• Summary of current service performance
  The Virginia Department of Health (VDH) provides a wide range of products and services to promote and protect public health. The definition of public health can be expressed as what society does collectively to create those conditions in which people can be healthy. VDH serves as a leader and coordinator of Virginia’s public health system. In conjunction with partners in the federal government and private sector, VDH plays a fundamental role in protecting and promoting the health of Virginians.
  
  Generally, VDH services are delivered to the public by local health departments or by VDH field offices, with the VDH central office providing training, technical assistance, policy development, quality assurance, evaluation and administrative support. Each county and city in Virginia is required to establish and maintain a local health department unless they have agreed to shared locations within the district. Pursuant to statutory authority, VDH has organized these 119 local health departments into 35 health districts to achieve efficiencies in operations. This structure allows for a statewide presence, and broad program priorities, for public health.
  
  VDH has 41 service areas, each with its own service area plan. VDH products and services, fully described within each of the service area plans, can be broadly categorized as follows:
  
  Communicable disease prevention and control,
  Environmental health hazards protection,
  Emergency preparedness and response and emergency medical services,
  Health assessment, promotion and education,
  Health planning, quality oversight and access to care,
  Drinking water protection,
  Vital records and health statistics,
  Medical examiner and anatomical services,
  Administrative and support services, and
  Financial assistance to improve access to health care and emergency medical services.
  
  VDH established and monitored a series of agency performance measures that are publicly reported on the Virginia Performs website. These measures were developed in order to provide a reasonable view of a wide range of VDH products and services. Ten of these measures were designated as "key" agency performance measures.
  
  Key Measures:
  
  Adult obesity rate. The rate during 2008 was 25.7 percent; VDH’s target is 25 percent, to be reached by the end of FY 2012, which is very ambitious.
  
  Prevalence of smoking. 16.4 percent of adults over age 18 smoked in 2008. This represents substantial progress towards the FY 2012 target of 12 percent. 11 % of middle and high-school age students smoked as of 2007. The target for youth is 9 percent by the end of FY 2012. The youth smoking data is collected biannually in odd-numbered years, with the next survey scheduled for the fall of 2009.
  
  Cumulative number of citizens who are provided an adequate quality and quantity of drinking water as a result of loans and grants from the Drinking Water State Revolving Loan Program. During FY 2009, the cumulative number of citizens reached 135,493, compared to the target of 159,500 to be reached by the end of FY 2012.
  
  Immunization rate for two-year old children. The immunization rate in FY 2008 was 79.6 percent, representing no progress relative to the 2004 baseline of 81 percent. The target is 90 percent to be reached by the end of FY 2012. VDH strategies for reaching this target include expanding linkages between the immunization program and the WIC program, and increasing interaction with private health care providers.
  
  Infant mortality rate. In 2008, Virginia’s infant mortality rate declined to its lowest level in history at 6.7 deaths per 1,000 live births. These dramatic improvements follow major efforts by the Governor’s Health Reform Commission which recommended targeted strategies to improve this critical health indicator. The target is 6.7 deaths per 1,000 live births by the end of FY 2012.
  
  Teenage pregnancy rate. VDH originally based this measure on the rates in seven local health districts which had state-funded teen pregnancy prevention programs. VDH has since determined and proposed that, for purpose of public reporting on Virginia Performs, a single statewide teen pregnancy rate is preferable. The statewide baseline is 26.5 per 1,000 females age 10-19 in CY 2004. The target is 26.2 in CY 2012, with the next data to be reported for CY 2008. There is a lag in the data used to calculate this rate.
  
  Pressure ulcer rate of residents of long term care facilities. During FY 2008, the pressure ulcer rate was 10.0 percent. This represented some progress relative to the FY 2005 baseline of 11.3 percent, but did not reach the FY 2008 target of below 10 percent. VDH continues to work in close collaboration with a wide range of public and private sector stakeholders in order to develop and implement new strategies in order to reach this target.
  
  Influenza and pneumococcal immunization rates of adults 65 years of age and older. The influenza immunization rate in FY 2009 was 73.0 percent. This represented modest progress relative to the FY 2006 baseline of 66.8 percent. The target is 80 percent to be achieved by the end of FY 2012. The pneumococcal immunization rate in FY 2009 was 67.7 percent, representing minimal progress relative to the FY 2006 baseline of 66.5 percent. The target to be reached by the end of FY 2012 is 80 percent. VDH continues to develop and implement a number of different strategies in order to reach these targets.
  
  Some examples of other VDH performance measures include the following:
  
  Percent of VDH employees who have emergency response roles documented in their job descriptions that have completed the VDH Roles in Emergency Response Course. Seventy three percent of applicable VDH staff had completed the course by the end of FY 2009, short of the target of 85 percent.
  
  Compliance with conditioned obligations of Certificates of Public Need. Recipients of COPN’s were in compliance with 92.7 percent of conditioned obligations (typically obligations to provide a certain level of charity care to indigent or uninsured individuals) during FY 2009. This was well above the target rate of 70 percent.
  
  Percentage of individuals with newly diagnosed HIV infection who receive their HIV test results. Only 45 percent of such individuals received their test results in CY 2008. VDH is on track to reach its target of 85 percent by the end of CY 2012. VDH has implemented a new HIV counseling, testing, and referral system which requires post-test data submission. VDH management has employed quality assurance measures to ensure this data is obtained.
  
  Percentage of HIV-infected persons receiving optimal drug therapy. The FY 2009 percent was 99.2, exceeding the target of 97.7 percent.
  
  Percentage of tuberculosis patients who complete an adequate course of treatment within 12 months of treatment initiation. Of those patients who began treatment in sometime in CY 2006, 90.1 percent had completed an adequate course of treatment within 12 months by the end of CY 2007. VDH’s target is 94 percent, to be achieved by the end of FY 2012.
  
  Number of cadavers provided to Virginia medical schools and research centers. A total of 310 cadavers were provided in FY 2009, short of the target of 360.
  
  Percentage of infants identified with a critical result for heritable/genetic disorders and referred for follow-up services by 6 months of age. During FY 2007, VDH achieved its target of 100 percent.
  
  Percentage of newborns diagnosed with a hearing loss who receive early intervention services before 6 months of age. During FY 2007, VDH achieved its target of 100 percent.
  
  Number of medically underserved counties, census tracts, institutions and minor civil divisions that are newly designated as medically underserved areas (MUA) or health professional shortage areas (HPSA). The percentage of census tracts in Virginia that could be considered medically underserved based on federal poverty level (i.e., at least 20 percent of the population is below the federal poverty level), that have been designated as either as MUA or a HPSA, in FY 2008 was 75.0 percent, compared to a target of 80.0 percent to be reached by 2012.
  
  Number of children participating in the fluoride rinse program. During FY 2009, 47,236 children participated, compared to the target of 48,000.
  
  Number of protective sealants placed on children's teeth at public health clinics. During FY 2009, 12,039 sealants were applied. This target has been reduced based upon the availability of dentists.
  
  Percentage of compliance with regulations by emergency medical services agencies. The compliance rate in FY 2009 was 94.0 percent, compared to the target of 96 percent.
  
  Number of emergency medical services personnel trained in mass casualty incident management. During FY 2009, 6,823 new personnel received this training, exceeding the target of 6,500.
  
  Number of business days required to respond to a mailed-in request for a vital record. This number declined from ten days as of January 1, 2004 to 3.05 days as of June 30, 2009, well on its way to reaching VDH’s FY 2012 target of 3 days.
  
  Number of Medicaid-eligible children identified as having been screened for elevated blood lead levels, with subsequent notification to the Department of Medical Assistance Services for follow-up care. During FY 2009, 20 percent of Medicaid-eligible children were tested and referred to DMAS, far exceeding the target of 11 percent.
  
  Average number of monthly visits to VDH Internet site containing results of restaurant inspections. During FY 2009, the website averaged 45,000 monthly visits, compared to the target of 59,000.
  
  Percentage of restaurant inspections conducted on time in accordance with department policy. Statute requires at least an annual inspection. VDH is in compliance with this statutory requirement. However, VDH policy is more aggressive, requiring more frequent inspections based on a restaurant's risk classification. During FY 2009, VDH had a 62.2 percent on-time percentage, compared to the target of 65 percent.
• Summary of current productivity
  VDH's FY 2010 full-time equivalent (FTE) appropriation is 3,622. VDH has averaged 3,711 FTEs over the past five years.
  
  VDH’s FY 2010 budget is approximately $578 million. This is comprised of 28 percent general funds and 72 percent non-general funds. The non-general funds consist of federal funds (43 percent), local funds (9 percent) and earned revenue (19 percent).
  
  VDH strives to ensure that its programs and services are administered as efficiently and effectively as possible. The Administrative Measures which replaced the Management Scorecard in 2009, tracks existing and emerging standards of management operations within VDH. During FY 2008, VDH met expectations for the agency in 100 percent of the Management Scorecard categories.

• Summary of Major Initiatives and Related Progress
  Summary of Major Initiatives and Related Progress
  
  Responded to initial surge of H1N1 activity in April 2009. VDH built on H1N1 lessons learned and Pandemic Flu plans to develop a work plan to address needs for H1N1 response in the fall of 2009. Approximately $13 million in federal grants has been received for H1N1 for planning which includes implementing a dual immunization flu vaccine campaign.
  
  Supported smoking ban legislation which will protect both restaurant workers and patrons from the harmful effects of secondhand smoke. The bill is a significant public health accomplishment and was strongly endorsed by numerous health advocates. It allows for only two narrow exceptions — private clubs and facilities with an independently-ventilated, physically-separated room. Although a number of states with smoking bans exempt bars, Virginia’s smoking ban will be one of the strongest in the region—and the strongest amongst the top tobacco-producing states—because the Commonwealth does not differentiate between bars and restaurants.
  
  Reduced the infant mortality rate to its lowest level in history, with 6.7 deaths per 1,000 live births in 2008, down from 7.7 in 2007. The rate among the state’s African-American population was also reduced to its lowest levels ever, with 12.2 deaths per 1,000 in 2008, down from 15.5 in 2007. These dramatic improvements follow major efforts by the Kaine administration to reduce the Commonwealth’s infant mortality rate–including the establishment of the Health Reform Commission in 2006—which recommended targeted strategies to improve this critical health indicator.
  
  Provided funding for 10 of the state’s localities with the highest number of infant deaths and engaged community partners in developing strategies, plans and actions for reducing the number of infant deaths. The Saving Babies Initiative increased screening (e.g., drugs, domestic violence, depression) for pregnant women, educated child-bearing age women about the benefits of folic acid in prevention of neural tube defects, worked closely with the March of Dimes Operation Preemie, and provided outreach education to all women on the importance of preconception care.
  
  Established and operated two state-wide Commissioner’s Working Groups on infant mortality and childhood obesity, mobilizing a broad based group with representation from health and medical professionals, insurers, educators, civic and community leaders retail and service organizations.
  
  Completed review of American Recovery and Reinvestment Act (ARRA) of 2009, project applications and compiled a list of 17 drinking water priority projects which has been approved by the Governor. The Environmental Protection Agency has reviewed VDH’s Intended Use Plan, and approved the 17 applications for $20.7 million in funding from ARRA.
  
  Requested $6.7 million in ARRA funding to provide recommended childhood vaccines to all underinsured patients 0-18 years of age who are not eligible for the Vaccines for Children program. Currently, these patients only receive vaccines mandated for school or day care attendance.
  
  Strengthened communication between public health and private clinicians through the development of two new advisory groups and with letters to clinicians.
  
  Obtained authorization from the General Assembly in 2009 to expand the Board of Health membership to include representation of emergency medical services and public health.
  
  Implemented the CHAMPION initiative in Tidewater and Southwest Virginia. This initiative has identified community based obesity prevention programs that have proven to be cost effective and replicable in other communities.
  
  Provided leadership in assuring the availability of culturally and linguistically appropriate health services. The VDH Culturally and Linguistically Appropriate Health Care Services (CLAS Act) program is currently updating the language needs assessment for all localities within the Commonwealth.
  
  Responded to numerous disease outbreaks including two high profile multi-state outbreaks investigated by the U.S. Centers for Disease Control and Prevention: Measles and Salmonella associated with peanut butter.
  
  Piloted the Virginia Immunization Information System. Partnerships between VDH, DMAS, private providers, hospitals and emergency departments, other state registries, public health and health insurers were strengthened as pilot sites were enrolled. This system has allowed for the sharing of electronic immunization data of more than 53 percent of children under the age of six with two or more immunizations.
  
  Implemented a standardized community needs assessment program in several health districts in each region of the state. The assessment tool, called Mobilizing for Action through Planning and Partnership (MAPP) helps local health departments share successful programs and, ideally, help all sectors of the community collaborate more strategically on unique public health challenges. These same districts are also completing the National Public Health Performance Standards (NPHPS). MAPP and NPHPS are required elements in a national voluntary movement to accredit local health departments.
  
  Moved Northern Virginia’s Chief Medical Examiner’s Office into a state-of-the-art facility. This includes the nation’s first biosafety Level 3 autopsy suite and first-in-the-state mass fatality capabilities, including the capacity to accommodate three tractor trailers.
  
  Improved the management of accounts receivables across all health districts, including the timely receipt of insurance claims and the recovery of claims initially denied.
  
  Obtained perfect scores in Emergency Preparedness and Response from the federal government for the management, distribution and dispensing of medication from the Strategic National Stockpile and from the Trust for America’s Health for public health preparedness.
  
  Enforced improved compliance with charity care conditions on the part of holders of Certificates of Public Need (COPN). Among all COPN holders, 92.7 percent have reported compliance with agreed upon conditions.
  
  Obtained a provision through legislation that allows for a licensed dental hygienist employed by VDH to provide educational and preventive dental care in three health districts. Results of this pilot will be reported to the General Assembly.
  
  Received $37,000 federal grant in the Office of Minority Health and Public Health Policy to evaluate the Healthy People 2020 Disease Prevention and Health Promotion Agenda. The project will position the Commonwealth of Virginia as a best practice site in using Healthy People 2020 (HP 2020) to inform and guide statewide health and public policy decisions in order to promote health and health equity.
  
  Completed an assessment of agency fees by developing a standardized costing methodology to evaluate and compare the costs of services supported by fees to earned revenue. Identified 10 out of 17 fees that did not fully fund the service, which presented opportunities for fee adjustments, as well as an agency process for a periodic evaluation of fees and costs.
  
  Implemented Agency’s Risk Management and Internal Controls (ARMICS) policy in 2008. As a result an Agency’s Code of Ethics was developed. No significant weaknesses were reported in 2009.
• Summary of Virginia's Ranking
  Since 1990, the United Health Foundation has annually ranked states in terms of their overall health status. The Foundation is a private, nonprofit foundation with a mission to support the health and medical decisions made by physicians, health professionals, community leaders and individuals that lead to better health outcomes and healthier communities.
  
