LOCAL HEALTH DEPARTMENT PERFORMANCE INCENTIVE INITIATIVE YEAR New York State Department of Health. Office of Public Health Practice

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1 LOCAL HEALTH DEPARTMENT PERFORMANCE INCENTIVE INITIATIVE YEAR New York State Department of Health Office of Public Health Practice November 24,

2 TABLE OF CONTENTS 1. Summary p Background on Environmental Health Electronic Inspection (eforms) Initiative p. 4 Development of eforms eforms Implementation Outreach, Training, Communications and Technology Support 3. Environmental Health Measures p STD Measures p. 9 Measure 1: Completeness of records submitted to the electronic syphilis serology registry Measure 2: Adequate Treatment for Reported Cases of Gonorrhea 5. LHD Eligibility for a Potential Award p. 11 Scoring Methodology Award Size Auditing Results and Awarding Payouts 6. Year 3 Timetable p. 14 Attachments p Map of NYS DOH Regional + District Offices and LHDs Providing Environmental Health Services 2. NYS DOH District Offices and Counties for Which They Provide Environmental Health Services 3A. Baseline Data for the Comparison Reporting Period (12/01/14 06/30/15) 3B. Percent of Inspection Data for Environmental Health Operations Submitted by Method in C. Counts of Inspection Data for Environmental Health Operations Submitted by Method Active Environmental Health Operations by County, Ordered by Operation Count 5. Health Commerce System Screenshots for eforms Information and Mobitask Screenshot of Available eforms 6. Syphilis Cases and Investigations with Complete Serology Records November 2014-June Same Day Treatment of Reported Gonorrhea Cases with Azithromycin and Ceftriaxone, by County. 2

3 Summary The New York State Department of Health (NYSDOH) General Public Health Work program includes a statewide performance based incentive program that allows the NYS Commissioner of Health to establish statewide performance standards for delivery of core public health services and to provide additional funding (referred to as incentive grants ) to Local Health Departments (LHDs) that meet or exceed statewide performance standards. $1 million has been appropriated annually for the incentive awards. The major focus of the Year 3 LHD Performance Incentive Initiative is submittal of electronic inspection reports for environmental health regulatory inspection and protection programs. The secondary focus area is the measures from Year 2 related to sexually transmitted diseases (STDs). The designated performance incentive period for year 3 is 12/1/15 06/30/16. The 37 full-service counties that deliver environmental health services (Attachment 1) must participate in both parts of the incentive program to be eligible to receive an award. The 21 LHDs (Attachment 2) that do not directly deliver environmental health services will be eligible to compete for a portion of the award funding to support continuance of LHD Year 2 program performance objectives related to STDs. For full service LHDs, 75% of the score will be based on the EH work, while 25% of the score will be based on STD measures. For LHDs that do not deliver EH services, the entire score will be based on STD measures. To be eligible to participate, a LHD must submit data through eforms to ehips and must use CDESS to submit STD data. Goals for the Environmental Health portion Increase the proportion of eforms submitted to ehips using NYSDOH supplied ipads and/or Tablets or LHD purchased devices for regulated activities/permitted facilities. Goals for the STD portion Ensure that 85% of gonorrhea cases will be adequately treated according to CDC guidelines Ensure that 90% of syphilis investigations will have a complete serology record This report includes background on the Environmental Health Electronic Inspection Initiative, background on the STD goals, the scoring methodology and award distribution as well as attachments with baseline data. 3

4 Background on Environmental Health Electronic Inspection Initiative The NYS DOH Center for Environmental Health s (CEH) Division of Environmental Health Protection (DEHP) oversees regulatory programs designed to minimize environmental health threats and provides policy directives and implementation guidance to county health department and regional and district offices. Program data for the DEHP s Bureau of Community Environmental Health and Food Protection (BCEHFP) regulatory inspection programs are maintained in the Environmental Health Information and Permitting System (ehips). CEH requires LHDs to maintain accurate and reliable records of their activities. Complete, consistent, accurate, and up-to-date reliable inspection data are necessary for proper programmatic oversight and enforcement at regulated operations, as well as to support mandated federal and state reporting requirements. These data are also needed to target implementation of public health initiatives, and support accurate reporting for LHD environmental health program time and activity for Article 6 reimbursement. Depending on the season, approximately state and LHD environmental health staff collect and enter inspection data annually. Field inspection time can range from 15 minutes to several hours, depending on the type, size and operation of the facility, the type of inspection, and inspector experience. Currently, LHDs can submit inspection data using any of four existing methods: manual data entry, file transfer process (FTP), scannable forms, and tablet-based electronic forms (e-forms). The quality of data completeness, consistency, accuracy and timeliness can vary depending on the method of data submission. Each one of these methods has challenges, as briefly described below: Manual Data Entry: After the field inspection, manual data entry of inspection information has to occur which can take approximately 20 minutes, depending on the size of the facility inspected and the number of permitted operations. In addition to being more labor intensive and less efficient, manual data entry into ehips is dependent upon the inspector schedule, and date and time of return to the office to enter inspection results, and therefore can take up to several days before the data is submitted into the database. There are no data accuracy quality control checks associated with manual data entry, other than the inspector s review and verification of data accuracy prior to saving within the database. FTP: This is an option for inspection data submittal that was provided to LHDs utilizing local databases to maintain inspection and permit records and information for the BCEHFP regulatory inspection and protection programs. However, based on past experience, the Department has determined that the FTP is unreliable as a method for inspection data submittals, as the process is prone to significant data errors if the FTP specifications are not precisely met to be accepted into ehips, resulting in significant data gaps and inaccuracies. Scannable forms: This method, like e-form, has more built-in business rules (i.e., checks and balances) to minimize data errors and inspection and data submitted via these two methods are less prone to errors than manual entry. Despite the automation provided through scannable forms, a significant level of effort is required to support this method of inspection data submittals, as scannable forms also require third party data verification to ensure data accuracy. A review of 2010 and 2011 data indicated that approximately 129,000 pages of scannable inspection forms were being reviewed annually and about 70% of those forms include data fields 4

