data collection tools (EHISs, software programs, and/or paper) for Food Safety Data collection tools used Figure shows 0 different combinations of data collection tools (EHISs, software programs, and/or paper) used by health units to collect data on food safety. 7% () of health units use Hedgehog (HH) exclusively to capture data related to food safety inspections. All health units reported using at least data collection program to collect food safety data. Siebel is used by health unit exclusively; health units are using HS exclusively or in combination with other data collection tools; and Amanda is being used by health unit in combination with paper. 5

16 # of HUs Program Area : Small drinking water inspections: a) Transitional-small drinking water systems Figure : Number of health units using various data collection tools (EHISs, software programs and/or paper) to collect data on small drinking water inspections: a) transitional-small drinking water systems Number of health units using various data collection tools (EHISs, software programs, and/or paper) for Small Drinking Water (a) Data collection tools used n/a = health units not collecting data Figure shows different combinations of data collection tools (EHIS, software programs and/or paper) used by health units to collect data on small drinking water inspections (transitional small drinking water systems). 8% () of health units are using RCAT exclusively and 5% (5) health units are using Excel exclusively to collect data. Overall health units are using RCAT, 8 health units are using Excel, and health units are using HH exclusively or in combination with other data collection tools. One health unit will use HH in 0 and another in 0 to collect data on small drinking water systems. Siebel is being used by health unit. None of the health units reported using Amanda or HS. One health unit will use HS for data collection in 0.

17 # of HUs Program Area : Small drinking water inspections: b) small drinking water systems Figure : Number of health units using various data collection tools (EHISs, software programs and/or paper) to collect data for small drinking water inspections (b) small drinking water systems Number of health units using various data collection tools (EHISs, software programs, and/or paper) for Small Drinking Water Inspections (b) n/a= health units not collecting data Data collection tools used Figure shows that different combinations of data collection tools (EHISs, software programs, and/or paper) are used to collect data on small drinking water systems (b). Eight health units use RCAT, health units use Excel and health units use HH exclusively to collect data on small drinking water (b). Overall, health units use RCAT, 7 health units use Excel, 7 health units use HH and 8 health units use Access either exclusively and/or in combination with other data collection tools. Four health units do not collect data on small drinking water inspections (b). Siebel is used by health unit. No health units reported using HS or Amanda to collect data on small drinking water (b). 7

18 # of HUs Program Area : Tobacco inspection Figure : Number of health units using various data collection tools (EHISs, software programs and/or paper) to collect data for Tobacco Inspection Number of health units using various data collection tools (EHISs, software programs, and/or paper) for Tobacco Inspection Data collection tools used n/a= health units not collecting data Figure shows different combinations of data collection tools (EHISs, software programs and/or paper) used to collect data on tobacco inspections. Almost 0% (9) of health units exclusively uses TIS to collect data related to tobacco inspections. Five health units reported that they are not using any system at the moment for tobacco inspection. Twenty seven health units are using TIS alone or in combination with other data collection tools. Five health units are using HH exclusively or in combination with other programs. Siebel and HS are not being used to collect data on tobacco inspection. Amanda is being used by health unit with paper and TIS for data collection. In 0 one additional health unit will be using TIS for tobacco inspections. 8

19 # of HUs Program Area 5: Day nursery and nursing home inspections Figure 5: Number of health units using various data collection tools (EHISs, software programs, and/or paper) to collect data for day nursery and nursing home inspections Number of health units using various data collection tools (EHISs, software programs, and/or paper) for Day Nursery and Nursing Home Inspection Data collection tools used n/a= health units not collecting data Figure 5 shows 0 different combinations of data collection tools (EHISs, software programs and/or paper) used to collect data on day nursery and nursing home inspections. 5% (7) of health units use HH exclusively to collect data on day nursery and nursing home inspections. Twenty-one health units use HH, 5 use CISS, and 8 health units use paper exclusively or in combination with other data collection tools. Siebel is being used exclusively to collect data on day nursery and nursing home inspections by health unit. One health unit is currently using HS in combination with CISS. In 0 additional health units will use HS. Amanda is currently being used by the health unit in combination with paper for data collection. 9

20 # of HUs Program Area : PSSI Figure : Number of health units using various data collection tools (EHISs, software programs, and/or paper) to collect data for PSSI Number of health units using various data collection tools (EHIS, software programs and/or paper for PSSI Data collection tools used n/a = health unit not collecting data Figure shows 8 different combinations of data collection tools (EHISs, software programs and/or paper) being used to collect data on PSSI. % (0) of health units are using HH exclusively to collect data on PSSI. In 0 5 additional health units and in 0 additional health unit will use HH for PSSI data collection. Currently health units use HH, 7 health units use paper, and use CISS exclusively or in combination with other data collection tools. One health unit is using Siebel exclusively for PSSI data collection. Two health units are using HS in combination with other tools. In 0 additional health units will use HS for PSSI data collection. Amanda is currently not being used for PSSI data collection. 0

21 # of HUs Program Area 7: Rabies Investigation Figure 7: Number of health units using various data collection tools (EHISs, software programs, and/or paper) to collect data on Rabies investigation Number of health units using data collection tools (EHIS, software programs, and/or paper) for Rabies Data collection tools n/a = health unit not collecting data Figure 7 shows different combinations of data collection tools (EHIS, software programs and/or paper) used to collect data on rabies investigations. Approximately 0% () of health units use HH exclusively to collect information on Rabies investigations. In 0 5 additional health units will start using HH for rabies investigations. Overall, 7 health units use HH, health units are using paper, and are using CISS exclusively or in combination with other data collection tools. Currently health unit is using Siebel exclusively for rabies investigations. Amanda is being used by health unit in collaboration with other tools. health units are using HS exclusively or in combination with other data collection tools. Two health units plan to use HS exclusively in 0.