  In the Foundation's rankings, Virginia was ranked 20th among all the states in 2008, which represents an improvement from 2007 when it was 22nd. In 1990, Virginia was ranked 22nd. The rankings are calculated using a methodology that is based on a series of variables representing various risk factors and health outcomes. While the methodology has some shortcomings, this annual report is increasingly used by states, communities and individuals as an important tool for community health improvement. None of the risk factors or health outcomes is completely, or even largely, subject to direct control by VDH. However, they are all key factors affecting Virginia’s public health system. These risk factors and health outcomes include the following: prevalence of smoking, motor vehicle death rate, adult obesity rate, prevalence of diabetes among adults, high school graduation rate, violent crime rate, uninsured rate, infectious disease rate, childhood poverty rate, occupational fatality rate, number of limited activity days in the past month among adults, cardiovascular death rate, cancer death rate, infant mortality rate, premature death rate, and total mortality rate.
  
  According to the 2008 rankings, Virginia’s strengths include a low prevalence of smoking, a low percentage of children in poverty, ready access to primary care, few poor mental health days per month, strong public health funding at $111 per person, and a low violent crime rate. Challenges include a high infant mortality rate at 7.0 deaths per 1,000 live births, high rate of uninsured population, high geographic disparity within the state, a high rate of deaths from cardiovascular disease, and a high rate of cancer deaths. The rankings also noted the continuation of certain health care disparities within Virginia. For example, cardiovascular death rates vary by race, with all races experiencing 291.0 deaths per 100,000 population, compared to African Americans who experience 378.0 deaths per 100,00 population. Access to health care also varies significantly by race and ethnicity; 10.8 percent of non-Hispanic white population lack health insurance, compared to 30 percent of Hispanics.
  
  Also in 2008, the U.S. Agency for Health Research and Quality (AHRQ) evaluated and ranked each state in terms of its overall health care quality performance. Each state was ranked as either very weak, weak, average, strong or very strong compared to other states. Virginia was ranked in the average range. Virginia ranked strongest in terms of home health care measures, including improved transportation and mobility of home health care patients; hospital care measures, including smoking cessation counseling in hospitals and flu vaccination screening in hospitals; diabetes measures, including percent of adults diagnosed with diabetes who received a hemoglobin A1c tests; and heart disease measures, including blood cholesterol testing. Virginia ranked weakest in terms of nursing home care measures, including nursing home long-stay-residents with declining mobility and with too much weight loss.
  
  In 2007, the Commonwealth Fund’s Commission on a High Performance Health System issued a report ranking each of the states in terms of their overall health system performance. States were ranked on their performance across five dimensions: access, quality, avoidable hospital use and costs, equity, and healthy lives. Virginia ranked 29th among the states in terms of the overall performance of its health system. Among the five dimensions, Virginia ranked highest in terms of access (23rd), and worst in terms of healthy lives (32nd).
  
  Another national organization, the Trust for America’s Health, provided Virginia with the highest ranking for readiness to respond to bioterrorism and other pubic health emergencies during 2008. The Trust for America’s Health is a national non-profit, nonpartisan public health organization. Virginia is one of only five states that received the perfect score of 10 on key indicators used to gauge state preparedness and determine overall readiness to respond to terrorism attacks and other health emergencies. Over half of the states received a score of seven or less. The report points out that Virginia has, among other indicators, purchased 50 percent or more of its share of federally-subsidized antiviral medications to prepare for a potential pandemic flu outbreak, a public health lab that has an intra-state courier system that operates 24 hours a day for specimen pick up and delivery, and increased or maintained funding for public health programs from FY 2006-07 to FY 2007-08. Additionally, Virginia was one of only two states, the other being California, to receive the perfect 100 from the U.S. Centers for Disease and Control and Prevention for its level of readiness for distributing medications and vaccines from the Strategic National Stockpile.
• Summary of Customer Trends and Coverage
  All 7.8 million Virginians benefit, directly or indirectly, from the public health services provided by VDH. There are specific population sub-groups, however, that particularly benefit from various products and services.
  
  Anticipated changes to VDH’s customer base are described in detail in VDH’s 41 service area plans. Some of these anticipated changes include, for example:
  
  Growing numbers of foreign born residents will create more culturally diverse populations which may impede traditional methods of health care delivery and communicable disease control, and likely present communication challenges. Emerging infections, particularly infections originating in foreign countries, will change the characteristics of the traditional VDH customer base.
  
  The demand for health care and family planning services is expected to increase among a growing number of noncitizen, working poor, and those residents who cannot afford health care in the private health care system and do not qualify for Medicaid.
  
  Increased activities of groups opposed to the use of vaccines, and widespread distribution of anti vaccine material, could result in decreased demand for vaccination services. This would result in an increased number of susceptible children and adults.
  
  The number of homeowners with waterfront property is expected to increase. Many of these individuals harvest oysters and clams from along their waterfront for recreational purposes. While the economic impact is minimal, it is quite important to them to be able to safely continue this practice, which is contingent upon the VDH capability to properly classify safe shellfish harvesting areas.
  
  The number of licensed well drillers, contractors, and engineers will continue to increase as the demand for new housing grows and as the number of new alternative and experimental onsite sewage disposal systems increases.
  
  The number of permitted food establishments continues to increase, and in some areas of the state the growth is significant.
  
  The number of Emergency Medical Services (EMS) responses will increase. As the public’s expectations for EMS services increases, local governments and EMS agencies will seek the assistance of the Office of EMS to increase the level of patient care while finding ways to maximize the impact of public funds.
  
  As Children with Special Health Care Needs live longer, more productive lives, the need for adult health care services appropriate to their medical conditions will become more significant and more complex. Assisting with transition to adulthood for these youth will become a higher priority.
  
  As Virginia's population ages, and encompasses an increasing percentage of the total population, VDH programs and services will likely be affected in a variety of ways. For example, there will be a growing demand for chronic disease management, long term care services, various type of acute care and rehabilitation services, and emergency medical services. VDH will need to respond across a number of dimensions, including direct service delivery, regulatory and enforcement, health and medical facilities planning, and emergency preparedness and response.
  
  Growing demand for the provision of direct dental services to indigent children and adults is anticipated.
  
  The number of Virginia’s citizens served by public waterworks will increase as Virginia’s population increases.
  
  The demand for nursing scholarships is expected to increase as the need to increase the nursing workforce continues, as a result of the significant number of nursing professionals who are retiring.
  
  The number of cases that the Office of the Chief Medical Examiner investigates has increased by approximately 200 cases a year since 1999. This trend is expected to continue unabated.

• Summary of Future Direction and Expectations
  Address the growing impact of chronic disease. Chronic diseases such as cancer, cardiovascular disease and diabetes are leading causes of death and disability in Virginia. These diseases threaten the quality of life and life expectancy of many Virginians. Poor diet, physical inactivity, obesity and tobacco use represent preventable risk factors for the development of many chronic diseases. These diseases are very expensive to treat, making prevention and control all the more important, particularly at a time when so many Virginians continue to experience difficulties with access to care. The economic cost in terms of lost productivity is also substantial. Virginia's health care system, similar to that of the U.S. as a whole, remains primarily designed to treat acute illness rather than chronic disease. Creative, multi-faceted initiatives are necessary to effectively address chronic disease in Virginia. VDH is administering a competitive chronic disease prevention grant program for local health districts.
  
  Respond to increasing demand for environmental health services due to growth in population, the number of restaurants and food festivals, and residential and commercial real estate development. VDH is having to respond to a demand for more restaurant inspections and for the issuance of additional on-site sewage disposal and private well permits. Proper performance of these functions is essential in order to adequately prevent the spread of disease and protect public health. This increased service demand is particularly acute in certain regions of the state and particular local health districts.
  
  Monitor the impact of increased federal funding and federal control of critical health services at the state level. Federal grants provide the single largest source of funding for VDH; non-general funds comprise 72 percent of VDH’s FY 2010 budget. The impact of the federal government’s increased investment in public health programs is two-fold: VDH becomes more dependent upon federal funding support while at the same time the federal government exerts greater control over services it funds at the state level.
  
  Continue the control of infectious diseases as non-English speaking and other "at-risk" populations grow. Many infectious diseases that used to cause significant morbidity and mortality have been essentially controlled. This has been accomplished through a number of public health interventions such as immunizations and public hygiene improvements including inspections of food and water supplies. However, demographic changes in many parts of the State carry the potential to begin reversing that trend. In some cases, this can be a result of immigrants bringing diseases with them from other parts of the world where the disease is still endemic. In other cases, it can be a result of language or cultural differences that serve as an obstacle to individual compliance with acceptable health and hygiene practices necessary to halt the transmission of infectious disease. This issue is no longer restricted to just urban or Northern Virginia localities. Many suburban and rural localities throughout the state have also seen dramatic increases in non-English speaking populations, thus creating health care service delivery issues related to adequately controlling infectious diseases such as tuberculosis and HIV/AIDS.
  
  Address the health care needs of areas that continue to be medically underserved. Numerous Virginia localities have been classified as medically underserved areas for many years. In order to improve access to health care for residents in many parts of the State, new financial or other creative incentives need to be identified to attract and retain physicians, dentists and nurses to health care service in medically underserved areas.
  
  Ensure efficient autopsy resources and other medical examiner services in areas of Virginia located west of Roanoke. The length of time required to transport bodies from far Southwest Virginia to Roanoke for autopsies (up to six hours), and the delivery of other medical examiner services west of Roanoke, is considered inadequate.
  
  Better define the role of local health departments in the health care safety net. Many legislators view VDH’s primary role as the safety net provider for indigent patients, but most local health districts are not funded or staffed to do so. Members of the General Assembly may be interested in how local health departments complement what is done by community health centers, free clinics, and the Virginia Health Care Foundation, since the role played by local health departments in providing direct services varies significantly according to their individual capacity and resources, as well as capacity and resources in the private sector. The Office of Minority Health and Public Health Policy affects access to care through efforts and activities such as the J-1 visa waiver program, designation of health provider shortage areas, and provider recruitment and retention activities.
  
  Ensure adequate information for the prevention, early identification and treatment of communicable diseases. The potential for pandemic flu provides an example of why an adequate public health capacity is critical throughout the state. The public expects a rapid and effective response to any newly arising health problems. Continued preparedness efforts will likely reveal further statutory or regulatory needs to ensure an appropriate state response to both natural and man-made health threats.
  
  Develop competent employees and establish effective emergency response plans to facilitate collaboration with others in an emergency situation. The public expects state agencies and local governments to work in close coordination on emergency response and preparedness efforts. The establishment and expansion of appropriate linkages with private and non-profit organizations must also occur.
  
  Provide suitable training and education efforts to assure compliance with safe drinking water and food handling regulations. Regulatory and other initiatives should be considered for ensuring Virginians’ access to a safe, adequate and affordable supply of drinking water.
  
  Provide a focus for quality care through oversight functions including appropriate licensing and inspecting of health care facilities, as well as timely investigation of complaints. Proposed revisions have been developed for the State Medical Facilities Plan for the first time since 1992. A comparable effort is needed regarding the other medical facility regulations such as hospitals and hospices. Hospital regulations were last reviewed and updated in the early 1980's.
  
  Ensure the periodic, timely review of all VDH regulations pursuant to Executive Order 36 (2006).
  
  Assess individual and community health service needs in a fair and timely manner. Each community’s health needs vary tremendously and are subject to significant and rapid change due to population, economic, and other developments. The array of public and private health care resources available to meet the health needs also vary widely and can change rapidly. The 1999 JLARC study of VDH recommended a comprehensive study of local health department staffing needs; however, no funding was appropriated.
  
  Provide for quality emergency medical services through appropriate and consistent licensing, certification, and adequate funding of services.
  
  Ensure adequate information technology and facilities to support the provision of public health services. Certain health district and other agency field operation facilities or facility costs will grow over the next several fiscal years. Staffing for preparedness efforts at the local and regional level has expanded and several localities intend to replace aging facilities and/or co-locate various agency services. Further, selected programs and functions currently use outdated technology. VDH must retain the management of, and associated resources for, public health information systems for activities such as medical examiner services, vital records, nutrition assistance, lead poisoning prevention, cancer registry, etc. in order to effectively meet its core missions. The agency’s reliance on non-general funds (nearly 70 percent) already poses a significant challenge to the management of these information systems.
  
  Strengthen internal and external communications. The VDH Office of Communications is engaging in a number of activities with a wide range of stakeholders in order to improve communications inside and outside of the agency. This has included training with the Office of Chief Medical Examiner concerning the handling of mass casualty events.
  
  Strengthen employee orientation and training. The VDH Education and Training Advisory Committee is working with the VDH Orientation Project Manager to develop and implement an enhanced employee orientation program, and to address related training issues.
• Summary of Potential Impediments to Achievement
  Virginia’s population continues to increase, and along with it rapid residential and commercial development in many parts of the state. This has significant implications for service delivery, such as in the areas of environmental health and emergency medical services, given relatively static funding levels.
  
  The percentage of elderly individuals in Virginia’s population is increasing, and is projected to continue increasing substantially. The percent of individuals age 85 and older is expected to double by 2030. This has implications for a number of VDH programs and services, including the regulation of hospitals, nursing facilities and hospices.
  
  As a result of continued immigration, Virginia’s population is becoming increasingly diverse in terms of race, ethnicity, and language. This has implications for almost every VDH program and service. For example, there is a great need for translation and interpretation services at many local health departments. In addition, increased immigration from foreign countries raises the potential for the introduction of infectious diseases that were previously rare or non-existent in many parts of the state.
  
  The prevalence of numerous risk factors, such as lack of physical activity, poor nutrition, and use of tobacco products, that increase the likelihood of developing one or more chronic diseases remains quite high. Many chronic diseases disproportionately affect certain racial, ethnic and geographic groups, thereby perpetuating existing health disparities. In order to effectively reduce the prevalence of these risk factors, VDH will have to collaborate creatively with a large number of traditional and non-traditional partners.
  
  The average age of Virginia’s public health workforce is two years higher than the state government average. Within a few years, a significant percentage of VDH employees will be eligible for retirement. Recruitment of new employees who are adequately trained and qualified is a significant challenge due, in part, to relatively low salaries compared to positions available in the private sector. Compensation issues also affect the retention of existing employees. Environmental health specialists and medical facilities inspectors are two examples of VDH positions that are particularly vulnerable to competition from the private sector.
  
  To manage ongoing budget reductions while ensuring that core public health services are protected and remain available, VDH has become increasingly dependent on federal funding sources for delivery of a wide range of services.
  
  The buildings in which local health departments are housed are, in many cases, aging giving rise to a variety of issues concerning the adequacy of the space to support the delivery of public health services. Many of these buildings will require significant renovation if not replacement over the next several years. Seventy-five percent of these buildings are owned by local governments
  
  Expenses associated with The Virginia Information Technology Agency represents an uncontrollable cost increase for VDH.

• Description of the Agency's Products and/or Services:
  VDH provides a wide range of products and services to promote and protect public health. The definition of public health can be expressed as what society does collectively to create those conditions in which people can be healthy. VDH serves as a leader and coordinator of Virginia’s public health system. In conjunction with partners in the federal government and private sector, VDH plays a significant role in protecting and promoting the health of Virginians. Several characteristics serve to distinguish public health from health care in general, and private medicine in particular. These include a focus on the population, emphasis on prevention, orientation towards the community, efforts directed at systems, and an overarching role of leadership.
  