5 that require correction (equating to approximately two Full Time Equivalents/FTE s), with transmittal of unresolved errors back to LHDs for correction. Printing, distribution and costs of maintaining scannable inspection forms are considerable: approximately 175,000 scan-able inspection forms are distributed by the NYSDOH annually at a cost of $15,000. eforms: The eforms method of data entry has built-in checks and balances that must be met in order for successful data transmittal/submittal to occur. Data submitted via the eforms method is instantaneous with internet connectivity and is less prone to errors than manual entry. Maintaining the various applications to accept inspection data submittals from each of the four different methods is very resource intensive. In partnership, Information Technology Services (ITS) and the BCEHFP initiated efforts to explore implementation of automated data collection methods to improve the timeliness, quality and accuracy of inspection data submittals, alleviating the burden on state and local environmental health programs allocated to error correction and processing of FTE and scannable inspection report submittals. Development of eforms The concept for development and implementation of eforms was initiated in The BCEHFP in conjunction with ITS implemented a small scale pilot program to develop an electronic inspection form for food service establishments (FSEs) and provide tablet devices to approximately thirty (30) volunteer inspectors from the Department s District Offices. In 2013, this pilot effort was expanded to a Phase I Implementation, with the development of additional eforms for the Department's environmental health regulatory inspection programs, and a broader team of approximately 80 inspectors statewide at State District Offices as well as nine (9) full-service LHDs in Western and Central New York Regions that decided to voluntarily participate in this expanded pilot effort, utilizing their own equipment. Throughout the expanded pilot, ITS and CEH provided technical support to users and evaluated field implementation issues to be addressed. Internal tracking of performance objectives related to implementation of the pilot supported continuation of the effort. Phase II implementation occurred in 2014, and ITS with BCEHFP continued to work on improving the quality and functionality of the electronic inspection forms based on field inspector input and feedback, improving efficiencies and resolving field implementation issues. The numbers and percent of inspections completed using eforms is shown in Attachments 3A-3C, for both the baseline reporting period (Attachment 3A) as well as calendar year percentages (Attachment 3B) and counts (Attachment 3C ). Active operations and inspections as of 10/31/2015 are shown in Attachment 4. At the end of the Phase I and II, ITS with BCEHFP, DEHP and CEH support, developed and implemented a plan to procure the required technology licensing to support broader, statewide implementation, and convert the existing "per seat" technology licensing model to an "enterprise" model, permitting installation to multiple servers for clustering and increased availability as necessary, significantly increase available license seats (i.e., number of users) and better control future additional user costs and annual maintenance. Available funding through the Centers for Disease Control and Prevention (CDC) enabled the Department to initiate efforts to purchase IPads and Tablets and related equipment for distribution to LHDs to support a statewide initiative to increase submittals of eforms to 5