22 # of HUs Program Area 8: Cold chain Inspections Figure 8: Number of health units using various data collection tools (EHIS, software programs and/or paper) to collect data on cold chain inspections Number of health units using data collection tools (EHIS, software programs and/or paper) for Cold chain inspections Data collection tools used n/a = health unit not collecting data Figure 8 shows 8 different combinations of data collection tools (EHIS, software programs and/or paper) are used to collect data on cold chain investigations. % () health units do not collect information on cold chain maintenance inspections (note: this could be done through other departments). 0% (0) health units reported using paper to collect information. HH is only used by health unit. One additional health unit will use HH in 0. Overall health units use paper, and 7 health units use Excel exclusively or in combination with other data collection tools. One health unit is using Siebel for cold chain inspections. No health units reported using Amanda or HS for cold chain inspections.

23 # of HUs Program area 9: Injury Prevention Inspections (IPI) Figure 9: Number of health units using various data collection tools (EHIS, software programs and/or paper) to collect data on IPI Number of health units using data collection tools (EHIS, software programs and/or paper) for Injury Prevention Inspections n/a HH paper HH, Excel Siebel Amanda, paper CISS, HS HH, paper, Excel Data collection tools used n/a = health unit not collecting data Figure 9 shows 7 different combinations of data collection tools (EHIS, software programs and/or paper) used to collect data on IPI. Almost 50% of health units do not use any EHIS to collect information on IPI. 8% () of health units are using HH exclusively. Three health units will implement HH in 0 and additional health unit in 0. Currently 9 health units use HH and 7 health units use paper exclusively or in combination with other data collection tools. Three health units use Excel in combination with other programs. One health unit is using Siebel exclusively for IPI data collection. One health unit is using Amanda in combination with paper. Only health unit is using HS for IPI data collection.

24 # of HUs Program Area 0: Part 8 Figure 0: Number of health units using various data collection tools (EHIS, software programs and/or paper) to collect data on Part Number of health units using data collection tools (EHIS, software programs and/or paper) for Part 8 n/a = health unit not collecting data Data collection tools used Figure 0 shows 7 different combinations of data collection tools (EHIS, software programs and/or paper) used to collect data on Part 8. % () of health units did not report using a system to collect information on Part 8. 5% (5) of health units use exclusively paper for data collection. Overall 7 health units use paper and use Access exclusively or in combination with other data collection tools. Currently only health unit is using HH. In 0 one additional health unit will use HH for Part 8 data collection. Amanda, HS and Siebel are not being used for data collection for Part 8 by any of the respective health unit users.

25 # of HUs Program Area : Health Hazard Investigation Figure : Number of health units using various data collection tools (EHIS, software programs and/or paper) to collect data on Health Hazard Investigations Number of health units using various data collection tools (EHIS, software program and/or paper) for Health Hazard Investigations Data collection tools used n/a = health unit not collecting data Figure shows different combinations of data collection tools (EHIS, software programs and/or paper) used to collect data on Health Hazard Investigations. % () of health units use HH and 5% (5) of health units use paper exclusively for health hazard investigation data collection. Overall, health units use HH, 0 use paper, and 5 use CISS in exclusively or in combination with other data collection tools for health hazard investigation. Three additional health units in 0 and one more in 0 will start using HH for health hazard investigation. Siebel is used by health unit exclusively for health hazard investigation data collection. One health unit uses HS exclusively and one health unit uses it in combination with CISS. Amanda is used by one health unit in combination with paper. Two additional health units will use HS in 0. 5

26 # of HUs Program Area : Local by-law enforcement Figure : Number of health units using various data collection tools (EHIS, software programs and/or paper) to collect data on local by-law enforcement Number of health units using various data collection tools (EHIS, software programs and/or paper) for local By-law enforcement n/a HH paper Amanda, paper CISS, TIS HH, Excel Data collection tools used n/a = health unit not collecting data Figure shows 5 different combinations of data collection tools (EHIS, software programs and/or paper) used to collect data on local by-law enforcement. 7% () of health units do not use any EHIS for local by-law enforcement data collection. 5% (5) of health units use HH. One additional health unit will use HH in 0. Siebel and HS are not being used by any of the health units to track local by-law enforcement. Amanda is being used by one health unit in collaboration with paper for data collection.

27 # of HUs Program Area : WNV related investigations Figure : Number of health units using various data collection tools (EHIS, software programs and/or paper) to collect data on WNV related investigations Number of health units using various data collection tools (EHIS, software programs and/or paper) for WNV related investigations n/a = health unit not collecting data Data collection tools used Figure shows different combinations of data collection tools (EHIS, software programs and/or paper) to collect data on WNV related investigations. 8 %( ) of health units use paper and 8% () of health units use HH exclusively to collect data on WNV related investigations. 8% () of health units do not use any EHIS for WNV data collection. Overall 9 health units use paper, 7 health units use HH, and 7 health units use Excel exclusively or in combination with other data collection tools for WNV data collection. Currently, one health unit uses Siebel exclusively for data collection. One health unit uses Amanda in collaboration with paper, and one health unit uses HS in combination with CISS. One health unit will start using HS in 0 to collect data related to WNV investigations. 7