  Each county and city in Virginia is required to establish and maintain a local health department unless they have agreed to shared locations within the district. Pursuant to statutory authority, VDH has organized these 119 local health departments into 35 health districts to achieve efficiencies in operations. This structure allows for a statewide presence, and broad program priorities, for public health. The local health districts operate in close partnership with the cities and counties they serve, with cooperative agreements delineating the basic health services to be provided in all jurisdictions and any additional services based on need and available funds. In two localities, Arlington and Fairfax, the General Assembly authorized the local governments to manage their own health programs. These locally administered health districts operate under contractual agreements with the state, similar to the cooperative agreements used with the other districts.
  
  Generally, VDH services are delivered to the public by local health departments or by VDH field offices, with the VDH central office providing training, technical assistance, policy development, quality assurance, evaluation and administrative support to the districts. However, some VDH services (e.g., vital records and health statistics) are provided directly to the public by Central Office staff.
  
  VDH has 41 service areas, each with its own service area plan. VDH products and services, fully described within each of the service area plans, can be broadly categorized as follows:
  
  Communicable disease prevention and control,
  Environmental health hazards protection,
  Emergency preparedness and response and emergency medical services,
  Health assessment, promotion and education,
  Health planning, quality oversight and access to care,
  Drinking water protection,
  Vital records and health statistics,
  Medical examiner and anatomical services,
  Administrative and support services, and
  Financial assistance to improve access to health care and emergency medical services.
  
  There are numerous public health services that by law, must be provided, or assured through collaboration with private sector partners, by each local health department. These include communicable disease prevention, childhood health services including immunization, maternal health services, family planning, environmental health services including restaurant inspections and permits for on-site sewage disposal and private wells, and vital records. However, many local health departments provide an array of additional optional services, often supported by 100 percent local funding. These can include dental care, school health services, sick child care, clinical services for adults with chronic diseases, immunizations required for foreign travel, home health, personal care, and pharmacy. The array of optional services provided by local health departments varies according to local needs and resources.
  
  Communicable Disease Prevention and Control
  
  This encompasses the following VDH service areas: Immunization Program; Local Immunization Services; Tuberculosis Prevention and Control; Sexually Transmitted Disease Prevention and Control; Local Communicable Disease, Investigation and Control; Disease Investigation and Control Services; HIV/AIDS Prevention and Treatment Services; and Local Laboratory and Pharmacy Services. The following is a brief summary of some of the products and services provided:
  
  Provide disease consultation and develop recommendations regarding interventions that can be implemented to interrupt the spread of disease.
  Conduct outbreak investigations to identify the source of an outbreak and prevent other people from being exposed to the source.
  Monitor and respond to emerging infections and terrorism-related illnesses.
  
  Disease surveillance for all tuberculosis cases from time of initial suspicion through case disposition.
  Provide consultation to local health departments on tuberculosis diagnosis, treatment, case management, contact investigations, discharge planning, and media relations.
  
  Coordinate and facilitate initial health assessments of all newly arriving immigrants with refugee or asylum status.
  Collect data on refugee arrivals, health conditions and outcome of their assessment.
  Provide notification to local health districts that a newly arrived immigrant or refugee requires screening for tuberculosis.
  
  Conduct and support activities to investigate, prevent and treat HIV/AIDS and other sexually-transmitted diseases.
  
  Provide support and oversight for statewide immunization activities.
  Maintain and distribute an adequate and viable vaccine supply.
  Develop statewide immunization policy.
  Manage statewide vaccine adverse event reporting system.
  Implement and manage statewide Immunization Information System.
  
  Local health departments must maintain and operate effective immunization programs which provide vaccines to the public with an emphasis on the vaccine-preventable diseases of childhood such as chicken pox, diphtheria, haemophilus influenza B, hepatitis B, measles, mumps, pertussis, polio, rubella, human papillomavirus, and tetanus. Many local health departments provide immunizations required or recommended for foreign travel. Local health departments maintain an inventory of rabies vaccine and biologicals for administration to those citizens exposed to wild or domestic animals when rabies disease is suspected or proven in the animal. Many local departments offer meningitis vaccinations for beginning students at higher education institutions.
  
  Some local health departments operate their own laboratories. All local health departments work with the Division of Consolidated Laboratory Services to assure access to laboratory services.
  
  Some local health departments operate their own pharmacies. All local health departments work with the VDH Central Pharmacy to assure access to pharmacy services.
  
  Environmental Health Hazards Protection
  
  This encompasses the following VDH service areas: State Office of Environmental Health Services; Restaurant and Food Safety, Well and Septic Permitting and Other Environmental Health Services; Shellfish Sanitation; Bedding and Upholstery Inspection; Radiological Health and Safety Regulation; and Public Health Toxicology. The following is a brief summary of some of the products and services provided:
  
  Enforce laws and regulations relating to food safety, swimming pools, milk plants, hotels, summer camps, campgrounds, migrant labor camps, private wells, and onsite septic systems through issuance of permits and performance of inspections.
  
  Confine and test animals suspected of being infected with rabies.
  
  Respond to citizen complaints concerning environmental health hazards with the potential of endangering the public health.
  
  Assess health hazards of chemical and certain biological agents which pose a threat to human health and the environment, and advise policy makers and the public of findings and recommendations.
  
  License and inspect X-ray machines and facilities to assure that the public is protected from unnecessary and excessive radiation.
  
  Enforce laws and regulations governing bedding and upholstered furniture manufacturers, bedding renovators and re-upholsterers and sanitizers through issuance of licenses and performance of inspections.
  
  Develop policy; analyze local, state and federal legislation; evaluate public health programs; provide liaison assistance; and provide scientific and technical expertise.
  
  Emergency Preparedness and Response/Emergency Medical Services
  
  This encompasses the following VDH service areas: Emergency Preparedness and Response and State Office of Emergency Medical Services. The following is a brief overview of some of the products and services provided:
  
  Upgrade and integrate state, regional, territorial and local public health jurisdictions’ preparedness to respond to terrorism and other public health emergencies with federal, state, local and tribal governments, and government agencies, the private sector, and non-governmental organizations (NGOs).
  
  Support the ability of hospitals and health care systems to prepare for and respond to bioterrorism and other public health and healthcare emergencies.
  
  Develop emergency-ready public health departments, hospitals and health care.
  
  Provide coordination and integration for Virginia’s EMS system.
  Inspect, license and permit EMS agencies and vehicles.
  Coordinate and administer certification exams.
  Provide EMS education and training.
  Maintain EMS Patient Care Information System.
  Administer Poison Control Network contract.
  Develop comprehensive and coordinate response during declared states of emergency by engaging Health and Medical Emergency Response Teams.
  Establish and maintain provisions for Critical Incident Stress Management.
  
  Health Assessment, Promotion and Education
  
  This encompasses the following VDH service areas: Child and Adolescent Health Services; Women’s and Infants’ Health Services; Local Maternal and Child Health Services, Local Family Planning Services, Chronic Disease Prevention, Health Promotion and Oral Health; Local Chronic Disease Prevention and Control Services, Local Dental Services, Local Home Health and Personal Care Services, Injury and Violence Prevention; WIC and Community Nutrition Services; and Local Nutrition Services. The following is a brief overview of some of the products and services provided:
  
  Provide child and adolescent health surveillance through assessment, screening and other child-find activities; analyze and develop policy; work to assure that children and their families are linked to needed health services; and provide training and technical assistance to partners promoting safe and healthy environments for children.
  
  Perform health promotion and disease prevention activities designed to reduce the burden of chronic diseases. This includes:
  
  Addressing environmental and policy strategies that affect chronic diseases as well as oral health policies and plans.
  Encouraging healthy lifestyles and addressing risk factors that affect multiple chronic disease states.
  Developing education, training and oral health promotion programs targeted to maternal, early child, children with special needs, and adult/older adult populations.
  Developing, conducting, and evaluating oral health prevention programs utilizing topical and systemic fluorides to reduce the incidence of tooth decay.
  Assessing the oral health of Virginians through surveys and data collection as well as monitoring and evaluating existing oral health programs and producing chronic disease prevention data reports.
  Providing technical assistance to local health departments and communities regarding chronic disease intervention and regarding the practice of public health dentistry through on-site clinic reviews, tracking clinical services provided, and assisting in the recruitment and orientation of local health department dentists.
  
  Provide oral health services to the indigent population and other special population groups, especially children who lack access to basic oral health care.
  Provide clinical dental services (offered by some local health departments).
  Administer the fluoride mouth rinse programs in schools where lack of fluoridated water places children at higher risk of dental caries.
  Monitor the oral health status of the community.
  
  Assess the health needs of women and infants, develop policies, build capacity and strengthen the infrastructure to meet these needs, and assure that quality services are provided to this population. This includes services such as:
  
  Assuring pregnancy identification, prenatal care, follow up and referral services through postpartum care.
  Providing case coordination and/or case management services.
  Facilitating health insurance enrollment for children and families.
  Providing safety net ambulatory care for sick and well children in coordination with community health care resources.
  Screening and identifying early intervention for physical and developmental conditions that affect health and learning readiness, and health problems related to environmental factors, such as lead and asthma.
  Providing infant and child case management services, developmental assessment, anticipatory guidance and injury prevention.
  Promoting provider education on public health principles, practices, and professional care standards as they affect health outcomes.
  Assure care of children with health needs in group settings such as day care, preschool and school, including identification of individual and group health and safety needs.
  
  Promote abstinence education and family involvement messages to minors seeking family planning services.
  Provide acceptable and effective methods of contraception.
  Provide pre-conceptional counseling.
  Perform screening, diagnosis, and treatment of sexually transmitted infections.
  Conduct screening for cervical cancer.
  Provide education and referral services when conditions, illnesses, or disease indicate further medical intervention.
  Provide Level I infertility assessment.
  Perform diagnosis and treatment of minor gynecologic conditions.
  
  Promote oversight of statewide WIC and Community Nutrition program activities.
  Develop policy and procedures for the Virginia WIC Program.
  Provide vouchers to purchase a package of specifically prescribed high nutrient foods at local groceries, coupled with education for the mothers and/or primary caregivers about healthy eating.
  Review, contract, train, and monitor authorized retail stores providing food benefits to eligible for WIC participants.
  Review and select authorized foods for the Virginia WIC Program that meet federal guidelines and state cost containment goals.
  Manage compliance investigations of authorized retail stores to identify potential program fraud and/or abuse.
  Furnish public information to potential WIC participants through marketing and hotline services.
  Manage the marketing campaign for the WIC Program.
  Provide education and training for public health and community workers in nutrition.
  Certify WIC Competent Professional Authorities and Nutrition Assistants through Web-based education.
  
  Implement strategies to prevent the public health toll of injury and violence across the lifespan.
  
  Provide personal care services (offered by one local health district).
  
  Perform preadmission screenings for nursing home placement.
  
  Health Planning, Quality Oversight and Access to Care
  
  This encompasses the following VDH service areas: Certificate of Public Need (COPN); Regulation of Health Care Facilities; and Health Research, Planning and Coordination. The following is a brief overview of some of the products and services provided:
  
  Review, analyze and formulate recommendations for COPN requests based on eight criteria for determining need.
  Develop regulations to provide an orderly procedure for resolving questions concerning the need to construct or modify medical care facilities.
  
  License five categories of medical care facilities or services: hospitals, outpatient surgical hospitals, nursing facilities, home care organizations, and hospice programs.
  Develop regulations to establish minimum requirements to assure quality health care, while assuring efficient and effective program operation.
  Perform Medicare and Medicaid certification surveys for various types of medical care facilities and organizations.
  Administer certification and registration programs for managed care health insurance plans and private review agents.
  Investigate consumer complaints regarding the quality of health care services received.
  Furnish training and technical assistance to health care providers.
  Enforce medical care facility and services licensing laws and regulation through inspections.
  
  Analyze issues affecting the cost, quality, and accessibility of health care.
  Assist rural and medically underserved communities and populations to improve healthcare systems and access to care.
  Develop and administer programs to increase and strengthen the healthcare workforce.
  
  Drinking Water Protection
  
  This encompasses the Drinking Water Regulation and Drinking Water Construction Financing service areas. The following is a brief overview of the products and services provided:
  
  Perform inspections and investigations of waterworks.
  Conduct evaluations of engineering reports, plans, and specifications.
  Provide training assistance to waterworks owners and operators.
  Offer technical assistance to waterworks owners and operators.
  Establish and implement a drinking water quality monitoring program.
  Provide emergency assistance to waterworks owners and operators (during droughts, floods, etc.).
  Develop and maintain a database inventory of all of Virginia’s public waterworks, including compliance information.
  Conduct enforcement/compliance actions to ensure compliance with regulations.
  
  Provide technical oversight of funded drinking water infrastructure projects to ensure compliance with state and federal regulations.
  Perform inspections of funded drinking water infrastructure projects during the construction stage.
  Develop guidance and regulations.
  Administer training scholarships to assist owners and operators in broadening their knowledge of waterworks technical, financial and managerial needs.
  Create new assistance resources the use and benefit of waterworks owners.
  
  Vital Records and Health Statistics
  
  This encompasses the Vital Records and Health Statistics service areas. The following is a brief summary of the products and services provided:
  
  Administer registration, collection, preservation, amendment and certification of vital records. The vital records system consists of births, deaths, spontaneous fetal deaths, induced termination of pregnancy, marriages, divorces or annulments, and adoptions.
  
  Compile and disseminate health statistics.
  
  Medical Examiner and Anatomical Services
  
  This encompasses the Medical Examiner Service area and the Anatomical Services area. The following is a brief overview of the products and services provided:
  
  Conduct medicolegal death investigations.
  Provide donated cadavers to medical schools and research centers in Virginia for anatomical study.
  
  Administrative and Support Services
  
  This encompasses the following service areas: Administrative and Support Services and Support for Local Management, Business, and Facilities. The following is a brief overview of the products and services provided:
  
  Financial management, including accounting, payroll and budget services.
  Human resource management.
  Procurement and general services.
  Ongoing assessment and evaluation to assure that services and programs of the local health department continue to match local community needs.
  
  Financial Assistance to Improve Access to Health Care and Emergency Medical Services
  
  This encompasses the following service areas: Scholarships and Loan Repayments; Financial Assistance to Non Profit EMS Organizations and Localities; and Payments to Non-State Entities. The following is a brief overview of the products and services provided:
  
  Administer scholarship and loan repayment programs to serve as incentives for health care practitioners to locate in medically underserved areas.
  
  Administer payments of funds appropriated to VDH by the General Assembly for specifically identified grants to independent health care and non-state organizations.
  
  Administer Rescue Squad Assistance Fund Grants, Financial Assistance to Localities to support Non Profit EMS agencies, and funding to Virginia Association of Volunteer Rescue Squads.
• Factors Impacting Agency Products and/or Services:
  A wide range of factors impact the products and services provided by VDH. These various factors are fully described in the 41 service area plans. Some examples include the following:
  
  Communicable Disease Prevention and Control
  
  Increasing foreign travel by citizens of the Commonwealth and increasing tourism from other countries can affect services by exposing people to diseases that are common in other parts of the world that are not usually seen here.
  
