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Project contact person: Stuart Cohen, Chief Information Officer, Lori Williams-Peters Corporate Development Officer. TriSano Foundation c/co Collaborative Software Initiative. United States.
Brief description of the project
A project initiated by the US State of Utah Department of Health; TriSano is a highly configurable, comprehensive surveillance and outbreak management application for global public health and healthcare. The TriSano software application is designed to allow local, state, federal and international agencies to identify, investigate, and mitigate communicable and chronic diseases, environmental hazards, and bioterrorism events. TriSano supports secure data exchange with laboratories, clinicians, hospitals, vital records, immunization registries, and health information exchanges as well as offers sophisticated analysis, visualization, and reporting of contact and case information. TriSano increases overall effectiveness in preventing morbidity and mortality through decreased reporting time, automated assignment and routing processes, easy form-creation tools, trend analysis, detection of anomalies, and quality assurance.
Agencies with a responsibility for collecting and acting upon public health information. Includes all levels of government, health districts, state and country government.
State of Utah Public Health Department desired a more effective manner to collect public health information for sharing within multiple levels of government agencies, sought a facilitated approach to invest in system development and use the open source model to share code with other information providers, collaborate in future enhancements, sustain the project into the future.
Approach and proposed solution
State of Utah Department of Health contracted through a partnership agreement with Collaborative Software Initiative (CSI) to bring government and private concerns together in a collaborative approach to design, develop and deploy a solution, extending the value of the system beyond a single agency use.
The solution would also be compliant with industry standards and federal requirements of the United States Department of Health and Human Services, Center for Disease Control. CSI’s role as a facilitator of technical, programatic and financial needs in establishing a new, collaborative community was key to its execution. The non-profit “TriSano Foundation” was created to foster and sustain the new community.
As part of the long-range plan to create and sustain a stable community, software, and funding, two editions of the software were made available:
TriSano Community Edition: is free and available under an OSI-approved open source license (Aferro General Public License - AGPL)1. In the context of the community edition, Subject Matter Experts (SMEs) contribute user scenarios, software developers contribute code, and support for the Community Edition is found through the TriSano community (a community portal is hosted at http://www.trisano.org/community/).
Enterprise Edition or CSI TriSano® is available through an annual subscription under a commercial license. Support for the Enterprise Edition is provided through commercial resources. Customers of the commercial version have the option of paying for enhancements and customization to the Enterprise Edition to suit their needs.
As revenue is received for the Enterprise Edition of TriSano, enhancements are made to the TriSano Community Edition (code is cascaded to the community edition). TriSano project principals describe this as having a two-fold benefit to the project:
As Subject Matter Experts and Developers enhance the community edition, the enterprise edition is enhanced because the code is intertwined.
The revenue derived from the enterprise edition is used to enhance the code base for the community version.
Summary of technologies and project tools used
Lean and Agile Software Development.
Confluence for wiki.
Built on Ruby and PostGres
Utilizes Git Hub
Also use Pragmatic Marketing and Customer Discovery to ensure a product at the end that will be used in the market.
Community governance model
TriSano has two levels of governance: a Governance Council and a Core Team.
The governance council consists of senior government stakeholders (Utah Department of Health, and Office of Epidemiology); and senior CSI officials CEO (Chief Executive Officer and Chief Technology Officer). This group meetings quarterly face-to-face to address broader issues, market impacts, “big picture”. The council reviews project progress, burn rate (use of project funds and other resources against , where the market is and how quickly the project is entering the market. They also provide insight or guidance on other events in Public Health that could affect TriSano.
The Core Team consists of Subject Matter Experts and Software Developers.
Subject Matter Experts (SMEs ) include public officials from state level and local - local in this context includes county and special health districts. They provide essential knowledge of the business, background, practices and processes for health officials, use case, user testing and acceptance of the code. Software Developers were 100 % CSI resources for nearly three years. Public agencies are now beginning to contribute code.
Meetings occur several times a week by telephone conference. The core team brings together these two groups to build the project through Lean and Agile methods.
Licensing and Agreements include
A form that is filled out before downloading TriSano (name, email, occupation, company, expertise and one you learned about TriSano).
A Code Contribution Agreement for developers. “Corporate Contributor License Agreement”
A Membership Agreement: This is put in place for any significant enhancements to the project or product that will be funded (either cash or in-kind such as code contribution) and will include a Statement of Work. “CSI Core Team agreement”.
Community operating model
For several years all development resources where provided and managed by CSI. Although there is an increase interest in code contribution, CSI resources continue to provide core code development, project management services and community management services. Even so, forums, wikis and other resources for software developers are in place. End users/SMEs plays a significant role in the TriSano community and continue to provide guidance to the road map for the project through established communications tools and channels and through Customer Discovery processes put in place by TriSano.
