Public health cannot be practiced with outmoded tools. This paper discusses the use of modern means of data processing in a local health unit. Specific information is presented. DATA PROCESSING AND THE LOCAL HEALTH DEPARTMENT J. Carroll Chambers, M.D., M.P.H., F.A.P.H.A., and Felix Hartley, B.S. WE are living in a rapidly changing politan area. It was early in the 1930's environment, and find ourselves that the Division of Data Processing faced with the challenge of diverse began its operation in the Bureau of health problems and the demand for Vital Statistics of the State Health De- ever extending health services. Both partment. The initial equipment con- medical science and mankind are in a sisted of a mechanical sorter and a key- period of significant evolution. If order punch machine, and practically all of the is to be maintained in our progress, we early work related to records of vital must face reality by altering our tech- events. By 1941, it was recognized that niques of community diagnosis. there were other types of data which Among the many responsibilities of should be mechanically analyzed; as a the official health agency, none should result, the Division of Data Processing be considered more important than the was moved into the Bureau of Adminis- gathering, analysis, and dissemination of tration. facts and figures which relate to the Shortly after the organization of the health of the people within a particular unit at the State Health Department, the jurisdiction. In addition, larger health Jefferson County Health Department, departments are faced daily with the with headquarters in Birmingham, began handling of masses of routine operational data processing on similar equipment. data, such as that which relates to the Since that initial installation in Birming- payroll, purchasing, and inventory serv- ham, gradual improvement has been ices rendered by the various disciplines made in the type of equipment available and other matters. This adds up to a tre- and the variety of work accomplished. mendous modern-day responsibility. one This unit reached its present peak of which many health departments are capability in January, 1966, with the attempting to undertake with horse-and- installation of the Univac 1004. buggy equipment. The Jefferson County Department of Health serves a population of approxi- Background mately 700,000, with a staff of about 350 and an annual operating budget of 21/4 Alabama was among the first states million dollars. Several thousand addi- to install automatic data-processing tional dollars are budgeted for special equipment in the official health agencies projects annually. at the state level and in a major metro- The statement is sometimes made that FEBRUARY, 19969 311 the computer is a luxury item, that it is This will free employees to broaden the actually unnecessary in a public agency scope of data analysis or allow time for such as a local health department, and them to focus attention on previously that public funds should not be ex- neglected responsibilities. It would be pended for such items. Some have even unfair to imply that the installation of intimated that there is such a lack of electronic data-processing equipment will sophistication in public health agencies reduce the payroll because this will not that computer equipment would not be be the case. It is only possible to engage utilized to its fullest advantage. in more concentrated work at greater However, public health is a complex depth with the same personnel. discipline that demands skilled people 4. Less data-storage space is re- and quality machines. We need never quired by the computer operation. feel apologetic for our methods of prac- In 1965, it was recognized that the tice, for they stand at a high level of pro- basic punch-card system in the Jeffer- fessional competence. It must be recog- son County Department of Health was nized that we have a serious task to per- approaching maximum time utilization. form, and the best in men and materials It had become necessary for us to buy must be demanded if this task is to be additional report processing and com- accomplished. It seems essential that putation time from a commercial service adequate data processing units must be agency for special projects and some available in every local health depart- routine work. It was decided that a study ment. These units may consist of one should be made of our data-processing clerk and the simplest adding machines, needs, and that proposals should be or they may consist of an entire division sought from several companies for a of personnel and the latest auto- computer installation within the depart- mated, electronic processing equipment. ment. A subsequent study revealed that Of course, it is recognized that not every we were performing a wide variety of local health department could support a important reporting and recording ac- computer program of its own; neither tivities on the existing tabulation equip- does every local health department need ment, but that this operation had a computer. In some areas, the health reached a point of saturation beyond department can share a centrally located which nothing of significance could be unit with other governmental agencies. accomplished without additional equip- ment. Our primary interest was whether Advantages of Computer Operation or not the workload of the agency justi- fied conversion to a basic computer unit, Let us suppose that a health depart- rather than adding more tabulating ment has some tabulating equipment, as equipment. It was pointed out, and sup- many do now. What are the advantages ported, that electronic data-processing of conversion to a computer operation? equipment could be used to relieve the 1. The quantity of work can be in- increasing workload, and to provide creased in greater detail and with the more meaningful and comprehensive in- consumption of less time. formation for program directors. 