  People tend to eat out more often now than they have in the past, and more people eat imported foods. Such activities could potentially impact the chances of exposure to contaminated food items that may cause illness. Increasingly, health departments across the U.S. are investigating outbreaks that are due to a food item that has been widely distributed to multiple states rather than localized outbreaks.
  
  The overuse and misuse of antibiotics can lead to increasing antibiotic resistance of microorganisms and result in outbreaks of infections that are difficult to treat.
  
  Persons with serious underlying medical conditions (HIV infection, diabetes, end stage renal disease, collagen-vascular diseases) are surviving longer, so have more years at risk for re-activating latent tuberculosis (TB) infection or progressing to active TB if newly infected.
  
  National and state standards for the management of TB cases and their contacts are increasingly effective in curing patients and limiting transmission, but are also increasingly labor intensive and costly.
  
  New U.S. Centers for Disease Control (CDC) guidelines recommend HIV screening for all persons age 13-64, regardless of risk. This may increase demand for HIV testing.
  
  New HIV rapid test technology offers many benefits for increasing the number of people who agree to be tested and receive their test results; however, the high cost has limited the expansion of this service.
  
  New federal requirements for a client-level evaluation system have placed a significant burden on community-based HIV prevention providers. Less time is available to provide services and more staff time must be directed to implementing the data collection system.
  
  Years of level funding and recent reductions in federal funds for sexually transmitted disease (STD) prevention and control have resulted in the inability to expand program services.
  
  Insufficient vaccine supply or radically increased demand could cause delays in the on-time administration of vaccine, causing more persons to unimmunized or incompletely immunized.
  
  More comprehensive health care requirements and an increasing number of immigrants presenting to health departments for vaccinations could rapidly deplete the vaccine budget and result in gaps in vaccine supply.
  
  Environmental Health Hazards Protection
  
  Competition from other government agencies and from the private sector affects VDH’s ability to attract and retain highly trained environmental health professionals. In the onsite sewage program, most of the new Authorized On-Site Soil Evaluators (AOSEs) entering the private sector were first hired as Environmental Health Specialists by the local health departments, where they were trained and gained experience. This has created continuous turnover problems in some high growth districts. It has also strained VDH’s ability to continuously provide basic training for its new employees and reduces the resources available for continuing education.
  
  VDH has placed its restaurant inspection report information on its website. This reduced the Freedom of Information Act (FOIA) requests and has enabled the public to see what VDH observes during inspections. Web-based accessibility of this information has motivated both restaurants and environmental health specialists to do a better job.
  
  Emerging pathogens, complex water recreation attractions and increased attention to food and water security has necessitated a critical demand for continuing education for environmental health staff.
  
  Increased complexity of onsite sewage disposal systems requires increased time to perform plan reviews, permitting and inspections.
  
  As the population continues to increase along the shoreline of shellfish growing areas, the need for monitoring the attendant runoff pollution into shellfish waters increases.
  
  VDH staff is limited to conducting inspections of licensed and permitted bedding and upholstered furniture entities only upon receipt of a complaint. However, if conditions are such that a complaint is necessary, it is generally too late to prevent any contamination of product or sale of dirty or unsanitized used articles.
  
  Emergency Preparedness and Response and Emergency Medical Services
  
  Federal funding for Emergency Preparedness and Response is being reduced despite increasing responsibilities and public expectations.
  
  EMS agencies and personnel are expecting to transact more programmatic and financial business with the Office of EMS across automated systems. This requires the Office of EMS to expand electronic services.
  
  Emergency medical services are available statewide, but the level of service varies. This will require a greater coordination of services by the Office of EMS with local governments, EMS agencies and organizations.
  
  The Prehospital Patient Care Data collection system is inadequate. The Office of EMS has examined new technologies in the collection of data and has secured a commercial off the shelf product through a competitive request for proposal process. Implementation is being planned and approvals by the VITA Project Management Division are ongoing.
  
  Recruitment and retention of EMS providers are major problems for EMS agencies. The limited availability of accredited training programs, increased certification requirements and increase in the cost of training affect the number of certified EMS personnel.
  
  Health Assessment, Promotion and Education
  
  Genetic testing is available or under development for more than 900 diseases or conditions in more than 550 laboratories nationwide. Implications of testing involve (1) development of new predictive tests, preventive measures, and treatment for a wide range of diseases, and (2) privacy, confidentiality, discrimination, and informed consent concerns that accompany genetic discoveries.
  
  State social service licensing regulations for health and safety in child day care have been made more rigorous, particularly in the areas of daily health screening and medication administration.
  
  Children spend almost one-third of their waking hours in school. Continued emphasis in the schools on standards of learning and performance testing limits the opportunity and willingness to direct attention to health issues.
  
  In 2008, the infant mortality rate (death within the first year of life) was 6.7 deaths per 1,000 live births, which is a significant decrease from 7.3 in 2006. The leading causes of death were related to short gestation and low weight birth, congenital malformations, and Sudden Infant Death Syndrome. It is hoped that the downward trend will continue, but due to mounting financial and social factors, this rate may not be able to be sustained and may increase.
  
  As the population ages, the age of first pregnancies is increasing and the number of pregnancies is decreasing. Despite advancements in health care and medical technology, the low weight birth rate has continued to steadily increase. The use of infertility treatments is increasing and is contributing to low birth weight. The number of low weight births is expected to rise and there will be more high-risk infants born needing more intense and costly medical care.
  
  Economic decisions of hospitals and providers, including local health departments, to reduce services has restricted access to health care for women and infants. The number of federally qualified community health centers and capacity within Virginia has increased, but there has not been a concordant increase in women’s health services.
  
  The health care system continues to be primarily structured to address illness; therefore, shifting emphasis to health promotion, early intervention services, and alternative and complementary approaches to prevention and treatment will require a reorganization of funding priorities.
  
  The American Academy of Pediatrics has established a policy recommending a developmental approach to well child care, including screening for appropriate development at periodic well child exams in the early childhood period. The increased awareness about the prevalence of autism spectrum disorders underscores the need for early and periodic developmental screening. This represents a significant elevation of the standard of care for child health. The need for adequate and appropriate follow-up is substantial.
  
  Injury, unintentional and intentional with violence, is a leading cause of death for Virginia children. Child abuse and neglect, as part of domestic violence, increases morbidities and the need for services to address developmental, emotional and physical needs.
  
  Lack of adequate funding for chronic disease prevention and control directly impacts products and services. Funding influences both the availability of staff to develop and conduct programming and the necessary materials to do so.
  
  Health risk, outcome and access disparities persist among both geographic regions and socio-economic groups.
  
  Many of the community water systems which began fluoridation between 1950 and 1970 require significant replacement of fluoridation equipment or entirely new fluoridation systems as they transition into new water facilities. This trend is expected to continue as VDH responds to the highest priority funding requests for fluoridation.
  
  The public dental health workforce is aging. Approximately 20 of the 32 full time dentists currently employed by VDH will be eligible for retirement within the next 5 years. Low salaries relative to alternatives for clinical dentists negatively impacts recruitment and retention.
  
  Much of VDH’s dental equipment has been replaced over the last few years. Clinic items replaced in fixed and trailer facilities include x-ray unit (standard and panorex), delivery unit, vacuum pump, compressor, autoclave, film processor, chair, and light.
  
  Dental hygienists are allowed to practice under the general supervision of dentists, working within the prescriptive guidelines of signed plans of care for patients, has the potential to improve access to preventive dental care, particularly fluoride varnish. However, this public health dentistry service delivery model relies on the availability of dental hygienists, who are in short supply in some areas of the state.
  
  Virginia’s participation in the CROSSROADS consortium for development of a common WIC computer system in four states will require that business processes be examined, revised and/or re-engineered. This could have significant impact on the operation of the Virginia WIC Program at the state and local levels.
  
  Technological changes (e.g. automated telephone appointment reminders and computer-based health education for clients, etc.) may enhance WIC program participation and understanding of the importance of good nutrition, allow faster and easier communication between staff and customers, and streamline the record keeping process, among many other potential benefits. However, more technology may also deter some clients from enrolling or participating as desired.
  
  Injury and violence prevention products and services expand with additional state or federal funding and are reduced when grant funding ends or is decreased. Because this service area is predominantly federally funded, emerging national injury and violence priorities generally drive categorical federal funding opportunities and, therefore, determine the services that are funded and able to be provided.
  
  Health Planning, Quality Oversight and Access to Care
  
  Frequent legislative mandates requiring regulatory changes and the complexities of the regulatory promulgation process negatively impact the efforts to keep regulations (including those governing COPN, the State Medical Facilities Plan, and hospital licensure) current and effective.
  
  Growth in some COPN categories or services has remained static for a number of years, perhaps indicating no continued need for their inclusion in comprehensive health planning. Currently there is a downturn in the number of COPN requests, most likely tied to the current economic situation.
  
  Turnover rate in qualified staff to conduct medical facility inspections and investigations has resulted in delays in inspection processes.
  
  Drinking Water Protection
  
  The number and complexity of federal drinking water regulations is expected to increase the amount of technical assistance provided to waterworks owners and operators in an effort to maintain compliance with the regulations.
  
  The modernization of aging drinking water infrastructure facilities by waterworks will increase the VDH workload to provide oversight evaluating engineering reports, plans and specifications.
  
  VDH will need to replace a significant proportion of its engineering workforce in the near future. This will eliminate a significant amount of the institutional knowledge that helps VDH understand and plan for increased public health protection.
  
  The Federal Drinking Water State Revolving Fund (DWSRF) appropriation is distributed to each state based on that state’s proportional share of the total eligible needs reported for the most recent Drinking Water Infrastructure Needs Survey. The survey results were released March 26, 2009 and will be used to calculate state grant allotments for DWSRF appropriations made in fiscal years 2010 through 2013. The US EPA has indicated that Virginia may receive an increase of $16.2 million in response to the critical needs identified by the Needs Survey. The award of this allotment is contingent upon Virginia providing a reported twenty percent (20%) state match to receive the federal dollars. Any decrease in DWSRF funding will result in less funds being available for waterworks to improve, upgrade, or expand their drinking water infrastructure and less funding to administer the construction program and support the regulatory program.
  
  Vital Records and Health Statistics
  
  The Federal Intelligence Reform Act will increase the number of requests for a vital record. At the end of 2007 or early 2008, this statute will prohibit federal government agencies (i.e. SSA, Passport) from accepting birth certificates that are not issued on security paper that contain certain security features. Because of this legislation, individuals will be unable to use previous issued birth certificates to obtain service from a U.S. Government agency.
  
  Medical Examiner and Anatomical Services
  
  As a result of three non fatal cases of anthrax that occurred in Northern Virginia, the VDH Office of the Chief Medical Examiner (OCME) has had to significantly revise its death investigation protocols in order to place a higher priority on bioterrorism. Deaths due to infection, that previously were assumed to be natural deaths due to natural disease, must now be screened in real time to capture, investigate and autopsy for a possible bioterrorism agent.
  
  A growing concern for the OCME is mass fatality planning and its ability to manage a mass fatality event. Current staffing and suppy levels are barely able to provide adequate services to the citizens of Virginia. Surge capacity to manage larger mass fatality events is lacking.
  
  Administrative and Support Services
  
  As technology changes, information technology systems and equipment must be upgraded. Responding to these technological changes requires shifts in software and hardware platforms to support the customers.
  
  As policies and procedures change, accounting and budgeting services must be able to improve current internal financial systems. The ability to create and transmit current financial data is paramount to the continuity of financial operations.
  
  Many VDH positions require specialized expertise, as is also required in public health operations throughout the region and the country. A limited number of trained specialists who are in demand nationally creates challenges for both attracting and retaining specialists in the agency. As the business of public health changes to meet emerging community and national problems, availability issues in certain professions will persist.
  
  As the workforce continues to age and more employees become eligible for retirement, VDH must develop more creative and effective strategies to successfully compete for qualified, talented employees.
• Anticipated Changes in Products or Services:
  VDH anticipates a variety of changes to its products and services in the future. These anticipated changes are fully described in the 41 service area plans. Some examples include the following:
  
  Communicable Disease Prevention and Control
  
  More interstate coordination of investigations.
  
  Increasing emphasis on chain of custody to meet the needs of law enforcement in outbreak investigations.
  
  Greater need for services to be ethnically and linguistically diverse, and culturally appropriate.
  
  Some re-centralization of tuberculosis (TB) prevention and control services (i.e., consultation, contact investigations, and surveillance data collection) is occurring.
  
  Availability of pharmaceutical supplies, such as flu vaccine, will vary and affect product and service availability.
  
  Availability of enhanced laboratory testing can dramatically increase the accuracy and timeliness of disease detection.
  
  Community-based organizations are taking a larger role in services for newly diagnosed persons with HIV.
  
  Introduction of new vaccines for use by the public; e.g., adolescent/adult tetanus, diphtheria and pertussis (Tdap), meningococcal conjugate vaccine (MCV4), and human papillomavirus (HPV).
  
  Environmental Health Hazards Protection
  
  Incorporation of the Virginia Environmental Information System (VENIS) into all environmental health service areas for a centralized database. Part of this incorporation will include creation of a central temporary food vendor database that will be streamlined so that data can be easily shared among districts.
  
  Continued turnover of environmental health specialists in the local health departments will continue to strain VDH central office staff’s ability to train field staff. Also impacted will be the districts’ ability to maintain at least one food standardization officer in each district. This will require additional time from central office food staff to standardize new officers.
  
  High levels of frustration are expected to continue in both the private sector and local health departments as the fast changing technology outpaces VDH’s ability to modify its processes and amend its on-site sewage disposal regulations to incorporate technological changes.
  
  VDH is in the process of adjusting its growing area classification efforts to more intensely monitor and use new techniques to monitor the near shore environments of shellfish growing areas. VDH successfully competed for state-of-the-art fluorometers and real time PCR (polymerase chain reaction - genetic fingerprinting) equipment. The fluorometers will be used for use in the field detection of trace sewage inputs from septic tank drainfields and cracked sewer lines. The real time PCR equipment will be used to detect pathogenic strains of naturally occurring bacteria, i.e., those not related to sewage pollution events. All of these activities are workforce intensive, and will require scaling back on other activities, such as the extent of shoreline surveys and perhaps the frequency of processing facility inspections for those that achieve consistently good inspection results.
  
  Emergency Preparedness and Response and Emergency Medical Services
  
  Due to workforce shortages and demand on services, EMS will see a trend in returning to basics, i.e., a rapid and robust Basic Life Support system followed by a smaller group of experienced and well supervised paramedics. The demand for technical assistance from localities, EMS agencies and organizations to develop strategies to address recruitment and retention of EMS personnel will increase.
  
  There will be an increasing role for lay interveners within the EMS system. The impact of 9/11 has resulted in the development of citizen corps and other volunteer groups, support for neighbors and family, new courses being developed and an increasing role of bystander care until EMS arrives. This will require greater coordination and management of information and resources by the Office of EMS.
  
  Health care delivery issues such as declining on-call availability of physician specialists, diversion of ambulances, hospital overcrowding, difficulty of access to primary care, uninsured patients and increasing EMS call volume will require EMS to play a significantly larger role in community health delivery and coordination of services. In addition, there is greater emphasis and attention related to planning and prepared activities related to pandemic flu (H1N1). This will place a greater demand on the Office of EMS programs, services and financial resources.
  