Model of knowledge transfer
The community edition of the TriSano software is available openly to any public administration which desires to use it. Technical documentation, training materials, and community forums exist for any agency which are available on line. Live and embedded videos provide introductions and user training.
Training is provided through on-line webinars and through workshops designed to walk trainees through user data entry scenarios.
Occurs as part of the governance process as outlined above.
Tools used to create the community
Professionally designed web site and community portal, extensive use of web and cost-effective tools, social media use by community management, Internet Relay Channel (IRC), google groups and wiki for developers and technical support staff, blogs for general promotion, and video are among the tools use to create and sustain the TriSano community. Participation and presentation at industry specific conferences have also contributed to community building.
Implementation in the State of Utah and 29 of its counties. Three years after release as under an open source license, first agency code contribution has begun. US Department of Health and Human Services lists TriSano on its web site as a system available for tracking and supporting Sexually Transmitted Diseases (STDs).
On one hand for the communit, improved ability to capture and report public health information, continued expansion of the original code. On the other hand for CSI, the TriSano project has served as a prototype/proof of concept for a replicable model for other vertical applications and the company expects to enter other markets using the same approach.
Key aspects to success
Building a relevant and sustainable application. A key concept shared by project principals as below:
A strong focus on the Subject Matter Experts (SMEs),
creating a community with the same approach as with open source projects core values (openness, transparency, rewarding meritocracy of ideas) as one would with a technologist (software developer). This was emphasized as critical for a business/public administration application where the individuals writing the code are not also the consumers or end users of the project, such as with an infrastructure project which is where most of our understanding of open source projects have come to date. Thus TriSano focused on the SMEs as a primary concern, and then the technology. CSI/TriSano provided all initial coding services while working closely with the public health officials, doctors, nurses and other specialists who would inform and use the system.
Project principals underscored their approach building a relevant and sustainable application, that before embarking on any open source project it is vital to be clear on the difference between enterprise infrastructure projects and enterprise applications. Business applications require a non-technical resource to drive the development. This is in contrast to the way infrastructure projects work, infrastructure developers may choose to contribute to a project on their own, they are in fact a customer of their own work and understand its use and value of enhancements.
However, in developing applications an organization or team is needed to organize and drive the project, to harvest the knowledge of subject matter experts, to create and support the community, Such communities don’t self-organize. The developers are not their own customers, and require significant involvement of subject matter experts, thus a third party to bring the team together becomes critical.
Project personnel emphasized that broad collaboration is key and one must get the SMEs involved, a broad set working with a proper project management and development team.
Barriers encountered in the implementation of the community
A turn-down in the US economy early in the project slowed the project.
Unforeseen events impacting availability of key community members. The H1N1 virus broke out during the early stages of requirement gathering and the health emergency naturally became a priority over project participation.
Participation by other government agencies in respect to code contribution has been slow to come over two years, however it is important to note that the plan to develop the project was not dependent on this condition.
Barriers in the maintenance of the community
Not atypical of an open source project, it is unknown who may actually be downloading and using the software.
TriSano personnel reemphasized the importance of engaging the SMEs. Project personnel attribute the acceptance and use of the system to early emphasis in community building with the SMEs and moving development forward quickly though CSI’s investment. Once established, dedicated resources keep the community engaged. These CSI project resources supporting the operation and maintenance of the community include:
A dedicated Community Development Manager (technical).
A dedicated Subject Matter Expert (a nurse).
A marketing resource who maintains the community web site.
Executive summary of the case study
The TriSano project was the first government project created under the umbrella of the Collaborative Software Initiative (CSI), a private venture-funded company based in the United States. The first edition of TriSano was released in the spring of 2009. Today TriSano is in production in the State of Utah and twenty-nine of its counties, and has been downloaded for potential adoption in Europe, Asia, Africa, Latin America and by the World Health Organization.
The financial model includes supporting two versions of the TriSano product; one version that is free and open source (TriSano Community Edition), and a second which is commercially supported (TriSano Enterprise Edition). The latter includes additional documentation and training, support for installation, and support for customization. Revenue and associated code enhancements from from the Enterprise edition are used to feed back to continuously improve upon the Community edition.
The project was conceptualized through the need by a public agency to solve a critical information-sharing problem and a business interest in demonstrating the efficacy of this public-private partnership model. The governance model was designed to support a balance of interests public, private and non-profit. Now in its third year of development, the early direct investment of funds by the private firm and the contributions of public health information technology domain expertise thus far appear to have created a viable, sustainable application and growing community.