Listen, Understand, and Respond to User Needs

In 1999, Epi-X was an idea that John Ward, MD, then editor of the Morbidity and Mortality Weekly Report (MMWR), floated in informal conversations with colleagues at conferences and meetings. The idea gained momentum and Ward was able to secure funding. He and Demetri Vacalis, PhD, pressed ahead with design and development in late 1999. The process included hundreds more conversations with colleagues, dozens of iterations of prototypes, demonstrations, usability evaluations, and focus groups. The user-centered design process has been employed ever since for subsequent improvements to the system. During the Hurricane Katrina response, the Louisiana state epidemiologist pointed out that he had cell phone and Blackberry access, but the health department computers were under water. This prompted the Epi-X team to develop instructions for accessing Epi-X by Blackberry and some other mobile devices.

Likewise, in response to requests from states during the 2009 H1N1 influenza response, Epi-X staff worked with the Immunization Safety Office to send each state a weekly summary of vaccine adverse events reported to CDC by persons in the state. Similarly, daily summaries of the requests to the Strategic National Stockpile for peramivir (an influenza antiviral drug) were made available to each state. In this way, each state received feedback that might otherwise have remained within CDC.

Challenges Ahead

Ali Khan, MD, MPH, RADM (ret.), USPHS, Director, Office of Public Health Preparedness and Response (PHPR) welcomed the Epi-X editorial board at last year’s annual meeting on November 3, 2010. He asked the board to help set the direction for Epi-X 2020. The challenge in doing so requires balancing security with usability. The sensitive nature of some information on Epi-X, such as passenger contact tracing information from the Division of Global Migration and Quarantine, requires a higher level of security than many other websites.

Public health professionals with limited IT support or knowledge may experience difficulty in accessing the secure site in the first place. Busy public health professionals responding in an emergency are more apt to forget passwords and might not even have access to the needed technology. Epi-X will continue to look for innovative ways to solve these problems!

Vacalis summed it up well when he said, "Epi-X's success is due to its ability to provide federal, state, and local health officials with a method to rapidly exchange information, notify each other of routine and emergent events, and, as a result, strengthen personal relationships of the public health community."