  Health Assessment, Promotion and Education
  
  The expansion of newborn screening services will significantly increase the number of families served by VDH staff and contractors. The workload associated with following up on screened abnormal test results requires additional staff, new knowledge paths, and considerably more preparation to assist families. The additional screening tests for which there are no established treatments will place an as-yet-undetermined burden on the program. Services provided to families will shift to be delivered in the most cost-effective manner possible while maintaining an acceptable standard of timely customer service and medically necessary follow up.
  
  Policies and guidelines that support the appropriate use of genetics to improve health, prevent disease, and protect individuals from genetic discrimination will need to be developed.
  
  The Lead-Safe Virginia program will continue to adjust its goals, objectives, and strategies to the changing needs of grantors. This represents a substantial shift in focus away from providing outreach for screening children to primary environmental prevention.
  
  Services to child day care providers by local licensed health department staff have increased in response to the changes in regulations. This includes increasing hours of training for daily health screening, pandemic flu plans and consultation, and mandatory training for medication administration, which requires training by licensed health care providers. VDH will respond to greater demands for technical assistance and consultation on regulated issues.
  
  Core training of staff and quality improvement through evaluation of outcomes are steps identified by the Home Visiting Consortium which will increase efficiency and effectiveness of early childhood home visiting services. Integration of community health workers into the Virginia health care delivery system will enhance access by linking families to providers and improve effectiveness of care through patient education and follow-up in the community.
  
  Higher health care costs, fewer employers offering affordable health care insurance, and the long term impact of economy recovery in the Commonwealth will increase the numbers of women seeking publicly funded family planning services.
  
  VDH relies on funding from the federal Preventive Health and Health Services Block Grant to support its chronic disease prevention and oral health services. This funding source was greatly reduced in 2006 and 2007 and has become an uncertain funding source as a result. Possible shifts in this funding source could affect leadership capacity and coordination of chronic disease services, and cause elimination or reduction in services.
  
  VDH continues to anticipate a gradual reduction in federal funding for tobacco use prevention efforts, especially in the area of quitline services. This will impact the promotion of 1-800-Quitnow as well as potentially reduce the number of services available to tobacco users.
  
  Federal guidelines specifying the WIC food package will change October 1, 2009. These changes are expected to increase participation and acceptance of the program for eligible populations, by increasing the appeal and acceptability to various cultural groups. The new food package calls for the addition of fresh fruits and vegetables, and whole grains.
  
  Health Planning, Quality Oversight and Access to Care
  
  VDH will strengthen its efforts to ensure compliance with agreed upon conditions placed on granted COPNs.
  
  Demand for health care practitioners in medically underserved areas will increase as the pool of J-1 visa waiver physicians diminishes.
  
  Drinking Water Protection
  
  Increased resources are anticipated to be needed to evaluate engineering reports, plans and specifications as a result of increased regulation and upgrades for replacing aging infrastructure.
  
  On-site inspections of waterworks are expected to increase as the public demands greater oversight to protect public health.
  
  Training and technical assistance to owners/operators is expected to increase due to increasing complexity of drinking water regulations.
  
  Reduced funding sources will limit the program's ability to support local water utilities to address water quality and quantity needs in the future.
  
  Vital Records and Health Statistics
  
  An on-line tutorial for physicians will be developed that will assist them in completing the medical certification on the death certificate.
  
  An on-line tutorial for the local health department deputy registrars will be developed that will assist them in filing home births, reviewing and accepting death certificates, preparing acknowledgment of paternity forms, and correction affidavits.
  
  The VDH Division of Health Statistics is improving the flow of information to local health districts.
  
  Medical Examiner and Anatomical Services
  
  The OCME's new Northern district office is co-located with the Division of Forensic Science in a new facility in Prince William County. This facility is better able to accommodate the growing case load and staff needed to handle the cases and real time death reporting.
  
  More educational programs and mailings will be provided to assisted living facilities and hospices concerning anatomical donation.
  
  Financial Assistance to Improve Access to Health Care and Emergency Medical Services
  
  New awards in the Virginia Medical Scholarship Program were phased out, and the funds will instead be used in the Virginia Loan Repayment Program. There has been a 40 percent default rate in the scholarship program.
  
  Administrative and Support Services
  
  Agency financial system enhancements for reporting of financial and accounting information within statewide program offices and the local health departments are anticipated.
  
  Efficiencies through increased and expanded use of data warehousing and web-based applications as well as continuing automation of human resources processes will continue to be pursued.
  
  Emergency Preparedness and Response programs will continue to provide new and unique challenges to the agency human resources system, as expectations of workers change in response to emergency preparations and response.

• Financial Overview:
  VDH funds are managed across an array of 41 service areas and fund appropriations. The specific breakdown of all fund sources of the agency budget is: federal grants and contracts (43 percent); general funds (28 percent); local government funds for local health departments (9 percent); fees and charges for services (16 percent); dedicated special revenues (3 percent); and private grants, donations, and gifts (less than 1 percent).
  
  Through a contractual agreement, each locality commits funds to VDH to operate the local health department. The percentage of local match dollars is determined by an administrative formula and varies from locality to locality based on the estimated taxable wealth of each locality. Locality percentages range from 18 percent to 45 percent of the local health department budget, and state general funds represent the remainder.
  
  VDH has approximately 91 federal grants and 43 federal contracts. Federal grants fund a broad range of activities such as Public Health Preparedness and Response, Maternal and Child Health Services, Preventive Health Services, AIDS Prevention, Childhood Immunizations, Licensure and Medical Certification of Acute and Long Term Care Facilities, Women-Infants-Children (WIC) Nutrition, Chronic Disease Prevention, Safe Drinking Water, and include four American Recovery and Reinvestment (ARRA) grants.
  
  A substantial portion of the fees and charges for services are for environmental, medical, and personal care services provided in the local health departments; also included are those fees associated with waterworks operation, regulation of health care facilities, certified copies of vital records, and other miscellaneous services. Dedicated special revenues are those revenues generated from non-VDH related fees and fines such as the $4.25 surcharge on motor vehicle registrations earmarked for Emergency Medical Services and repayments on loans.
• Financial Breakdown:

  	FY 2011			FY 2012
  	General Fund	Nongeneral Fund		General Fund	Nongeneral Fund
  Base Budget	$163,781,770	$411,748,836		$163,781,770	$411,748,836
  Change To Base	$1,803,487	$814,560		$1,803,487	$814,560
  Agency Total	$165,585,257	$412,563,396		$165,585,257	$412,563,396

  This financial summary is computed from information entered in the service area plans.

• Overview
  VDH services to the Commonwealth are delivered by a highly skilled, diverse workforce of salaried and wage employees as well as contractors, federal assignees, local government employees, and volunteers in locations throughout the state. Public health services in Fairfax and Arlington are provided by employees of local government since these two jurisdictions operate locally administered health departments under contract with VDH. Services in the balance of the state are provided by VDH staff in over 200 locations statewide.
  
  VDH salaried and wage positions are configured into 108 roles and 252 job working titles. As of July 1, 2009, VDH had an appropriated level of 3,622 salaried FTEs, with 3,494 positions filled.
  
  Agency demographics are similar to the Commonwealth’s workforce profile. As of June 30, 2009, the average age of VDH employees was 48 years, with a median age of 50 years, compared with an average age of 46 years and a median age of 47 years in the state workforce. Twenty-five percent of the VDH workforce has over 20 years of state service, compared with twenty-three percent of the state workforce. Twelve percent of the VDH workforce is currently eligible for full retirement, compared with eleven percent of the state workforce overall. All of this data reflects an aging VDH workforce with the associated challenge of effective succession planning and workforce development. Additionally, as the practice of public health continues to evolve, the workforce must repeatedly update their knowledge and skills to continue promoting and protecting the health of Virginians.
  
  VDH continues to depict a diverse workforce with 78 percent female and 22 percent male employees. Thirty percent of VDH's employees are members of minority groups.
• Human Resource Levels

  Effective Date	7/1/2009
  Total Authorized Position level	3622
  Vacant Positions	-128
  Current Employment Level	3,494.0
  Non-Classified (Filled)	3
  Full-Time Classified (Filled)	3444		breakout of Current Employment Level
  Part-Time Classified (Filled)	47
  Faculty (Filled)	0
  Wage	510
  Contract Employees	286
  Total Human Resource Level	4,290.0		= Current Employment Level + Wage and Contract Employees

• Factors Impacting HR
  Manmade and natural disasters pose a significant challenge for VDH in preparing for and responding to emergencies, managing disease surveillance, and providing general administration services. Meeting this challenge will require additional training, financial resources, and expert staff in the future. The public health infrastructure of financial and resource management professionals will be needed to address challenges in monetary resources, policy, practices, and regulations. Resources and expertise will also be required to ensure worker safety and to manage risks through background investigations and enhanced security measures.
  
  VDH staff must continue to partner with public and private training and educational programs statewide to ensure a public health workforce that is educated, trained and prepared. In-house training efforts will be necessary to provide existing staff with current information, skills, and knowledge that are essential to promote and protect the health of the citizens of the Commonwealth.
  
  Consistent with national trends in public health, VDH will continue to need expert workers that are also in high demand in the regional as well as the national marketplace. These workers include dentists, public health physicians, public health engineers, environmental health specialists and managers, registered nurses, and general administrative managers. Effective marketing and the use of compensation and retention strategies are essential for attracting and retaining expert staff.
• Anticipated HR Changes
  On June 30, 2009, 39.3 percent of the VDH workforce was 50 years or older and eligible for reduced and unreduced retirement, with 12 percent eligible for full retirement. Succession planning and enhanced training programs will represent new demands on managers statewide.
  
  Additional information regarding changes in human resources may be found in the VDH Workforce Plan.

• Current Operational IT Investments:
  VDH hosts 119 applications. Most applications are used by small numbers of employees to address program, division, or office issues. The core applications with more of an enterprise focus appear below. Agency goals can be viewed in the Agency Goals section of the Agency Strategic Plan.
  
  VENIS - Environmental system for restaurant inspection, wells, septic, etc. Contributes to Agency Business Goals 1, 2, 5, and 9. Supports many environmental health activities which are required by Code.
  EMS Trauma Registry (Oracle) - Tracks medical reports on each patient transported to an ER by ambulance. Contributes to Agency Business Goal 4, Supports activities of the state-wide emergency medical services.
  Strategic National Stockpile - Tracks federal drugs and medical supplies provided during an emergency. Contributes to Agency Business Goal 6. Part of the Agency's emergency response.
  Volunteer Management - Registers medical volunteers for deployment in an emergency. Contributes to Agency Business Goal 6. Part of the Agency's emergency response.
  Vaccine Registry (VIIS) - Code-mandated statewide immunization registry. Will support H1N1 vaccination efforts. Contributes to Agency Business Goals 1, 2, 3, 4, and 6.
  ESSENCE - Syndromic surveillance system. Receives and analyzes daily data from hospital ERs to detect emerging patterns of disease syndromes. Accessed by DSI and district staff. Contributes to Agency Business Goals 1, 2, 4, 5, and 6: Part of a multi-state (MD, DC, and VA) early-warning system to detect bioterrorism events and other disease patterns.
  NEDSS - A CDC developed application for tracking reports of notifiable diagnoses. Contributes to Agency Business Goals 1, 2, 4, and 5. Meets Code-required reporting of certain diseases of public importance.
  Cancer Registry - Central Office application for tracking and reporting cancer. Contributes to Agency Business Goals 1 and 5. Meets federal funded cancer data reporting needs.
  VISITS - Birth defects tracking. Contributes to Agency Business Goal 1. Meets Code-mandated birth defects tracking requirements.
  WICNet - Federal nutrition program. Contributes to Agency Business Goals 1and 4. USDA required system to provide nutritional assessments and to print WIC food checks.
  Financial & Admin System (F&A) - Administrative support and front end to CARS. Includes Web F&A. Supports all Agency Goals. Allows coding to federal grant requirements.
  HAN - Alerting system for medical providers. Contributes to Agency Business Goals 1, 4, and 6. Provides emergency notification to licensed medical providers through multiple channels.
  WebVISION - Patient management system for clinics. Contributes to Agency Business Goal 1. Meets Code-mandated requirement to provide medical services based on ability to pay.
  Vital - Vital records production system. Contributes to Agency Business Goals 1 and 5. Meets Code-mandated vital records needs.
  
  All of these applications were developed for specific business needs, and are actively managed to the system owner’s specifications.
  
  The VDH mission always included elements of emergency preparedness and response, but as the lead state agency for response to bioterrorism, and as an important part of the response to chemical and radiological emergencies, the required level of reliability and redundancy of key systems, especially communications, has increased. The emergence of a novel influenza A (H1N1) virus has heightened the reliance on several systems and has accelerated deployment of the immunization registry (VIIS). Additionally, the strategic National Stockpile system and Volunteer Management System are more likely to be needed and must be available.
  
  The major enterprise application at VDH is WebVISION. This in-house developed statewide system provides local health departments the ability to manage the business of providing patient care. It is currently running on Oracle 10g and has proven to be a reliable, flexible, and popular application. Changes in external requirements (such as third party payer electronic billing changes) and evolving user requirements continue to create substantial ongoing maintenance requirements. This application will need to be upgraded to Oracle 11g to remain supported.
  
  VDH has recognized the expanding needs for health related data and is making a focused effort to improve the agency data warehouse’s accessibility and functionality. As the common end point for many applications, this function has many potential benefits to both employees and citizens.
  
  VDH has completed transferring key application development and maintenance personnel from contractor to full time employee status. This was an important risk in the past that has now been substantially reduced. We are now converting most contractors to classified employees, further decreasing risk.
• Factors Impacting the Current IT:
  Operations at VDH are currently dominated by planning for our response to the 2009 Influenza A (H1N1) virus. This response will challenge our vaccine registry (VIIS), alerting (HAN), surveillance (ESSENCE), and general communications.
  
  Like all executive branch agencies, many of VDH’s IT issues are impacted by outsourcing the infrastructure through VITA to Northrop Grumman. The transformation process has introduced substantial change and we have not fully achieved a steady-state.
  
  Federal grantees are increasingly unwilling to fund state-specific development. Multi state consortia, such as the Crossroads 4-state consortia for the new Women, Infants, and Children's program application, or federally funded applications, such as the Wisconsin Immunization Registry and the NEDSS project, decrease start-up costs for VDH but substantially decrease flexibility and may increase maintenance costs and/or frustrations.
  The pressures to increase telecommuting have stressed our ability to provide technical solutions and support for telecommuting during transformation.
  
  Though VDH is decreasing its reliance on IT contractors, uncertainty in future contracting anticipates that the IT Staff Augmentation Operational Review will provide avenues to address the issue of long-term reliance on IT contractors.
• Proposed IT Solutions:
  We anticipate achieving an infrastructure steady state in about 1 more year.
  
  VDH plans to continue to enhance the functionality of the data warehouse and to add the number of data sources being captured. Providing a comprehensive tool for public health decision-making is the long term goal.
  
  All applications require regular maintenance including upgrades to operating systems, software, servers, and network, as well as training at all levels.
  