6 ehips. To date, the Department has provided ipad and Tablet devices to approximately 400 LHD inspectors statewide, and has provided implementation resource support to ensure successful implementation of eforms through multiple regional webinars. The NYSDOH with ITS is relying on a shared, cooperative partnership with LHDs to support statewide implementation of this data quality improvement initiative. All LHDs that deliver environmental health services have indicated that they will participate in eforms implementation and are expected to participate in the Year 3 Article 6 Performance Incentive. Thus, CEH is moving toward statewide implementation of electronic inspection report submittals (eforms) submission to address the timeliness and accuracy of data submittals and eliminate the burden of data verification. eforms Implementation Outreach, Training, Communications and Technology Support NYSDOH has conducted considerable outreach with LHDs to support and ensure successful implementation of electronic inspections, statewide. In August 2014, the Department and ITS conducted outreach through a statewide webinar and distributed a survey to identify interested LHDs, assess local technology infrastructure, preferred equipment type (i.e., IPads versus Tablets) and needs, assigned users/staff, as well as establish contacts at each LHD for initiating and coordinating equipment purchase and delivery. ITS worked closely with each LHD to identify each LHD s technology infrastructure, confirm ipad/tablet equipment preferences and needs (i.e., number of inspectors); identify and resolve, where possible, technology barriers to eforms implementation prior to a bulk technology purchase of equipment for LHDs. Distribution of the ordered equipment occurred in 2015 over the span of several months in late spring through mid-summer. In mid-august 2015, NYSDOH and ITS held a statewide conference call with regional environmental health staff (i.e., Field Coordinators) to discuss their anticipated roles and responsibilities related to LHD implementation of eforms. Specifically, the regional Field Coordinators (FC) will serve in a support capacity to LHDs, as they are not expected to be technology experts. The FC role will involve providing technical support to LHDs within their capacity, directing staff with inquiries to the designated LHD technology or environmental health contact as appropriate, making referrals to the existing guidance documents posted on the Health Commerce System (HCS), and directing the LHD to submit any unresolved requests for assistance and eforms issues to the designated shared mailbox (i.e., ehips@health.ny.gov) for follow-up by ITS and NYSDOH. In September 2015, DOH and ITS again partnered to conduct four (4) regional webinars for LHDs to support statewide eforms Implementation. The purpose of these regional webinars was to review and provide links to existing guidance and resources for ipad/tablet users, clarify expectations for identified/established LHD technology and program contacts for troubleshooting technology issues, and establish regional points of contact for eforms implementation. During the webinar, the roles and responsibilities pertaining to operation and maintenance of the distributed ipad/tablet equipment, assigned user expectations, and electronic inspection reporting were reviewed. Invitees and participants to the regional webinars included DOH regional environmental health partners, LHD Environmental Health Directors, LHD technology and environmental health program contacts and all of the designated ipad/tablet users for each participating LHD. Following each of the regional webinars, each LHD was asked to review NYSDOH and ITS information for accuracy pertaining to the key environmental health 6

7 and technology contacts, and also designate an eforms user within the local environmental health program area that LHD staff may contact with questions and/or requests for assistance related to eforms implementation issues (i.e., LHD eforms Contact ). LHDs were also asked to verify information about the designated ipad/tablet users, the associated serial number (ipad) or service tag number (Dell Tablet) of the assigned equipment for each user, as well as user addresses, HIN Identification and environmental health ehips/citrix ID to ensure accuracy with respect to tracking of electronic inspection submittals and to support assessments of reporting for the Year 3 Article 6 Performance Incentive. The ipad and Tablet devices purchased by the Department with available funding through the CDC and distributed to LHDs to support electronic inspection reporting (eforms), are Department-owned equipment. The LHDs and assigned users for each of the provided devices are responsible for proper use, maintenance, care, and storage. Any damage to Department-provided equipment that requires repair will need to be coordinated through the Department with support from ITS. LHDs and individual users should not attempt to arrange for equipment repair as the devices are under warranty through DOH only, nor is there any available funding to support reimbursement for LHD-initiated repairs of damaged equipment. LHDs should report damage and requests for repairs to DOH-provided ipads and Tablets to ehips@health.ny.gov. DOH and ITS will continue to provide support for forms development, updates and installation. The priority for new electronic inspection forms development is the Healthy Neighborhoods Program (HNP) and we anticipate that this form will be available in January ITS will continue to work with Groveware to resolve any eforms software functionality issues and will continue to coordinate distribution of notices relating to new releases of software installation updates through the Health Commerce System (HCS), Lotus Quickr Application. It is important that individual users attempt to install the software updates as they are released, as failure to do so after multiple software updates could result in incompatibility issues between the user device and forms submittal. The LHDs are responsible for configuration of each of the individual ipad/tablet devices within the local network environment for each of the assigned users (individual/shared). Technical guidance and resource support information (Attachment 5) are posted on the Health Commerce System (HCS) at under: My Content>All Applications>Lotus Quickr>Environmental Health Topics> EH Applications and Support>eForms Information. It is expected that all assigned ipad/tablet users will review the guidance and resource documents posted on the HCS prior to using their assigned device and refer to this information as an initial resource to resolve operational issues with their assigned device. Due to the large number of inspectors that will be implementing electronic inspections statewide, NYS DOH is requesting that every effort to troubleshoot technology issues and resolve individual inspector inquiries be first initiated at the local level, through the identified/established LHD Technology and eforms Support contacts. If a user is unable to resolve the issue at the local level, the Regional Field Coordinators may be able to assist with directing the ipad/tablet user or eforms Support contact to an appropriate resource. Any unresolved 7

