NERV - a cost-effective software solution for a small health department

State: IN Type: Neither Year: 2015

Our Lotus Notes database for our department was installed in 2000. Over time, IBM discontinued support for this product while we were expanding the use of it across all divisions. Our county population is just under 50,000, and since 2010 we have lost 4 full time equivalent positions. We do not have an IT professional on staff, but do pay for maintenance and repairs of the computers and network in the office. However, on contracted IT business does not have anyone on staff with expertise in Lotus.  The system has been showing signs of failure for 3 years.  We found very few IT professionals that had any interest in working with a local health department and had knowledge of Lotus Notes to help us transfer our data. I contacted the vendors that come to the NACCHO Annual and bi-annual Informatics conferences, but none were interested in meeting our pricing restrictions.  We have 14 years of data from public health nursing, environmental health, vital statistics, and our financials that needs to be preserved, all within a budget of less than $32,000. We could not afford to lose our data, and could not find a provider to meet our price. We approached NACCHO for help in finding an IT provider that could meet our needs, within our budget. NACCHO's IT staff traveled to the Henry County Health Department in New Castle, Indiana in August of 2013, and met with the staff and researched the Lotus Notes database. NACCHO initiated two request for proposals cycles the 4th quarter of 2013. A proposal was submitted by an IT vendor new to the field of public health practice, WDD Software Solutions, from Indianapolis, began working with Henry County Health Department intensively in July of 2014. The production schedule will be completed in January of 2015, but the results within the environmental health division will be tremendous. Inspections will now be completed with smart phones or tablet computers in the field. Before, our department completed all reporting by hand and then entered it a second and third time in the office. The software will also be used for septic, pool and tattoo inspections, property complaint investigations, and a receipt system. Our environmental division has only two full time staff, so decreasing redundant processes will lift a burden from our staff and increase efficiency. The nursing division's needs are to have a bio-metric electronic medical record for patients, and a receipt system.  The vital records division needs a record management system for birth and death certificates, amendments, affidavits, and a receipt system.  Accounts receivable and payable and budgeting will also be included. These systems are scheduled to be completed in Q4 of 2014 and Q1 of 2015.   Our objective was simple - to replace an obsolete database within our price range. But our factors were not immediately understood by our staff. We have never worked on a project like this in our small department. The software professionals host bi-weekly sessions with divisions as the software is developed. We have had some field testing with WDD Software staff and continue to work to evolve our operations within the software. NACCHO's IT staff traveled to Henry County Health Department last month and offered their assistance in the process. The impact on practice could be the evolution of NACCHO's role in providing technical support to local health departments that are under resourced and unaccustomed to planning for their IT needs.  The Henry County Health Department has also endeavored to underwrite the majority of the cost for the development of software that WDD will price advantageously for health departments that cannot afford to develop new software. WDD has also donated extra software architects time in developing the software for this project.  The process of working with software developers is new to our department, and it is hoped that this project will help other health departments prepare for the work of developing, or transitioning into, new software. The website for Henry County Health Department can be found at, and the website for WDD Software Solutions is  
What we believe is new to the public health field is the involvement of NACCHO as a convener of IT solutions between IT vendors and local health departments on a small scale.  NACCHO using their resources to help author, distribute and manage the RFP process for local health departments around the country.  NACCHO's commitment to local health departments, its advocacy for public health policy, and its service to the membership will make it a viable partner in IT solutions around the country. NACCHO can be a virtual marketplace for local health departments and IT vendors to convene and collaborate to develop real, cost effective solutions that can impact vital operations in public health.   The software within the environmental health division is geared to follow the standardized food inspection template as it is currently being circulated in Indiana. The electronic medical record system is built around heart disease, and diabetes and obesity prevention.
Food Safety|Nutrition, Physical Activity, and Obesity
Our goal in the beginning was simply to find a solution for ourselves. We are using a $32,000 carryover from a grant from the Indiana State Department of Health in 2012.  NACCHO's senior IT Director, Dennis Small, viewed this as an opportunity for NACCHO to explore deepening its relationship with local health departments and looking for new, unrestricted revenue for the agency. WDD Software recognized the opportunity to get involved in a new line of business with a viable partner such as NACCHO, with a breadth of knowledge and relationships that are diverse. 
We developed a simple framework for evaluation during our meetings with NACCHO's IT staff: Does the software meet the needs specified by staff determined in the RFP and future meetings with software developers? Does the software work in the field and in the office? Was the Lotus Notes data transferred appropriately and completely? Is the solution scalable for future health departments? Can NACCHO's IT staff continue to recreate this success with other health departments? To be fair to the process described above, we are still in the evaluation phase as most of these criteria are yet to be completed. But, the scaling issues for on boarding NERV into other health departments is promising as WDD's price will be a per user, monthly fee, costing departments significantly less than the cost specified in this proposal. Whether the solution for future health departments is NERV from WDD, other existing vendors that do business with NACCHO, or new partners, we believe the answer is a resounding YES! NACCHO is in the perfect place to help provided these forums, with technical assistance, to meet IT needs for health departments that are underserved or inexperienced in finding and developing IT solutions.
The project is sustainable for Henry County as the software is low or no cost moving forward. As for NERV, and WDD, their solution can be low cost and on boarded for a much smaller fee than listed in this project. NACCHO can easily discuss technical assistance with its membership and look for opportunities at a low cost for itself and its members. NACCHO can develop an evaluation tool to assist in developing RFPs and measure the progress of development between matched vendors and its members. This study can also lend advice to other local health departments faced with replacing databases. We would advise the Board of Directors of NACCHO, senior NACCHO staff and the IT Department of NACCHO to develop their own cost/benefit analysis of developing this project further.