  Several new projects will enhance current business functions through automation.
  
  1. Electronic Death reporting - The Electronic Death Registration (EDR) will allow the Division of Vital Records to go from a paper-based reporting system to an electronic filing system. EDR will be a web-based system that will allow the many participants of the death registration process to remotely submit; register; and certify deaths occurring in the Commonwealth of Virginia. The EDR system is expected to reduce reporting delays, improve data quality, and increase the usability of death data. This application will support:
  
  221.20 Citizen Operations - Describes the direct provision of a service for the citizen by government employees (or contractors).
  
  222.20 General Purpose Data and Statistics - Includes activities performed in providing empirical, numerical, and related data and information pertaining to the current state of the state in areas such as the economy, education, labor, weather, global trade, etc.
  
  2. VDH’s efforts to adopt an electronic health record (EHR) for its own patients have experienced a number of obstacles during previous planning efforts. A new effort is in the conceptual phase. This will enhance clinic operations, and improve patient safety.
  
  111.10 Access to Care - Involves activities focused on the population, including the under-served, receiving care and ensuring the care received is appropriate in terms of types of care. A successful implementation of these processes will result in the population receiving the appropriate guidance to care/appropriate care, at the right location for the most appropriate cost.
  
  111.30 Health Advancement - Addresses the evolutionary process in healthcare, quality improvements, and delivery of services, methods, decision models and practices. These cover all aspects of health.
  
  111.40 Health Care Services - Involves programs and activities that provide delivery of health and medical care (inpatient and outpatient) to the public, including health care benefit programs.
  
  3. VDH has recognized the many benefits of Electronic Content Management and has made progress in defining requirement and detailing business processes, but budget challenges have paused this project. Many operational efficiencies will be realized from this project. Processes will be simplified, documents will be safer and more easily found, storage costs will be eventually reduced.
  
  329. 60 Central Records and Statistics Management - Involves the operations surrounding the management of official documents, statistics, and records for the entire state government. This Sub-Function is intended to include the management of records and statistics for the state government as a whole, such as the records management performed by the Library of Virginia or the statistics and data collection performed by the Virginia Employment Commission. Note: Many agencies perform records and statistics management for a particular business function and as such should be mapped to that line of business. The Central Records and Statistics Management is intended for functions performed on behalf of the entire state government.
  
  440. 50 Record Retention - Involves the operations surrounding the management of the official documents and records for an agency.
  
  4. The Electronic Birth Certificate (EBC) Project will allow the Division of Vital Records (VR) to implement enhancements to its EBC that will allow VR to capture birth data as well as performing amendments, delayed birth and adoptions. This application will also include a correspondence tracking system which tracks and manages requests from the public. It is currently deployed internally and will be rolled-out to hospitals this fall.
  
  221.20 Citizen Operations - Describes the direct provision of a service for the citizen by government employees (or contractors).
  
  222.20 General Purpose Data and Statistics - Includes activities performed in providing empirical, numerical, and related data and information pertaining to the current state of the state in areas such as the economy, education, labor, weather, global trade, etc.
  
  5. The WIC Electronic Benefits Project is part of the USDA-funded Crossroads Project. Virginia is taking the lead on developing this module for the multi-state consortium providing better constituent services. This credit card type system will be more convenient for customers, safer, easier to track, cheaper to manage, eliminate any stigma associated with WIC checks.
  
  221.20 Citizen Operations - Describes the direct provision of a service for the citizen by government employees (or contractors).
  
  6. Central Pharmacy Non-Vaccine Items Inventory in WebVISION Project. The Central Pharmacy Non-Vaccine Items Inventory in WebVISION will incorporate new functionalities within a new module that will integrate both the non-vaccine items inventory from old F&A along with the vaccine inventory that currently exists in WebVISION. WebVISION will require some modifications to permit the merger of the two inventories into one module, providing users with a streamlined system. This will provide operational efficiencies by providing a single application to manage inventories.
  
  111.10 Access to Care - Involves activities focused on the population, including the under-served, receiving care and ensuring the care received is appropriate in terms of types of care. A successful implementation of these processes will result in the population receiving the appropriate guidance to care/appropriate care, at the right location for the most appropriate cost.
  
  111.40 Health Care Services - Involves programs and activities that provide delivery of health and medical care (inpatient and outpatient) to the public, including health care benefit programs.
  
  7 Virginia Volunteer Health System (VVHS, aka VMS) and SNS offline modules and enhancements. In order to use VVHS and SNS in a major emergency with no power and Internet connectivity, we need to build a mobile module for the both applications that can be run on a laptop. This new module will give the user capability to access the data from a laptop without Internet connectivity and synchronize data after the connectivity is established to the central database. This feature is very critical to both the applications due to the nature of business in which both these applications can be used. Another major effort is customizing the existing VVHS for the usage by Human Resources to track the staff usage in the event of emergency. This effort includes capturing some new data elements required by HR and generate the related reports. Included will be an interfaces for automating the credential validation process for volunteers and downloading data from TRAINVA.
  
  112. 10 Key Asset and Critical Infrastructure Protection - Involves assessing key asset and critical infrastructure vulnerabilities and taking direct action to mitigate vulnerabilities, enhance security, and ensure continuity and necessary redundancy in government operations and personnel.
  
  8. Web F & A Assets Management Module. Web F & A Assets Management Module is an add-on to the current VDH Financial and Administration system that has been developed in-house. This new module will contain the asset management module, the federal grant management module, a new reporting module and other enhancements as requested by the business unit to make their operations more efficient. The add-on module helps integrate assets accounting to the existing system and allows inventory maintenance, funding management, cost center accounting etc. The integration will achieve data redundancy and reduce errors. Since the modules will be seamlessly integrated to existing modules, there will not be accounting error introduced by data synchronization issues. This new module will also help manage agency VITA inventory and related accounting of the same. Lines of Business supported are:
  
  438.10 Accounting - Entails accounting for assets, liabilities, fund balances, revenues and expenses associated with the maintenance of funds and expenditure of state appropriations (Salaries and Expenses, Operation and Maintenance, Procurement, Working Capital, Trust Funds, etc.), in accordance with applicable state standards.
  
  438. 20 Asset and Liability Management - Provides accounting support for the management of assets and liabilities of the state government.
  
  438. 70 Cost Accounting/Performance Measurement - Includes the process of accumulating, measuring, analyzing, interpreting, and reporting cost information useful to both internal and external groups concerned with the way in which an organization uses, accounts for, safeguards, and controls its resources to meet its objectives. Cost accounting information is necessary in establishing strategic goals, measuring service efforts and accomplishments, and relating efforts to accomplishments. Also, cost accounting, financial accounting, and budgetary accounting all draw information from common data sources.
• Current IT Services:

  Estimated Ongoing Operations and Maintenance Costs for Existing IT Investments

  	Cost - Year 1		Cost - Year 2
  	General Fund	Non-general Fund	General Fund	Non-general Fund
  Projected Service Fees	$15,813,418	$4,681,891	$16,050,619	$4,752,119
  Changes (+/-) to VITA Infrastructure	-$317,000	$0	-$317,000	$0
  Estimated VITA Infrastructure	$15,496,418	$4,681,891	$15,733,619	$4,752,119
  Specialized Infrastructure	$0	$0	$0	$0
  Agency IT Staff	$3,273,470	$1,664,729	$3,273,470	$1,664,729
  Non-agency IT Staff	$0	$0	$0	$0
  Other Application Costs	$360,000	$100,000	$360,000	$100,000
  Agency IT Current Services	$19,129,888	$6,446,620	$19,367,089	$6,516,848

  Comments:
  The negative amount entered in the Changes to VITA Infrastructure field is to eliminate the duplicate entry. This procurement is listed in the Previous Year's VITA Fees field and again as a proposed IT procurement.
• Proposed IT Investments

  Estimated Costs for Projects and New IT Investments

  	Cost - Year 1		Cost - Year 2
  	General Fund	Non-general Fund	General Fund	Non-general Fund
  Major IT Projects	$0	$1,955,921	$0	$1,517,441
  Non-major IT Projects	$0	$736,500	$0	$406,000
  Agency-level IT Projects	$0	$100,000	$0	$95,000
  Major Stand Alone IT Procurements	$1,148,613	$1,167,906	$1,148,613	$1,448,460
  Non-major Stand Alone IT Procurements	$317,000	$173,680	$317,000	$443,680
  Total Proposed IT Investments	$1,465,613	$4,134,007	$1,465,613	$3,910,581

• Projected Total IT Budget

  	Cost - Year 1		Cost - Year 2
  	General Fund	Non-general Fund	General Fund	Non-general Fund
  Current IT Services	$19,129,888	$6,446,620	$19,367,089	$6,516,848
  Proposed IT Investments	$1,465,613	$4,134,007	$1,465,613	$3,910,581
  Total	$20,595,501	$10,580,627	$20,832,702	$10,427,429

• Current State of Capital Investments:
  [Nothing entered]
• Factors Impacting Capital Investments:
  [Nothing entered]
• Capital Investments Alignment:
  [Nothing entered]

As the leader and coordinator of Virginia's public health system, VDH is expected to provide effective guidance and collaboration in areas such as policy development, legislative and regulatory review, business process improvements, internal and external communications, and quality control. Strong leadership and operational support also entails providing high quality customer service in a culturally-sensitive manner. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Be recognized as the best-managed state in the nation.
• Inspire and support Virginians toward healthy lives and strong and resilient families.

In the absence of adequate precautions and effective safeguards, innumerable infectious agents are capable of being spread throughout the population via numerous mechanisms. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Inspire and support Virginians toward healthy lives and strong and resilient families.

• We will Increase immunization rates of children at two years of age
  Objective Strategies

  • The children served in VDH WIC clinics represent a significant percentage of the children that are delinquent in their immunizations. VDH will work with WIC staff to broaden immunization screening and referral activities at all WIC certification and recertification visits.
  • VDH will increase the number of private practice immunization coverage assessments conducted by VDH immunization staff.
  • VDH will expand the immunization registry into the private sector in order to provide physicians with accurate immunization data to identify patients due or overdue for their immunizations.

  Link to State Strategy

  • nothing linked

  Objective Measures

  • Percentage of two-year old children in Virginia who are appropriately immunized
    Measure Class:

    Agency Key

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    84

    Date:

    6/30/2004

    Measure Baseline Description: Percent of children

    Measure Target Value:

    90

    Date:

    6/30/2012

    Measure Target Description: Percent of children

    Long-range Measure Target Value:

    90

    Date:

    6/30/2014

    Long-range Measure Target Description: Percent of children

    Data Source and Calculation: Percentage obtained from the National Immunization Survey (NIS) conducted by the U.S. Centers for Disease Control and Prevention (CDC). The NIS is a large ongoing, random-digit dialing survey used to provide annual estimates of immunization coverage rates among 19-35-month-old children. The vaccination coverage estimate is based on the provider-verified responses from the parents of children who live in households with telephones. The CDC uses complex statistical methods to adjust for children whose parents refuse to participate, those who live in households without telephones, or those whose immunization histories cannot be verified through their providers.

Establishing and securing effective linkages between Virginia's residents, health care practitioners and health insurers is necessary to assure adequate public health. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Inspire and support Virginians toward healthy lives and strong and resilient families.

Improving the overall health status of Virginia's population, by reducing the burden of chronic disease, assuring appropriate care for Children with Special Health Care Needs, promoting the health of women and children, and preventing injuries, is a key dimension of Virginia's public health system. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Inspire and support Virginians toward healthy lives and strong and resilient families.

• We will reduce the prevalence of obesity in Virginia
  Objective Strategies

  • VDH is continuing to work on its CHAMPION obesity prevention initiative. This is designed to help equip Virginia’s communities with the tools they need to reduce obesity rates. The CHAMPION strategic planning process identified four common themes for solutions: media intervention, nutrition education, community involvement, and public policy changes. VDH staff are evaluating existing programs and interventions that address these four themes, and that have demonstrated positive outcomes, and that have been proven to be replicable and cost effective. The Commissioner has established a Task Force on the Prevention of Obesity which has a statewide advisory committee, in order to provide an additional level of expert review of specific programs recommended by VDH for inclusion in CHAMPION. The committee’s function was critical, as its review determined which initiatives were included in the final plan. That plan, a public guidance document containing the best resources, practices, information and ideas to help communities combat obesity levels and increase better nutrition and physical activity opportunities was released May 2009. The CHAMPION website (http://www.vahealth.org/wic/champion.asp) includes a comprehensive searchable database of obesity prevention programs in Virginia, and will continue to be updated. Upon release of the final plan, VDH has conducted re-engagement conferences in two areas of the state, those with highest obesity rates, and recently awarded nine mini-grants for implementation of first year CHAMPION programs to those areas.

  Link to State Strategy

  • nothing linked

  Objective Measures

  • The percentage of adults in Virginia who are obese
    Measure Class:

    Agency Key

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Down

    Measure Baseline Value:

    25.1

    Date:

    12/31/2005

    Measure Baseline Description: Percent based on calendar year

    Measure Target Value:

    25.0

    Date:

    6/30/2012

    Measure Target Description: Maximum of 25.0% (15% reduction) by end of FY 2012.

    Long-range Measure Target Value:

    23.0

    Date:

    6/30/2014

    Long-range Measure Target Description: Maximum of 23.0% (15% reduction) by end of FY 2014.

    Data Source and Calculation: Obesity is defined as the percentage of adults with a Body Mass Index (BMI) of greater than 30.0. BMI is a weight to height ratio. These are the three BMI categories: Normal weight (Neither overweight or obese), BMI less than 25.0 Overweight, BMI between 25.0 - 29.9 Obese, BMI over 30.0, which is about 30 pounds or more overweight. This measure uses BMI data calculated by the CDC using the self reported height and weight provides as part of the Behavioral Risk Factor Surveillance System (BRFSS), which is a CDC-funded random digit dial (RDD) survey administered in all 50 states, including Virginia, as well as U.S. territories. The Virginia Department of Health Office of Family Health Services is the grant recipient and administrator of the state BRFSS grant. The survey is administered to adults ages 18 and older in non-institutional settings, and thus excludes, for example, adults residing in nursing homes, prisons, and college dormitories. The survey is conducted annually and was first implemented in 1984 (1989 for Virginia). In 2007, the state sample size for the survey was over 5,400 adults.

• We will reduce the prevalence of smoking among Virginians
  Objective Strategies

  • The VDH Tobacco Use Control Program’s (TUCP) grantees and partners continue efforts to develop and implement policies to reducing smoking through smoke-free restaurants and businesses.
  • The Virginia Foundation for Healthy Youth (VFHY), formerly known as the Virginia Tobacco Settlement Foundation, continues to strive for a reduction in youth tobacco use through social marketing media campaigns.
  • The TUCP provides grant funding to work on tobacco use control in local communities.
  • VFHY funds grantees to work on tobacco use control prevention measures in schools and community groups-via best practices curriculum.
  • VDH continues to promote its tobacco Quitline (1-800-QuitNow).