2. The quality of work can be im- proved because of computer logic and Budget Considerations expanded abilities. This will provide more comprehensive reports and analy- With these facts well documented, sas. consideration was given to equipment 3. Fewer employees will be required available to suit the needs of the de- to perform the same amount of work. partment, and at the same time be within 312 VOL 59, NO. 2. A.J.P.H. DATA PROCESSING AND HEALTH DEPARTMENTS a realistic price range for our budget. Some of this equipment is owned by the Three companies submitted equipment department, and some is rented. If it proposals. One was obviously beyond the were all rented, the total rental cost range of our funding capabilities. A de- would be $435 monthly. Personnel in the tailed review of the capabilities of the Computer Section includes a program- remaining two types of equipment was mer, a machine operator, and 4 key. made, consisting of several weeks of con. punch verifier operators. Their total sultation, deliberation, and visitation of salaries are approximately $2,400 local installations. The Univac 1004 was monthly. ultimately selected as the unit more It has been intimated, and justifiably closely paralleling our proposed needs so, that such an installation is expen- and funding ability. sive. It must be recognized, however, During the deliberations about the that the quality and quantity of work type of equipment desired, it was neces- required in a large health department sary to decide upon the actual method of justifies this expense in the same way acquisition. For the equipment selected, that the expense of highly trained com- there were three methods by which the petent technical people is justified. funding could be arranged: Many reports are required by state and 1. Rental including maintenance at $1,450 federal agencies, and these can be easily monthly. provided by the computer installation. 2. Purchase for $40,600, plus maintenance Several of these reports relate to special contract, as an option. projects which are directly supported by 3. Lease/purchase from a third party com- federal funds, and such project funds mercial company at $822 monthly, with addi- tional maintenance. can be used to defray a portion of the cost. At the present time, about $2,500 It was definitely felt that the equip- monthly is being used from special ment in question would serve the needs project funds for this purpose. of the department for several years and, if necessary, its capacity could be ex- Range of Programs panded by additional equipment. The decision was therefcre made to purchase The computer installation has been the Univac 1004, and this decision has utilized in a broad range of programs, not been regretted. The optional main- some of which may be briefly described tenance contract was offered at $295 as follows: per month. Careful investigation of An extremely rapid and efficient pay- local installations of the Univac 1004 roll system has been developed as a re- caused us to budget $150 monthly for sult of the installation. On one pro- maintenance and refuse the option for gram, a single report is produced pro- the contract. Up to the present time, this viding current payroll deductions and decision has also been supported as the net pay, year-to-date deductions and net proper one. pay, and a check register for reconcilia- Incidentals, such as transportation and tion. Another program provides the accessories, totaled almost $2,500. Sup- capabilities of payroll chec!k listing, W-2 plies are costing approximately $5,000 form listiing, and Social Security 941 annually, but this figure varies with the form listing. extent of work performed during any An extensive Immunization Program time period. has been conducted in the department In addition to the computer, the in- for the past three years, including a stallation includes three key punches, two birth certificate maintenance program. verifiers, one sorter, and one collator. A program has been developed for vari- FEBRUARY, 1969 313 ous mailouts which are sent to the par- mon use made of the computer. Such ents of newborn to stimulate the initia- automation greatly increases the speed tion of immunizations. Similar listings of the bulk mailing process and also aids are prepared to simplify tabulations of in updating such lists. The Southern mailouts returned to enable rapid follow- Branch Office of APHA uses this pro- up on those not returned. cedure for its mailings on a contractural Programs have been developed to pro- agreement with the department. vide for tabulation of the daily activi- ties of public health nurses, as well as Conclusion nursing clinic activities. These reports, required by certain state and federal The number of programs presently on agencies, previously demanded many the computer reaches into the hundreds. hours of hand tabulation. Programs have Many simple programs have been pre- been designed to accurately maintain pared that enhance the efficiency of vari- and update the tuberculosis register for ous bureaus of the department and more the county. Listings currently provide the are anticipated. In summary, it can be status of tuberculosis patients, and create said that the expenditures for the com- an easily accessible up-to-the-minute puter operation can be transposed into mechanism for follow-up of patients who increased ability, efficiency, and a great may be delinquent for examination or deal of satisfaction in the handling of drug refills. This particular program a large statistical workload in this de- served as a guide to the statewide tuber- partment. The installation was an essen- culosis register program. tial step in the provision of an adequate The Dental Health Report provides a service. The State Health Department monthly tabulation of clinical and other has recently installed similar equipment activities in this field, and allows both in order to permit an expansion of the the dental director and the health officer capabilities at both state and local levels. to easily evaluate the current status of The future looks extremely bright. these activities. Statistics from this re- Steps are being taken to improve the port are also forwarded to state and fed- existing system. The greatest delays, at eral agencies. Monthly analysis of pol- present, occur in preparation of the data lutants are calculated for the Air Pol- for the computer, but every effort is lution Section of the Bureau of Environ. being made to overcome these delays as mental Sanitation. Each pollutant is soon as possible. It seems no less im- individually programed, as required by portant to practice public health with the mathematical formulas being utilized. outdated equipment than it does with Monthly results are maintained and outmoded techniques. If we are to keep further analyzed for the provision of our hand on the pulse of the community geometric means, standard deviations, in modern times, we must have at our coefficients of variance, and confidence fingertips mechanisms which will com- limits. The provision of labels from a pletely analyze what that pulsebeat is variety of mailing lists is a rather com- saying to us. Dr. Chambers is Health Officer, and Mr. Hartley is Director, Bureau of Statistics and Vital Records, Jefferson County Department of Health (1912 Eighth Avenue South, P.O. Box 2591), Birmingham, Ala. 35202. This paper was presented before the Health Officers Section of the American Public Health Association at the Ninety-Fifth Annuial Meeting in Miami Beach, Fla., on October 25. 1967. 314 VOL. 59, NO. 2, A.J.P.H.