8 technology and/or operational issues and requests for assistance should be directed to As a reminder, any updates to inspector addresses due to changes is user assignments and/or county wide address changes also needs to be reflected in ehips, so that the information transmitted by the new address is recognized for receipt and acceptance into ehips. Updates to addresses in ehips will need to be made by the LHD s designated ehips Administrator. Electronic inspection submittals from inspectors at LHDs that were assigned either an ipad or Tablet as provided by NYSDOH, will be monitored to ensure that the equipment is used for its intended purpose. Any equipment that is not being used for inspections may be subject to recall by NYSDOH and ITS for reassignment to an alternate LHD. Environmental Health Measures The goal of the Environmental Health portion of the performance incentive initiative is to increase the proportion of eforms submitted to ehips for inspections of regulated and permitted facilities using NYSDOH supplied ipads and/or Tablets or LHD purchased devices. LHDs that complete the highest proportion of inspections using eforms for inspections during the performance incentive period (and meet the STD goals) will gain the biggest awards. Electronic inspection forms currently exist for the majority of environmental health regulatory and permit inspection programs, including: Retail Tobacco Sales (ATUPA), Agricultural Fairgrounds, Bathing Beaches, Campgrounds, Children s Camps, Food Service Establishments, Migrant Farmworker Housing, Mobile Food Service and Push Carts, Mobile Home Parks, Recreational Aquatic Spray Grounds, Swimming Pools, Tanning Facilities, Temporary Food Service Establishments, Temporary Residences and Water System Field Compliance. An eform is being developed for use during Home Assessments conducted under the Department s Healthy Neighborhood Program (HNP), and if the HNP eform becomes available during the performance incentive period, LHDs that deliver this program will be able to include any HNP eform submittals towards the total number of electronic inspection submittals that will be counted under the Year 3 Performance Incentive. Those that do not deliver this program will not be penalized. NYSDOH will prepare and disseminate periodic reports using ehips data during the performance incentive period for each participating LHD to review. The reports will provide LHD specific performance report results compared to other LHDs, the statewide average, and to baseline data. Baseline data is shown in Attachment 3A. It is expected all counties will exceed their baseline performance. Data Analyses will be conducted monthly during the implementation period to track LHD progress with electronic inspection submittals. Reporting/Feedback will be conducted monthly during the implementation period. Technical Support The BCEHFP and ITS will continue to provide technical support to LHDs for ehips and related activities through the ehips shared mailbox, ehips@health.ny.gov. 8

9 STD Measures Measure 1: Completeness of records submitted to the electronic syphilis serology registry For the measurement period, the goal for completeness is 90%. Based on performance incentive data, 99.4% of syphilis serology records were complete. 49 of 55 (89.0%) LHDs with syphilis cases in the measurement period exceeded this statewide average, with 44 of these 49 (89.8%) achieving 100% completion. Table 1 summarizes these performance data and Attachment 6 has county specific data. For measurement purposes, when calculating the proportion of complete syphilis serology records, the denominator will be the number of ECLRS lab reports for syphilis cases and reactors received during the measurement period and the numerator will be the number of lab results that were entered in the syphilis serology registry with complete information. A completed record is defined as having a response for each of the following data elements in the serology record upon completion of record creation: specimen collection date, type of test for both non treponemal and treponemal tests, test result including quantitative and titer value for non treponemal test results, specimen source, laboratory accession number and name of testing laboratory. Measure 2: Adequate Treatment for Reported Cases of Gonorrhea For the period, the goal for adequate treatment is 85%. This measure has been updated from last year. In 2014, gonorrhea was the third most commonly reported communicable disease in NYS outside New York City with 6,616 cases. The causative organism, Neisseria gonorrhoeae, has progressively developed resistance to the antimicrobial agents used to treat it successfully. The only class of antibiotics currently recommended by the Centers for Disease Control and Prevention (CDC) for treatment of gonorrhea infection is the cephalosporins, with ceftriaxone representing the last available antibiotic that is safe and highly effective at treating gonorrhea infections at all anatomical sites. Although ceftriaxone remains effective, treatment failures involving N. gonorrhoeae resistant to cephalosporins have been reported in several areas of the world and data collected through national sentinel surveillance indicate reduced susceptibility to cephalosporins, raising concerns about the possible emergence and spread of cephalosporin resistance. In 2012, CDC announced that oral cephalosporins were no longer recommended for the treatment of gonorrhea infections due to reduced susceptibility and issued revised treatment guidelines, recommending a single intramuscular dose of Ceftriaxone 250mg plus either a single dose of Azithromycin 1 gram orally or doxycycline 100 mg twice daily for 7 days of treatment. In 2015, CDC revised the treatment guidelines again to recommend dual therapy with a single dose of Azithromycin 1 gram orally and a single intramuscular dose of Ceftriaxone 250mg to be administered on the same day, preferably simultaneously. 1 Same day dual therapy using two antimicrobials with different pharmacokinetics improves treatment efficacy and may delay emerging resistance. Furthermore, dual 1 Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines,