  Link to State Strategy

  • nothing linked

  Objective Measures

  • Percentage of adults in Virginia who smoke
    Measure Class:

    Agency Key

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Down

    Measure Baseline Value:

    20.8

    Date:

    6/30/2004

    Measure Baseline Description: Percent

    Measure Target Value:

    12

    Date:

    6/30/2012

    Measure Target Description: Percent

    Long-range Measure Target Value:

    10

    Date:

    6/30/2014

    Long-range Measure Target Description: Percent

    Data Source and Calculation: The state adult smoking rate, which is reported as a weighted percentage of the sample, is based on the proportion of survey respondents who reported that they smoked at least 100 cigarettes in their lifetime and either smoked every day or some days. The data source for the adult smoking rate is the Behavioral Risk Factor Surveillance System (BRFSS), which is a CDC-funded random digit dial (RDD) survey administered in all 50 states, including Virginia, as well as U.S. territories. The Virginia Department of Health Office of Family Health Services is the grant recipient and administrator of the state BRFSS grant. The survey is administered to adults ages 18 and older in non-institutional settings, and thus excludes, for example, adults residing in nursing homes, prisons, and college dormitories. The survey is conducted annually and was first implemented in 1984 (1989 for Virginia). In 2007, the state sample size for the survey was over 5,400 adults.

  • Percentage of youth ages 12-17 in Virginia who smoke
    Measure Class:

    Agency Key

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Down

    Frequency Comment: Biannually

    Measure Baseline Value:

    15.5

    Date:

    6/30/2005

    Measure Baseline Description: Percent

    Measure Target Value:

    9

    Date:

    6/30/2012

    Measure Target Description: Percent

    Long-range Measure Target Value:

    7

    Date:

    6/30/2014

    Long-range Measure Target Description: Percent

    Data Source and Calculation: The youth smoking rate, which is reported as a weighted percentage, is based on the number of survey respondents who reported that they smoked at least 100 cigarettes in their lifetime and have smoked on at least one day in the previous 30 days. The data source is the state Youth Tobacco Survey (YTS), which was developed by the CDC and is administered by a majority of states, including Virginia. The Virginia Tobacco Settlement Foundation sponsors the YTS. The survey is administered as a paper-and-pencil questionnaire in a school setting to a statewide random sample of public middle- and high school students in grades 6 through 12 (representing ages 12 to 17 years). The survey has been administered every other year in Virginia since 2001. In 2007, the state sample size for the survey was over 2,600 students.

• We will reduce infant mortality
  Objective Strategies

  • The State Health Commissioner convened a diverse group of community leaders with medical and health professionals to develop specific strategies and actions that can be taken in the state’s local communities over the next several years to improve the health of pregnant women, new mothers and infants. Several projects have been started and are near being launched. One project is VDH partnering with the AARP to raise awareness regarding infant mortality by using the AARP newsletter and website to launch a Grandmothers Campaign. VDH is also partnering with the Healthy Mothers Healthy Babies Coalition to launch Text4Baby, a project using cell phones to text women health messages during their pregnancy and in the first few months of parenthood.
  • Programs targeting pregnant and postpartum women and their families which include Resource Mothers Program (RMP) and Loving Steps (Healthy Start) have been continued.
  • Home visiting is used as a major strategy to address poor birth outcomes including both medical and social issues. Since November 2006, VDH staff has provided leadership to convene a workgroup representing all home visiting programs in the state to identify ways these programs could work more efficiently and effectively. Annual reports have been submitted to the Governor’s Working Group on Early Childhood Initiatives. Multiple trainings have been conducted and data elements have been approved for statewide collection to start in FY 2010.
  • It is known that hospital nurses play critical roles in influencing and encouraging the infant safe sleep environment in the hospital and at home. VDH has received a grant from the C.J. Foundation for S.I.D.S, Inc. to provide train-the trainer workshops for birth hospitals in order to develop hospital-based policies and nursing competencies regarding infant safe sleep practices.
  • An interagency Substance Exposed Newborn Workgroup has continued to meet in the past year to identify ways to address the issue of maternal substance abuse during pregnancy. The workgroup initiated has reviewed and recommended valid and reliable assessment tools that can be used by providers to assess for substance use during pregnancy. The tools are available on the Department of Behavioral Health and Developmental Services website.
  • VDH worked with DMAS to streamline BabyCare paperwork requirements, increase mileage reimbursement, and continue to revise the manual. VDH in partnership with DMAS provided a web-based training for all health district staff on the implementation of the changes in order to encourage district participation in the program. Recommendations were made to DMAS to update the criteria for risk and determining eligibility for the program.
  • The Maternal Death Review Team is fully operational and reviewing approximately 40 cases per year. Many of the issues identified by this team are important to understanding infant mortality. An initial report for 1999-2001 cases was released in October 2007 and a subsequent report focusing on obesity and maternal mortality was released in October 2008.

  Link to State Strategy

  • nothing linked

  Objective Measures

  • Number of infant deaths per 1,000 live births
    Measure Class:

    Agency Key

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Down

    Measure Baseline Value:

    7.4

    Date:

    12/31/2004

    Measure Baseline Description: Number of deaths per 1,000 live births

    Measure Target Value:

    6.7

    Date:

    6/30/2012

    Measure Target Description: Number of deaths per 1,000 live births

    Long-range Measure Target Value:

    6.5

    Date:

    6/30/2014

    Long-range Measure Target Description: Number of deaths per 1,000 live births

    Data Source and Calculation: Calculated by dividing the number of infant deaths in a given year by the number of live births in that same year multiplied by 1,000. All births and deaths are registered through the birth and death certificate process. This methodology is consistent with the National Center of Health Statistics method.

A sound system for administering vital records, including birth and death certificates, is crucial to many aspects of public and private sector activities. Timely and informative health statistics provide a basis for analysis of public health issues. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Engage and inform citizens to ensure we serve their interests.
• Inspire and support Virginians toward healthy lives and strong and resilient families.

State, regional and local partners work together to enhance readiness to respond to bioterrorism, infectious disease outbreaks and other public health emergencies. Virginia's Emergency Medical system is a key component of Virginia's overall emergency preparedness efforts. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Inspire and support Virginians toward healthy lives and strong and resilient families.
• Protect the public’s safety and security, ensuring a fair and effective system of justice and providing a prepared response to emergencies and disasters of all kinds.

Deaths that are potentially due to causes that would pose a public health hazard, such as bioterrorism and emerging infectious agents, must be thoroughly investigated in order to identify and develop preventive measures. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Inspire and support Virginians toward healthy lives and strong and resilient families.
• Protect the public’s safety and security, ensuring a fair and effective system of justice and providing a prepared response to emergencies and disasters of all kinds.

Clean and safe drinking water is vital in order to prevent the spread of water-borne diseases, and is an essential component for ensuring Virginians an acceptable quality of life. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Inspire and support Virginians toward healthy lives and strong and resilient families.
• Protect, conserve and wisely develop our natural, historical and cultural resources.

Assurance of safe food is vital in order to prevent the spread of food-borne diseases, and is an essential component for ensuring Virginians an acceptable quality of life. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Inspire and support Virginians toward healthy lives and strong and resilient families.

The purpose of this goal is to assess potential health hazards, advise policy makers and others concerning the nature of the hazard, and communicate with the public concerning the nature of the threat and preventive measures that should be taken. This goal is directly aligned with VDH's mission to protect and promote the health of Virginians.

• Inspire and support Virginians toward healthy lives and strong and resilient families.

This goal ensures compliance with federal and state regulations, policies, and procedures for Commonwealth preparedness, as well as guidelines and best practices promulgated by the Assistant to the Governor for Commonwealth Preparedness, in collaboration with the Governor's Cabinet, the Commonwealth Preparedness Working Group, the Department of Planning and Budget, and the Council on Virginia's Future. The goal supports achievement of the Commonwealth's statewide goal of protecting the public's safety and security, ensuring a fair and effective system of justice, and providing a prepared response to emergencies and disasters of all kinds.

• Protect the public’s safety and security, ensuring a fair and effective system of justice and providing a prepared response to emergencies and disasters of all kinds.

• We will be prepared to act in the interest of the citizens of the Commonwealth and its infrastructure during emergency situations by actively planning and training both as an agency and as individuals.
  Objective Strategies

  • The agency Emergency Coordination Officer will stay in regular communication with the Office of Commonwealth Preparedness, the Virginia Department of Emergency Management, and other Commonwealth Preparedness Working Group agencies.

  Link to State Strategy

  • nothing linked

  Objective Measures

  • Agency Preparedness Assessment Score
    Measure Class:

    Other

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    89.03

    Date:

    6/30/2009

    Measure Baseline Description: Percent

    Measure Target Value:

    93.0

    Date:

    6/30/2012

    Measure Target Description: Percent

    Data Source and Calculation: The Agency Preparedness Assessment is an all-hazards assessment tool that measures agencies' compliance with requirements and best practices. The assessment has components including Physical Security, Continuity of Operations, Information Security, Vital Records, Fire Safety, Human Resources, Risk Management and Internal Controls, and the National Incident Management System (for Virginia Emergency Response Team - VERT - agencies only).

• Factors Impacting the Products and/or Services:
  State funding for the Dental Scholarship and Dentist Loan Repayment Programs was eliminated in FY 2009. However, there is still one student enrolled in Virginia Commonwealth University School of Dentistry with an obligation to practice in an area of need who will be tracked upon graduation.
  
  The demand for nursing scholarships increases each year as tuition increases. However, funding for nursing scholarships decreased because the 2005 General Assembly approved a reciprocal agreement with surrounding states to accept licenses for nurses that have been issued by other states. Therefore, the licensure fees used to support the nursing scholarship program decreased by approximately $10,000. This equates to between 5 and 10 scholarships per year.
• Anticipated Changes to the Products and/or Services
  Rather than grant new dental scholarship and loan repayment awards, the Division of Dental Health will monitor dentists who have obligations to repay or who are in default until all recipients have been tracked to fulfillment of their obligations.
  
  New awards in the Virginia Medical Scholarship Program were phased out and the funds used for this program will instead be used in the Virginia Loan Repayment Programs. This is because there is a 40% default in the scholarship program. This can be attributed to students deciding not to go into primary care, not working in an underserved area of Virginia, or not returning to Virginia after completing an out of state residency program. Currently, funds collected through default are used in the loan repayment programs. As these funds are exhausted, fewer recipients in the loan repayment programs are expected.
• Listing of Products and/or Services
  • The Dental Scholarship Program provided financial assistance to dental students at Virginia Commonwealth University (VCU) School of Dentistry in exchange for practice in an underserved area upon graduation. The dental student who still has an obligation to this program will be provided with a listing of potential areas of practice and tracked throughout his obligation.
  • The Dentist Loan Repayment Program established in 2000 was first funded in FY 2006. It assists dentists who have graduated from any accredited dental school in the nation with repayment of their educational loans in exchange for service in an underserved area in the Commonwealth. The final loan repayment awards were made in FY 2009 with federal funding. These individuals will be tracked to completion of their contracts.
  • The Virginia Medical Scholarship Program provides financial assistance to medical students at Eastern Virginia Medical School in Norfolk; the University of Virginia in Charlottesville; Virginia Commonwealth University in Richmond; and Pikeville School of Osteopathic Medicine in Pikeville, Kentucky. Eligible applicants must be medical students pursuing primary care specialties in family practice, general internal medicine, pediatrics, or obstetrics/gynecology. First-year primary care residency students are also eligible. After completion of their residency program the recipient is required to practice in a federally designated Health Professional Shortage Area (HPSA) or a Virginia Medically Underserved Area (VMUA). If a recipient fails to practice in an underserved area, he is deemed in default and must monetarily repay the Commonwealth the amount of the award, plus penalty, interest, and lawyer fees, if applicable. This program will be phased out in 2007.
  • The Virginia Physician Loan Repayment Program assists primary care physicians and psychiatrists repay educational loans in exchange for service in a federally designated primary care HPSA or a mental HPSA (psychiatrists only), a VMUA, or a state facility, i.e., VDH, Department of Corrections, Department of Behavioral Health and Developmental Services. Applicants must specialize in primary care family or general practice, internal medicine, pediatrics, obstetrics/gynecology or psychiatry. Participants may receive up to $120,000 for a 4-year commitment in addition to the salary and benefit package offered by their employer.
  • The Virginia State Loan Repayment Program (SLRP), a federal grant through the Health Resources Services Administration, Bureau of Health Professions is a joint federal and state program that assists primary care physicians, psychiatrists, physician assistants, or nurse practitioners repay educational loans in exchange for service in a federally designated primary care Health Professional Shortage Area (HPSA) or a mental HPSA (psychiatrists only). Applicants must specialize in primary care family or general practice, internal medicine, pediatrics, obstetrics/gynecology or psychiatry. An eligible practice site must be located in a HPSA, and must be a public or not-for-profit entity. Participants may receive up to $120,000 for a 4-year commitment in addition to the salary and benefit package offered by their employer.
  • The Mary Marshall Nursing Scholarship Program is for students earning a degree as a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) attending nursing school in Virginia. Scholarships are competitive and are awarded by a Nursing Scholarship Advisory Committee appointed by the Board of Health. Awards are based upon criteria determined by the committee including scholastic attainments, character, need, and adaptability of the applicant for the service contemplated in the award. The service obligation can be fulfilled any where in Virginia in the chosen field of the recipient, RN or LPN.
  • The Virginia Nurse Practitioner/Nurse Midwife Scholarship Program awards are competitive and are awarded by a Nurse Practitioner/Nurse Midwife Scholarship Advisory Committee appointed by the Board of Health. Awards are based upon criteria determined by the committee and include scholastic attainments, character, need, and adaptability of the applicant for the service contemplated in such award. Preference for a scholarship award is given to residents of the Commonwealth; minority students; students enrolled in adult primary care, obstetrics and gynecology, pediatrics, and geriatric nurse practitioner programs; and residents of medically underserved areas of Virginia. Scholarships are awarded for a single academic year. Scholarships must be repaid with service, one year for every year an award is received. The recipient must engage in full-time nurse practitioner or nurse midwife work in a medically underserved area of Virginia.
  • The Nursing Loan Repayment Program was established by the 2000 General Assembly, but was not funded. It established a loan repayment program requiring service anywhere in the Commonwealth with a preference for working in a long term care facility in the Commonwealth.
  • Assessment: Determine the primary care, dental and mental health underserved areas for the scholarship and loan repayment programs to meet the health needs of the state utilizing data from various sources, i.e., the Virginia Board of Dentistry, the American Dental Association, the Department of Health Professions, American Medical Association, Virginia Nurses Association, etc. Continue to conduct dentist manpower analyses based on regulatory requirements. Maintain ppova.org web site where interested practice sites and practitioners can post vacancies and/or resumes to pursue placements in medically underserved areas. Maintain a listing of all primary care physicians and psychiatrists and their practice locations in Virginia to use for designation purposes. Track the recipients of the scholarship and loan repayment programs to ensure compliance with the various programs. Ensure the practitioner is working in an approved underserved area of the Commonwealth.
  • Policy Development: Promulgate regulations and adopt rules and regulations related to the scholarship and loan repayment programs. Interact with agencies, divisions, academic institutions, offices, societies, coalitions, task forces, joint interagency work groups, commissions, boards, advisory councils, legislative hearings, governor’s staff, etc. concerning the scholarship and loan repayment programs.
  • Assurance: Link people in communities to primary care, dental and mental health services by providing students, dentists, primary care physicians, psychiatrists, nurse practitioners, physician assistants, and nurses with opportunities through the scholarship and loan repayment programs in order to increase access to primary care, oral, and mental health services in rural and underserved communities in the state. Dental scholarship and loan repayment recipeints are tracked through the single provider of dental Medicaid services in the state, Doral Dental, USA. Quarterly reports from Doral provide data to determine if a dentist is meeting their obligation to serve in an area of need and provide access to care for underserved populations. Students or dentists who go into default will be tracked until they have have repaid their financial obligation. The demand for nursing scholarships increases each year as tuition increases. However, funding for nursing scholarships decreased because the 2005 General Assembly approved a reciprocal agreement with surrounding states to accept licenses for nurses that have been issued by other states. Therefore, the licensure fees used to support the nursing scholarship program decreased by approximately, $10,000. This equates to between 5 and 10 scholarships per year.
  • The Virginia Nurse Educator Scholarship Program was established by the 2006 General Assembly to provide annual nursing scholarships to students who are enrolled part- or full-time in a master's or doctoral level nursing program and who commit to fulltime teaching after completion of their degree program within a nursing program in the Commonwealth.

