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track incidents across county lines. Planners hope that the system will encourage greater communication between the state and local communities or the CDC and that it will improve compliance with reporting requirements. Several issues have informed the planning for this proposed system. One is the use of the Internet, which is not only a logical choice but also the only viable option. Another issue is the sensitive nature of the data; there is, for example, a state requirement for reporting AIDS cases. A third issue is privacy, which is a major concern of the governor and residents of Washington.
A pilot program is under way with Group Health of Puget Sound. Labs encrypt their test reports and send them to the state health department's file transfer protocol server, which sits outside a firewall. State personnel move the file behind the firewall, check for errors, run it through an HL-7 formatter, put the data on an SQL database server, and send them to the county. They use a public key cryptography system (Pretty Good Privacy) described as minimal. There is no formal program in place for changing keys. According to a preliminary evaluation, the pilot program improved the completion and timeliness of reports. The time required to send information to the local health office improved modestly (to less than 1 day) and the time required to send information to the state improved by an average of 40 days (to about 1 day).
1. Bernie H.K. Huang relocated to the Children's Hospital of Los Angeles and the University of Southern California as professor and director of Informatics effective January 1, 2000.break