10 therapy follows recommendations to routinely treat gonorrhea infections with an antibiotic that provides coverage for Chlamydia. Prevention of the emergence of cephalosporin resistance relies on a comprehensive approach involving primary and secondary public health prevention efforts. A priority is for health care providers to treat all cases of gonorrhea according to recommended treatment guidelines. Under 10NYCRR Parts 2 and 40, LHDs are required to verify treatment for diagnosed cases of STDs and play a critical role in ensuring adequate therapy through provider follow up for persons without evidence of adequate treatment in CDESS case reports and through educational efforts. The CDESS supplemental form for STDs captures treatment information including date of treatment, type of medication, and dosage. LHD staff manually enter this information based on information received on the Confidential Case Report Form (DOH 389) or through provider follow up. For this measure, NYSDOH will categorize a gonorrhea case as adequately treated based on the following criteria: Treatment type and dosage for each of two antibiotics is documented on the STD supplemental form; The combination of antibiotics reflects the dual regimens recommended for the treatment of gonorrhea in current CDC STD Treatment Guidelines for gonorrhea; A valid date of treatment is documented for each of the two antibiotics; Administration of each of the two antibiotics is on the same date. To calculate the proportion of gonorrhea case reports with adequate treatment, the numerator will be the number of gonorrhea case reports fulfilling each of the criteria noted above and the denominator will be the total number of gonorrhea case reports. Based on baseline data, 80% of persons infected with gonorrhea received adequate treatment. Eighteen of 57 (32%) LHDs met or exceeded this statewide average and seven (12%) LHDs met or exceeded the 85% goal. Two Counties reported no cases. Table 1 summarizes these performance data and Attachment 7 provides county-specific baseline data. NYSDOH encourages LHDs to follow up with providers that do not comply with federal treatment guidelines for gonorrhea in order to make providers aware of treatment recommendations. It is anticipated that this provider follow up will lead to improved treatment outcomes over the course of the performance period. NYSDOH recognizes that LHDs cannot control some provider and patient factors that lead to inadequate treatment. For this reason, the CDESS supplemental for gonorrhea will be modified to allow LHDs to document selected factors that influenced the treatment regimen, e.g., patient allergy, patient lost to follow up. Those records will be removed from the performance indicator calculation so as not to penalize the LHD. 10

11 Table 1: Performance Measures, Baseline Data and Goals* for STD Case Reporting STD Performance Measure The percentage of syphilis cases and reactors with a The percentage of gonorrhea cases with adequate treatment complete syphilis serology record Baseline 99% 80% Number of LHDs at or above Baseline 55 counties (96%) 18 counties (32%) Minimum Goal % 85% Number of LHDs Meeting Minimum Goal for counties (100%) 7 counties (12%) LHD Eligibility for a Potential Award Each full service county must achieve the following minimum performance goals to be eligible for an incentive award: eforms submittals---counties must exceed their baseline (Attachment 3A). Adequacy of gonorrhea treatment---85% of cases will be adequately treated according to CDC guidelines Complete syphilis serology records---90% of syphilis investigations will have a complete serology record Scoring Methodology To score counties, NYSDOH will assess performance using a weighted formula. For the full service LHDs, 75% of the total composite score will be based on the percent of inspections submitted using eforms. The remaining 25% of the total composite score will be based on the STD measures. A heavier emphasis will be placed on the proportion of gonorrhea cases receiving adequate treatment in accordance with CDC recommended regimens within 24 hours. For the scoring formula, each metric will be assigned a weight. NYSDOH will utilize the proportion of Environmental Health inspections that are submitted electronically, as well as the reports that meet or exceed the minimum goals in each of the STD goals and enter these numbers into the weighted formula, as follows: County Goal Achievement Score=[54*(proportion of EH eforms submittals)+12*(proportion of gonorrhea cases receiving adequate treatment)+6*(proportion of syphilis serology record meeting completeness goal//72*100% The maximum score is 100%. In the event that a county does not have a syphilis investigation, a normalization factor will be applied to the lack of an investigation does not impact the county s composite score. 11

