Learning from Government's Response to the West Nile Virus
CTG Project Examines the way New York Health Authorities Integrated Information Systems to Combat Disease
By Karen Heyman
For the DGRC

Watching the West Nile Watchers
	• Researcher profile: Anthony Cresswell • Project profile: Modeling the Social and Technical Processes of Interorganizational Information Integration • Center for Technology in Government

During the 9/11 crisis, some government workers found themselves keying in air quality data from air monitoring stations into spreadsheets at one agency, and then printing out the spreadsheets and sending the paper over to another agency, where the information was re-keyed into the larger system.

"It wasn't because people were stupid," says Anthony Cresswell, deputy director of the Center for Technology and Government at SUNY-Albany. "It was because they needed to do something their technology wasn't set up to do in the first place."

Cresswell and his colleagues and students at CTG have made a specialty of studying such real-world instances of the challenges for governments trying to integrate information from disparate sources.

One of their current Digital Government grants has more happily involved them in examining what went right when the West Nile virus first hit New York state in 1999. In this instance, health officials were well-prepared to deal with the crisis because of the existing information infrastructure.

Responding to the disease outbreak required, according to a paper in the journal Public Health Management Practice, "rapid mobilization and coordination of hundreds of public health workers, expenditure of millions of dollars on an emergency basis, and immediate implementation of massive disease surveillance and vector control measures."

For all of that, public officials were not caught short. Instead, the crisis provided an excellent test of a system that had already been put in place to coordinate health information, called HIN or Health Information Network.

HIN was created in 1996 as an electronic alert and reporting system for use between state and local health departments. "The New York State Health Department had already made a substantial investment; there was already an information infrastructure in place that they modified to help coordinate and control and distribute the West Nile virus information. If they had to build the whole thing from scratch, it would have been a much, much bigger problem," says Cresswell.

HIN was brought to the attention of Cresswell and other Digital Government researchers at CTG when they were seeking examples for a project to model the social and technical processes of inter-organizational information integration. "We wanted to look at information problems in two different domains," says Cresswell, the project's co-PI. The other side of the project looks at New York's criminal justice system (reported last September in dgOnline).

In the case of the criminal justice system, DG researchers are not only creating a theoretical model of how information integration occurs, they are working with government officials to propose and implement changes to current processes. With West Nile, the approach is to look retrospectively at a successful situation and try to create a generalized model of how and why it worked, in the hopes of creating a template from which academics and practitioners can learn about successful inter-organizational integration.

Debra Sottolano, a program manager with the New York State Department of Health, says she excited by the project, "My dissertation [on change management] was very similar to the work they're doing; it's been very much a pleasure to talk to them. I think it helps the agency to relive it and examine it Ñ the things that they did that were so successful."

SUNY's researchers are in the field stage of this part of the project. They have interviewed dozens of state and local health officials who used the HIN first to coordinate a response to the 1999 outbreak and then to plan a response to the 2000 outbreak. In addition, they are analyzing internal documents and research reports to try to put together as complete a description of the activity as possible. "It's a very complicated situation and there's a lot of different actors who had a role to play," says Cresswell.

What made it complicated is the very nature of the transpecies transmission of the disease: The first clue that humans might be at risk in a given area is not human illness, but dead and dying birds. Birds are the reservoir for the virus, mosquitoes the vector, and humans its ultimate victims. In order to mobilize an appropriate response, private and public health professionals had to interact with specialists in fields they had never concerned themselves with before. Suddenly veterinarians and wildlife specialists were talking to family physicians and viral specialists.

In New York, local health departments officials would collect samples from dead birds and send them into the state health department. Once the samples were tested, the results would be published on the HIN. Each local health department would then take that information and have the authority to respond on its own to the virus.

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From their interviews with all of those who interacted through the HIN during the crisis, the SUNY researchers will create a preliminary model of the integrated communication process. It will be tested for its potential as a generic model against the information they are currently gathering from interviews with public health officials in other states, where both responses and governmental structures may be different. "They might not have the same county agency structure or as many villages and towns, they might have state people assigned at the local level," says Cresswell.

Ultimately, they want to speak both to the research community and the community of practice and use the lessons of one to inform the other. They're planning for a workshop, likely to take place in June, to bring participants in from both projects to reflect on the lessons learned from the research and progress on creating a model of the social interaction. "It seems like it's all common sense, but then when you get into a project a lot of the social aspect is overlooked," says Brian Burke, a former defense analyst and current researcher at CTG.

"You really need to spend the time on the social issues or you just don't get anywhere. I saw that in my military background too," continues Burke, "Everybody's attitude was, 'Let's just dive into the technology!' But without taking the time to really define your problem and work through the organizational and political issues, you might get some short term gains, but you're not going to develop anything that's long-term and sustainable." Says Sottolano, "They're looking at other implementations and I think they're going to pull together the elements that seem to be coming up again and again that demonstrate what are some of the good models for successful IT implementation. I think it's a very interesting study, it's a very valuable study."

Gotham, I., et. al. West Nile Virus: A Case Study in How NY State Health Information Infrastructure Facilitates Preparation and Response to Disease Outbreaks J. Public Health Management Practice, 2001. 7(5), 75-86