Customer Profile
Project SHARE serves two customers working in collaboration: San Diego County Health and Human Services Agency (HHSA) and San Diego County Office of Education (SDCOE). HHSA provides a broad range of health and social services, promoting wellness, self-sufficiency, and a better quality of life for all individuals and families in San Diego County. SDCOE oversees 42 school districts with approximately 600 schools and about a half a million students.

Situation and Challenges
Concern about the control of infectious disease and increasing fears of bioterrorism have highlighted the need to significantly strengthen disease surveillance and response capabilities in the U.S. Whether treating outbreaks of influenza, diagnosing a case of West Nile virus, or detecting an anthrax attack, real time information plays a crucial role in the ability to effectively respond to health emergencies. Frontline health workers, including family doctors and school nurses, serve as the primary entry point into the health system for most patients. As such, frontline workers can serve as an “early warning system” for disease outbreaks of all kinds. A lack of resources has slowed efforts to connect these healthcare providers, and compliance with reporting requirements remains low.

HHSA wanted to strengthen its disease surveillance and communications infrastructure by extending it to encompass the school nurses who serve the County’s 590 schools and 470,500 students. Of these nurses, virtually none had been reporting to county public health officials. County health officials wanted to track indicators such as school attendance, unexplained symptoms, and other syndromes indicating disease to monitor student health and implement an early warning system for bioterrorism. In addition, County officials wanted to communicate health alerts and other vital information rapidly to school nurses, building on the County’s innovative E-MAN system of health alerts for physicians.

Solution
In December 2003, in collaboration with SDCOE, the Community Epidemiology Branch (CEB) of HHSA launched Project SHARE at selected schools throughout the County. Initially 35 elementary and secondary schools provided daily information about absenteeism and types of health office visits (e.g. asthma management, chicken pox, fever, flu symptoms, rash, etc.). During the 2004-2005 school year, the number of schools was expanded and additional health categories were incorporated, including dental, diabetes management, injury, and insect bites/stings. Since inception of the program, more than 170,000 student health office visits have been reported through Project SHARE.

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Project SHARE Management Dashboard

Through Project SHARE, public health officials can monitor data submitted in real time through a web based interface, including a map-based view of data using GIS (geographic information system). Officials can use Project SHARE’s communication features to communicate with individual health workers, send broadcast voicemail, email, and SMS alerts to groups, post the latest health guidance, and host conference calls. When predefined trigger events are reported, the system generates emergency notifications via email, voicemail, pager and SMS text message. The information collected through Project SHARE is accessed and analyzed by the Community Epidemiology group which looks for trend information and identifies and investigates abnormal levels

Benefits
Data collected on a daily basis serves as an early warning system among participating schools with the potential for early identification of a large-scale disease outbreak or bioterrorism event. In addition, schools may access their submitted reports, allowing them to better monitor health office visits and student attendance. The information is used to support school health programs and efforts aimed at reducing absenteeism. During the life of the project, eventual coverage rates of 90% of all students in San Diego County are expected, consistent with population coverage targets set by the Department of Health and Human Services for disease reporting.

In the 2004/2005 School year, 22 school districts are participating in Project SHARE, including 87 school sites and 95,000 students from 52 elementary, 13 middle and 22 high schools.

“I see great potential for using SHARE reports to keep administrators informed about health issues and effects on absenteeism.”
- School Nurse

“From my perspective, the system is very easy to use. It takes lees than a minute to file a report.”
- Attendance Clerk