12 Those counties that do not deliver Environmental Health programs will be compared separately and the total score will be calculated as follows: County Goal Achievement Score=12*(proportion of gonorrhea cases receiving adequate treatment)+6*(proportion of syphilis serology record meeting completeness goal//18*100% Award Size for Full Service LHDs Every full service county that is participating in the electronic inspection program will receive a base financial award sized according to when they started using electronic inspection technology for environmental health. Base awards will be given in the following amounts: Early adopters (i.e., those who began electronically reporting at least 1/3 of their environmental health inspections in 2014 or before) will be awarded a base amount of $10,000 (n=7) Emerging users (i.e., those who began using eforms prior to 2015 but did so in a lesser amount (n=6), will receive a base amount of $3,250. Every county that is participating in the electronic inspection program that was not an early adopter or emerging user (i.e., those who began using eforms in 2015) will receive a base award of $1,500 (n=23). In addition to the base award, each full service county that meets the minimum performance goals will be eligible for a performance award. The size of these awards will be based on the burden of active environmental health operations (Attachment 4). Counties will be ranked by their total composite county achievement scores and awards will be given to the top performers as detailed below. Table 2. Proposed Performance Award Size and Structure for Environmental Health Service Provider Counties Participating in the Year 3 Environmental Health Performance Incentive Annual Active Operations Number of LHDs in Size Group Number of Awards Available Amount ($) of Each Award Total $ Amount < , , < , ,000 > , ,000 12

13 Award Size for LHDs that do not Deliver Environmental Health Services. Table 3. Proposed Performance Award Size and Structure for Counties that do Not Offer Environmental Health Services Population Group Number of LHDs in Size Group Number of Awards Available Amount ($) of Each Award Total $ Amount <75, ,000 75,000 75, , ,000 Auditing Results and Awarding Payouts The NYSDOH reserves the right to audit any and all data reports at the county level to ensure the integrity of the data being reported. The NYSDOH statistical unit will periodically run analyses to identify potential outliers which may trigger an audit. The NYSDOH reserves the right to adjust payouts based on substantially poor or substantially exceptional results. It also reserves the right to adjust the timeline of award payments after discussion with NYSACHO. 13

14 Year 3 Timetable The NYS DOH will monitor inspection data from 12/1/2015 to 6/30/16. Awards will be announced in September Award funds can be used to support costs associated with Article 6 eligible services. These are one time only payments. Timetable Year 3 Activity July 2015 Aug Sept Oct Nov Dec Jan 2016 Initiative X X X X Development; Tablet deployment New X Initiative Announced Feb March April May June July Aug Sept Training on electronic reporting Performance Period Data analyzed and award formula applied Awards announced at NYSACHO meeting X X X X X X X X X X X X X X X 14

15 ATTACHMENTS 15

16 Attachment 1. Map Showing NYS DOH Regional Offices, NYS DOH District Offices Jurisdictions and Local Health Departments Providing Environmental Health Services (in white) 16

17 Attachment 2. NYS DOH District Offices and Counties for Which They Provide Environmental Health Services District Counties Served Address Telephone Canton St. Lawrence 58 Gouverneur Street, Canton (315) Geneva Ontario, Wayne, Yates Glens Falls Saratoga, Warren, Washington Herkimer Hornell Fulton, Herkimer, Montgomery Schuyler, Steuben 624 Pre-Emption Road, Geneva (315) Mohican Street, Glens Falls (518) State Route 5, Herkimer (315) Broadway, Room 105, Hornell (607) Monticello Sullivan 50 North Street, Suite 2, Monticello (845) Oneonta Saranac Lake Delaware, Greene, Otsego Essex, Franklin, Hamilton 28 Hill Street, Suite 201, Oneonta (607) St. Bernard Street, Saranac Lake (518) Watertown Jefferson, Lewis Dulles State Office Building, 317 Washington Street, Watertown (315)

18 Attachment 3A. Baseline Data for the Comparison Reporting Period (12/01/14 06/30/15): Counts and Percent of Environmental Health Operations Inspection Data Submitted via Manual Entry, Scannable Forms Entry and Electronic (eforms) Entry, By County County Code Manual Count Scanned Count eform Count Manual % Scanned % eform % ALBANY % 75% 0% ALLEGANY % 0% 0% BROOME % 24% 0% CATTARAUGUS % 0% 0% CAYUGA % 0% 16% CHAUTAUQUA % 1% 78% CHEMUNG % 5% 79% CHENANGO % 1% 8% CLINTON % 83% 0% COLUMBIA % 0% 0% CORTLAND % 83% 0% DUTCHESS % 0% 0% ERIE % 89% 0% GENESEE % 63% 0% LIVINGSTON % 0% 0% MADISON % 0% 0% MONROE % 94% 0% NASSAU % 98% 0% NIAGARA % 0% 0% ONEIDA % 0% 84% ONONDAGA % 70% 0% ORANGE % 0% 0% ORLEANS % 0% 79% OSWEGO % 0% 3% PUTNAM % 0% 0% RENSSELAER % 0% 0% ROCKLAND % 72% 1% SCHENECTADY % 81% 0% SCHOHARIE % 6% 0% SENECA % 0% 38% SUFFOLK % 87% 0% TIOGA % 1% 0% TOMPKINS % 72% 0% ULSTER % 15% 0% WESTCHESTER % 36% 0% WYOMING % 10% 71% 18

