PRISM, Public Health Entry Into Open Source

An application developed and deployed by the Florida Department of Health’s Bureau of STD is Public Health’s entry into the Open Source effort. Licensed under the GPL, the Patient Reporting, Investigation, Surveillance Manager or PRISM application an application designed for the management, surveillance, and reporting of infectious diseases aligned with the efforts of most public health programs. Its design to use automated work flows, business logic, external tools like Electronic Lab Reporting, are all part of the efficiencies and cost savings that are critical in a modern public health program.

As a public health organization, the Bureau of STD in Florida was faced with the same situation faced by so many over the years. The technology used to support the business had become increasingly outdated and did not align with the needs of a modern program with the advances in technology and updated business methods used. The federal government produced products that were silos. These products were often built on older technology that was difficult to support in modern networked environments. They were labor and resource intensive, because of the lack of automation and dependency on manual entry.

Additionally, public health programs responsible for the prevention and control of infectious diseases within local communities and states continue to face annual cuts in funding, reductions in available resources, and increases in responsibilities. It was within this environment that the PRISM (Patient Reporting Investigation Surveillance Manager) effort looked for a solution that would help other programs nationally or internationally that needed technology and software to help in their efforts. We saw that the Open Source approach would be the best way to help others and promote collaboration among professionals that could add value to the PRISM product over time.

The PRISM application provides case management, surveillance, epidemiological analysis, management of workloads through ‘task lists’ approach, public health reporting, and a variety of other functions that support decisions and workflows related to disease investigations of public health. Using a centralized database, the application allows for the registration of an individual and associates the history of infections, treatments, and other related medical information to that person. This improves the ability of care providers to understand the medical history and ensure that proper care is provided for the current infection presented. Rather than silos, PRISM assists in a holistic view of the client.

The application is built using Microsoft’s SQL 2005 database and .Net program language. The application is licensed under the Open Source GPL. The concept of open source, in terms of the development and tools used to produce PRISM was controlled by the governance requirements of the state’s Information Technology Office. Although we used the Microsoft products to produce the application, we did feel that using the GPL and open source approach could provide technology to other programs and cost savings to the implementation of this application.

There are over a dozen states that are currently adopting or giving consideration to PRISM as their infectious disease application. There are states that are looking to expand the functionality of PRISM by adding a clinical module or expanding the diseases and business logic around the management of those diseases. Each will share back to others, the improvements they make. This effort is groundbreaking for public health. It provides an opportunity for public health / government to own its own efforts and not be owned by the corporate interests that sell applications and their associated hidden costs. Introduction of automation and integration with other tools like Electronic Laboratory Reporting provide opportunities for cost savings and reduction in resources required to complete the work. The entry of PRISM into the Open Source world is one that can spark new interest in the possibilities of collaboration among professionals within the field. The increasing financial restraints that are faced by everyone are a real and present consideration. With PRISM and similar Open Source efforts, we hope that more resources can be spent on health and less on the technology to support that effort. We sincerely believe in the benefits and efficiencies that are gained by Open Source and hope that PRISM can contribute to that effort for others.

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