✅ Are you authoring by committee?

First, disclaimer: I recently left WA DOH and now work with the eCR team with APHL, but speaking of my experience in WA, we set up authoring appointments with whoever the epi was who 'owned' the disease. Often epis would cross lines functionally, but there was always someone who was the SME for that condition, and we'd author with that person. I would advise strongly against multi-epi authoring, especially authoring meetings - things ran much faster and more efficiently when there was one SME, and we always reassured them that authoring is very easy to change if they became overwhelmed by volume or decided later they wanted to make changes, they weren't setting anything in stone.

I know some folks are doing worksheets and asking epis to fill those out and then having someone more eCR or informatics-focused enter those into RCKMS, but I found it more straightforward to just set up a call with the epi, give a 2m re-coverage of what eCR is (the flow diagram with the big blue RCKMS box in the middle and a HTML eICR so they could see data elements) and then get into authoring. Our epis were pretty swamped with either catch up after getting pulled into covid for a year, or still working COVID part time, so I didn't want to ask them for any more time beyond meeting time (ie no 'homework'). I then published to test and had to go back later and run test messages through to verify I understood authoring and publish to production after that. One hint though - it's much faster if you create the condition first, that way you don't have to wait through the initial condition and test message creation process with the epi on the phone!

It was more efficient for the epis, less efficient for eCR, but since data weren't flowing into production it seemed like a good trade off. That may have changed in the last 3 weeks - I defer to Claudette :-)

Initially, AL State Epi was the lead on authoring conditions. But now, we have identified lead epis in multiple divisions. Most of the conditions belong to our Infectious Diseases, STDs, and VPD divisions, with multiple conditions in each category, so we have identified a lead authoring epi from each of these. For other programs with a single condition (Lead, TB, HIV), we have a lead epi who will be reviewing the reporting specifications for one of the authoring epis to edit/publish in RCKMS. 

In Utah, we worked with our local HDs to determine a list of 
"priority" conditions that would most benefit the most from receiving case data. Once the list was established, we began authoring RCKMS rules in a very targeted way. 

Currently, there is a group of 4 informaticians that work on authoring RCKMS rules. Each week, 2 staff members will pick a condition or conditions to author. The staff members review the condition specific disease plans, as well as any previous published versions, determine the specifications, and publish to test. Weekly, all 4 informaticians meet to review all the conditions that have a status of "Published to Test". We review all the proposed specifications, previous versions, verify against the disease plans and make any necessary changes. Once we all approve, we publish the latest version to production. If there are any questions on the specifications or disease plan for any condition we are authoring, we will reach out and consult with the SME/disease-specific epidemiologist. 

We have worked through all of our "priority" conditions, and are now working down the list to author rules into production for all conditions.

Thanks! 
-Emily Roberts, Utah Department of Health