19 Attachment 3B. Percent of Inspection Data for Environmental Health Operations Submitted Via Manual Entry, Scannable Form Entry and Electronic (eforms) Entry in , Ordered by Percent 2015 E-Form Submittals, as of October

20 Attachment 3C. Counts of Inspection Data for Environmental Health Operations Submitted Via Manual Entry, Scannable Form Entry and Electronic (eforms) Entry , Ordered by Counts of 2014 E-Form Submittals, as of October County Manual 2012 Scanned 2012 eform 2012 Manual 2013 Scanned 2013 eform 2013 Manual 2014 Scanned 2014 eform 2014 Manual 2015 Scanned 2015 ONEIDA CHEMUNG CHAUTAUQUA ORLEANS CAYUGA WYOMING OSWEGO SENECA ROCKLAND GENESEE CHENANGO CLINTON ONONDAGA WESTCHESTER NASSAU RENSSELAER TOMPKINS PUTNAM NIAGARA MADISON ALBANY SCHOHARIE CATTARAUGUS CORTLAND LIVINGSTON ERIE ULSTER ORANGE SUFFOLK ALLEGANY COLUMBIA BROOME DUTCHESS MONROE SCHENECTADY TIOGA Footnotes - Attachments 3A-3C: (1) The data includes the service types: inspection, re-inspection and pre-operational inspection; does not include field visit, HACCP, sanitary survey, complaint, incident or illness investigation. (2) The values indicate the number or percentages of services submitted by the three submission methods: manual, scannable and eform. (3) Data does not include services submitted via file transfer. eform 2015 (4) New York City data is not included. (5)Active operations were those active on 10/31/2015 and include core BCEHFP programs only. (6) Calendar Year is January-December. 20

21 Attachment 4. Active Environmental Health Operations by County, Ordered by Operation Count County Number of Active Operations in ehips 1,2,* SCHOHARIE 362 WYOMING 480 SENECA 537 CHEMUNG 591 TIOGA 593 ALLEGANY 646 LIVINGSTON 668 CHENANGO 749 PUTNAM 800 CLINTON 842 CORTLAND 873 COLUMBIA 893 ORLEANS 914 GENESEE 977 CATTARAUGUS 991 MADISON 1016 CAYUGA 1060 SCHENECTADY 1107 RENSSELAER 1237 TOMPKINS 1385 CHAUTAUQUA 1602 OSWEGO 1602 BROOME 1613 ONEIDA 2202 ROCKLAND 2485 NIAGARA 2789 ULSTER 3054 DUTCHESS 3300 ORANGE 3454 ALBANY 3634 MONROE 4229 ONONDAGA 4351 ERIE 6017 WESTCHESTER 6492 SUFFOLK 7934 NASSAU *Source ehips 10/31/15 Grouped by < 1020 operations, those between 1021 and 3000 and those > 3000 operations. (1) Core operations active on 10/31/2015. Some of these may be active in ehips but not operating during 7-month time frame. (2) Core Operations include: Children s Camps, Temporary Residences, Mobile Home Park, Migrant Farmworker Housing, Swimming Pools, Bathing Beaches, Food Service Establishments, Temporary Food Service Establishments (linked to an event), Mobile Food Service Establishment, Vending Food Machine, Campgrounds, Mass Gatherings, Agricultural Fairgrounds, Recreational Aquatic Spray Ground, Tanning Facility, SOFA Food Service, SED Summer Feeding Program, Institutional Food Service. 21

22 Attachment 5. Health Commerce System (HCS) Screenshots for eforms Information HCS>All Applications>Lotus Quickr>Environmental Health Topics>EH Applications, Software and Support eforms Information Folder: 22

23 Mobitask Windows Client Mobitask Support Documents Folder: 23

24 Mobitask Screenshot of Available Electronic Inspection Reports (eforms) As of November 23,

25 Attachment 6: Syphilis Cases and Investigations with Complete Serology Records Nov June Total Serology Record with Lab Data County Cases and Investigations Investigation* Cases** Total Percent Albany Allegany Broome Cattaraugus Cayuga Chautauqua Chemung Chenango Clinton Columbia Cortland Delaware Dutchess Erie Essex N/A Franklin Fulton Genesee Greene Hamilton Herkimer Jefferson Lewis Livingston Madison Monroe Montgomery Nassau Niagara Oneida Onondaga Ontario Orange Orleans

26 Oswego Otsego Putnam Rensselaer Rockland Saratoga Schenectady Schoharie Schuyler N/A Seneca St Lawrence Steuben Suffolk Sullivan Tioga Tompkins Ulster Warren Washington Wayne Westchester Wyoming Yates Total

27 Attachment 7. Same day treatment of reported gonorrhea cases with Azithromycin and Ceftriaxone, by County. Adequate Treatment (%) Inadequate Treatment (%) Missing Information (%) Albany 226 (76.1) 61 (20.5) 10 (3.4) 297 Allegany 7 (100.0) 0 (0.0) 0 (0.0) 7 Broome 87 (82.9) 17 (16.2) 1 (0.9) 105 Cattaraugus 8 (66.7) 4 (33.3) 0 (0.0) 12 Cayuga 9 (75.0) 3 (25.0) 0 (0.0) 12 Chautauqua 49 (76.5) 14 (21.9) 1 (1.6) 64 Chemung 34 (82.9) 7 (17.1) 0 (0.0) 41 Chenango 2 (50.0) 2 (50.0) 0 (0.0) 4 Clinton 9 (64.3) 4 (28.6) 1 (7.1) 14 Columbia 12 (85.7) 2 (14.3) 0 (0.0) 14 Cortland 10 (71.4) 4 (28.6) 0 (0.0) 14 Delaware 2 (66.7) 1 (33.3) 0 (0.0) 3 Dutchess 73 (77.6) 18 (19.1) 3 (3.2) 94 Erie 811 (84.1) 119 (12.3) 35 (3.6) 965 Essex 2 (66.7) 1 (33.3) 0 (0.0) 3 Franklin 0 (0.0) 0 (0.0) 0 (0.0) 0 Fulton 5 (55.6) 4 (44.4) 0 (0.0) 9 Genesee 20 (95.2) 1 (4.8) 0 (0.0) 21 Greene 18 (78.3) 5 (21.7) 0 (0.0) 23 Hamilton 0 (0.0) 0 (0.0) 0 (0.0) 0 Herkimer 12 (70.6) 4 (23.5) 1 (5.9) 17 Jefferson 42 (87.5) 6 (12.5) 0 (0.0) 48 Lewis 1 (100.0) 0 (0.0) 0 (0.0) 1 Livingston 2 (66.7) 1 (33.3) 0 (0.0) 3 Madison 6 (60.0) 4 (40.0) 0 (0.0) 10 Monroe 832 (84.2) 150 (15.2) 6 (0.6) 988 Montgomery 6 (66.7) 3 (33.3) 0 (0.0) 9 Nassau 252 (75.2) 72 (21.5) 11 (3.3) 335 Niagara 153 (81.8) 30 (16.1) 4 (2.1) 187 Oneida 68 (76.4) 21 (23.6) 0 (0.0) 89 Onondaga 498 (81.1) 90 (14.7) 26 (4.2) 614 Ontario 16 (64.0) 9 (36.0) 0 (0.0) 25 Orange 104 (78.2) 27 (20.3) 2 (1.5) 133 Orleans 10 (62.5) 6 (37.5) 0 (0.0) 16 Oswego 16 (64.0) 8 (32.0) 1 (4.0) 25 Otsego 7 (77.8) 1 (11.1) 1 (11.1) 9 Putnam 6 (66.7) 2 (22.2) 1 (11.1) 9 Rensselaer 79 (76.0) 23 (22.1) 2 (1.9) 104 Rockland 39 (86.6) 3 (6.7) 3 (6.7) Total Cases

28 St Lawrence 3 (75.0) 1 (25.0) 0 (0.0) 4 Saratoga 18 (58.1) 13 (41.9) 0 (0.0) 31 Schenectady 81 (81.0) 18 (18.0) 1 (1.0) 100 Schoharie 4 (100.0) 0 (0.0) 0 (0.0) 4 Schuyler 3 (100.0) 0 (0.0) 0 (0.0) 3 Seneca 2 (50.0) 2 (50.0) 0 (0.0) 4 Steuben 16 (84.2) 3 (15.8) 0 (0.0) 19 Suffolk 287 (75.7) 85 (22.4) 7 (1.9) 379 Sullivan 15 (65.2) 7 (30.4) 1 (4.4) 23 Tioga 3 (75.0) 1 (25.0) 0 (0.0) 4 Tompkins 44 (83.0) 9 (17.0) 0 (0.0) 53 Ulster 32 (69.6) 13 (28.3) 1 (2.2) 46 Warren 3 (75.0) 1 (25.0) 0 (0.0) 4 Washington 2 (40.0) 3 (60.0) 0 (0.0) 5 Wayne 6 (75.0) 2 (25.0) 0 (0.0) 8 Westchester 267 (77.4) 69 (20.0) 9 (2.6) 345 Wyoming 2 (50.0) 2 (50.0) 0 (0.0) 4 Yates 1 (100.0) 0 (0.0) 0 (0.0) 1 Total 4322 (79.9) 956 (17.7) 128 (2.4)