• Increase access to primary health, oral health, and mental health care services in underserved areas of the Commonwealth.
  Objective Description
  All OMHPHP programs seek to eliminate health inequities within the Commonwealth. To fulfill this mission, OMHPHP looks at ways to identify and monitor inequities in helath and health care and identify the social determinants that contribute to these inequities. Although Virginia has an overall favorable number of practitioners statewide and a practitioner to population ratio that mirrors the nation, a maldistribution of providers exists in many areas of the state resulting in underserved areas for access to primary health, oral health, and mental health care services. The scholarship and loan repayment programs seek to correct this maldistribution through contracting with students and practitioners to serve in these areas in exchange for funding for tuition or debt reduction of school loans.
  Alignment to Agency Goals
  • Agency Goal: Lead and collaborate with partners in the health care and human services systems to create systems, policies and practices that assure access to quality services.
  • Agency Goal: Promote systems, policies and practices that facilitate improved health for all Virginians.
  Objective Strategies
  • The VDH Office of Minority Health and Public Health Policy will develop a rational service area plan to guide designation efforts so that high poverty areas are prioritized for assessment.
  • The VDH Division of Dental Health (DDH) will administer the Dental Scholarship Program through collaboration with VCU School of Dentistry to track those students currently under obligation and provide information to students concerning the program.about potential areas of need and their contractual obligation.
  • DDH will track those dental students who graduate and begin to practice in an area of need regarding the terms of their obligation as well as students who decide to proceed with financial payback rather than serve.
  • DDH will monitor those dentists currently under contract in the Dentist Loan Repayment Program.
  • DDH will update areas of need through a manpower analysis as required by regulation.
  • DDH will complete the periodic review of the Dental Scholarship and Loan Repayment Regulations.
  Link to State Strategy
  • nothing linked
  Objective Measures
  • Percentage of physicians, physician assistants, and nurse practitioners in underserved areas that received assistance through VDH administered loan repayment programs who successfully complete their service obligation.
    Measure Class:

    Other

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Maintain

    Measure Baseline Value:

    95

    Date:

    6/30/2009

    Measure Baseline Description: Percent

    Measure Target Value:

    97

    Date:

    6/30/2012

    Measure Target Description: Percent

    Data Source and Calculation: This measure is calculated based on the number of active loan recipients minus the number of recipients who default divided by the total number of active loan recipients.

  • Number of signed contracts that obligate a dental student or dentist to serve in an area of need for one year.
    Measure Class:

    Other

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Maintain

    Measure Baseline Value:

    14

    Date:

    6/30/2006

    Measure Baseline Description: Number of contracts for dentists and dental students

    Measure Target Value:

    14

    Date:

    6/30/2012

    Measure Target Description: Number of contracts for dentists and dental students

    Data Source and Calculation: This measure is calculated based on the number of students at VCU School of Dentistry (who entered into a contract with VDH to serve in a dental area of need upon graduation) plus the number of licensed dentists (who have recently graduated from any dental school in the country and enter into a contract with VDH to serve in a dental area of need).

• Factors Impacting the Products and/or Services:
  FOUR FOR LIFE FUNDING
  
  In FY 2002, funding under this program increased from $2 per vehicle registration to $4 per vehicle registration to support EMS.
  
  The FY 2002-2004 Biennium budget retained the increase in funds to support other Commonwealth general funded initiatives.
  
  In FY 2005, the additional funding under this program was partially distributed for EMS purposes; however $3.45 million was retained in the general fund for other purposes, and $1.04 million was set aside to support the Virginia State Police Medevac program.
  
  In FY 2008, all funding under this program will be provided, except for the $1.04 million set aside to support the Virginia State Police Medevac program.
  
  In FY 2009, funding under this program increased from $4 per vehicle registration to $4.25 per vehicle registration to support EMS. The additional $0.25 “shall be deposited into the Rescue Squads Assistance Fund and used only to pay for the costs associated with the certification and recertification training of emergency medical services personnel.”
  
  In FY 2010 Budget Bill, required an additional $600,000 be set aside to support the Virginia State Police Medevac program increasing the total allocation to $1,645,375.
  
  PERCENT DISTRIBUTIONS AS ESTABLISHED IN § 46.2-694 OF THE CODE TO TAKE EFFECT IN FY 2008:
  32% Rescue Squad Assistance Fund Grants
  26% Return to Localities
  2% Virginia Association of Volunteer Rescue Squads (VAVRS)
  10% Department of Health, EMS
  30% State Department of Health for EMS training programs; advanced life support training programs; recruitment & retention of volunteer EMS personnel; system development, communications and emergency preparedness and response; and regional EMS councils.
• Anticipated Changes to the Products and/or Services
  Change in the RSAF regulations to allow for the funding of new or innovative projects through the RSAF grant program:
  
  To meet statewide critical needs especially in EMS training, communications equipment and programs; computers, emergency management, retention of EMS providers.
  
  To meet the 18 objectives identified in § 32.1-111.13 of the Code.
• Listing of Products and/or Services
  • Financial Assistance to Localities for Non Profit EMS agencies provides non-supplanting funds to support training, equipment and supplies to eligible non profit EMS agencies and organizations within their jurisdiction. Annually, funds are transferred to the locality based upon the fees collected within that jurisdiction. The locality’s comptroller must report annually on the use of these funds before subsequent fiscal year funding is released.
  • Rescue Squads Assistance Fund program grants support training and equipment to eligible non profit EMS agencies and organizations. The grant application process and award criteria are established in regulations with two distinct grant cycles each year.
  • VAVRS funding is to be used solely for the purpose of recruitment, retention and training activities for volunteer EMS personnel and agencies. Funding is provided through quarterly payments, and § 32.1-111.13 requires VAVRS to submit an annual financial report on the use of its funds to the State EMS Advisory Board.

• Provide balanced and sound financial support for EMS.
  Objective Description
  The Commonwealth provides direct financial assistance for emergency medical services through a $4.25 surcharge on motor vehicle registration. These funds are to support the provision of training and education of EMS personnel, the purchase of EMS equipment and supplies and, to support local government EMS operations.
  Alignment to Agency Goals
  • Agency Goal: Drive operational excellence in the design and delivery of health department services and provide exceptional services to all customers.
  • Agency Goal: Lead and collaborate with partners in the health care and human services systems to create systems, policies and practices that assure access to quality services.
  • Agency Goal: Promote systems, policies and practices that facilitate improved health for all Virginians.
  • Agency Goal: Respond in a timely manner to any emergency impacting public health through preparation, collaboration, education and rapid intervention.
  Objective Strategies
  • Develop and monitor regional and state priorities for funding of EMS programs and services through effective use of RSAF Program.
  • Coordinate and conduct bi-annual RSAF grant awards.
  • Provide technical assistance and monitoring of Return to Locality funds.
  • Provide technical assistance to VAVRS in use of funds and review of annual financial report by state EMS Advisory Board as required in Code.
  Link to State Strategy
  • nothing linked
  Objective Measures
  • Percentage of funds collected and distributed as defined in Section 46.2-694 of the Code of Virginia.
    Measure Class:

    Other

    Measure Type:

    Input

    Measure Frequency:

    Annual

    Preferred Trend:

    Maintain

    Measure Baseline Value:

    100

    Date:

    6/20/2006

    Measure Baseline Description: Percent

    Measure Target Value:

    100

    Date:

    6/30/2012

    Measure Target Description: Percent

    Data Source and Calculation: The measure for Rescue Squads Assistance Fund (RSAF) is calculated based upon the amount of funding available as defined in Code. Grants are awarded based upon criteria established in regulations.

• Factors Impacting the Products and/or Services:
  Changes driven by VITA transformation activities have negatively impacted OEMS’ ability to serve external agency and internal information technology customers. Agency costs to increased substantially in order to meet the transformation mandates.
  
  EMS agencies and personnel are expecting to transact more programmatic and financial business with OEMS across automated systems. This requires OEMS to expand electronic services.
  
  Emergency medical services are available statewide, but the level of service varies. This will require a greater coordination of services by OEMS with local governments, EMS agencies and organizations.
  
  Prehospital Patient Care Data collection system is inadequate and local response time standards are needed. OEMS has examined new technologies in the collection of data and has secured a commercial off the shelf product through a competitive request for proposal process. Implementation is being planned and approvals by the VITA Project Management Division are ongoing.
  
  Recruitment and retention of EMS providers are major problems for EMS agencies. Local, regional, and state initiatives are needed to address recruitment and retention.
  
  The number of certified EMS personnel is affected by access and availability to participate in educational programs, especially by volunteers who have competing demands placed on them by family and employers. Additional factors include changes to the educational curriculum required to comply with national standards and increase in the cost of training.
  
  Revenue recovery and local funding of emergency medical services is an evolving issue. In general, EMS is moving from a free service provided by volunteers to a service that bills for care.
  
  Trauma Center designation is voluntary and has lead to gaps in trauma care in certain areas of the state. There has not been a financial incentive to being a designated trauma center. A 2004 JLARC report on “The Use and Financing of Trauma Centers” indicated that Virginia’s Trauma Centers were losing $45 million annually ($52 million annualized inflation rate; at risk of downgrading or closing; experiencing difficulty recruiting specialty physicians; and facing increased medical malpractice liability costs.
  
  § 18.2-270.01 of the Code established the State Trauma Center Fund and it is expected to raise $9.5 million annually; however, this is less than 20% of the financial losses being experienced by the trauma centers.
  
  Virginia’s Poison Control Centers have a growing financial concern. The centers have not had their funding increase in 10 years and have undergone five budget reductions. During these 10 years of level funding the three poison centers that serve Virginia have managed an increase of human exposure consults by over forty (40) percent. Despite these funding issues, they have had increased costs for staffing and services. Community outreach, injury prevention, surveillance services and other programs are limited due to a reduction in funding and the costs associated with inflation,
  
  The Virginia EMS for Children Program has been funded through federal funds and it is unclear if federal grant support will continue. Demands for emergency care and EMS services for children with chronic illnesses, or technology-dependent conditions continue to increase.
  
  Increased violence in the workplace, schools and public areas continue to drive the demand for crisis intervention and peer support services for EMS and public safety personnel.
  National changes in laws and processes will impact the availability of EMS personnel and resources.
  Homeland Security issues - National Incident Management System and local/federal coordination. Financial reimbursement - revenue recovery; Emergency Medical Treatment and Labor Act; and Medicaid/Medicare laws. New training – time and resource commitments.
  
  Regulation and oversight of EMS agencies will remain a significant focus of this service area plan. Anticipated changes in the service area include the EMS System through OEMS and the regulatory process needs to promulgate new/revised regulations concerning designation of Regional EMS Councils; financial assistance to EMS agencies; and pursuant to legislation passed in 2005 (HB 2238); EMS regulations need to define response times, data collection requirements and, enforcement provisions to include civil penalties (currently in development).
  
  Changes, updates and new legislation from the Federal Communications Commission concerning public safety communications will impact EMS agencies. Changes in communications technology (e.g., improved two way radios, voice over internet, digital radios, etc.) will have a financial impact upon EMS agencies and they will seek alternative sources of funding for these major investments. Greater technical and financial assistance from OEMS is anticipated. OEMS will continue to offer its program in emergency medical dispatch and accreditation program for 911 Public Safety Answering Points (PSAP) and Emergency Dispatch Centers. Accreditation promotes implementation of standardized emergency medical dispatch (EMD) protocols and continued training and education of dispatchers.
  
  Critical Incident Stress Management (CISM) services have primarily focused on EMS and fire. Legislation passed during the 2005 General Assembly increased the objectives of § 32.1.111.3 to include CISM. OEMS has been working with Virginia’s law enforcement community and this service area is expected to expand substantially. There will be an increased need for CISM training and crisis intervention and peer support services across the Commonwealth as violence in the workplace, schools and public areas continue to escalate. CISM is now being requested by public schools (school shootings), jails and mental hospitals (abused staff) and private business (robberies) leading to increased requests for debriefing services.
  
  EMS agencies, particularly volunteer agencies with higher workforce turnover rates, need to continue to develop new leaders who are competent to manage a changing and challenging environment and the complex issues of managing an EMS agency. Volunteers will be more dependent on career support for answering EMS calls and managing their day-to-day operations. With the changing demographics of Virginia, leaders will need to be trained in dealing with a variety of ethnic and cultural backgrounds and issues. OEMS will experience an increase in demand for technical assistance services and funding related to recruitment and retention of EMS personnel.
  
  OEMS customer services are anticipated to increase as the number of EMS responses increases. As the public’s expectations for EMS services increases, local governments and EMS agencies will seek the assistance of OEMS to increase the level of patient care while finding ways to maximize the impact of public funds. Informing the public remains a challenge and will require innovative methods to educate the public about the EMS System.
  
  Demands for emergency care for children continue to increase due to inadequate access to primary care, increased survival and home care of children who suffer from chronic illnesses or who are technology-dependent, racial and ethnic disparities in pediatric emergency care, terrorism concerns, and staff, facility, and other resource limitations. OEMS will experience an increase in demand for technical assistance services and funding.
  
  New regulations and contract deliverables required of the Regional EMS Councils will increase the demands on regional council resources and focus greater attention on local priorities.
• Anticipated Changes to the Products and/or Services
  The quality of patient care can be improved when there is a coordination and integration of resources. Fuller integration of pre-hospital providers and hospital providers into a unified EMS system will result in faster access, better pre-hospital care, and continued high quality patient care through the rehabilitative phase. OEMS has begun to utilize Webinars and other technologies to provide administrative updates to EMS instructors and coordinators as well as offering on-line continuing education for EMS providers through VATrain..
  
  Due to workforce shortages and demand on services, EMS will see a trend in returning to basics, i.e., a rapid and robust Basic Life Support system followed by a smaller cadre of experienced and well supervised paramedics. The demand for technical assistance from localities, EMS agencies and organizations to develop strategies to address recruitment and retention of EMS personnel will increase.
  
  There will be changes in EMS curricula and certification programs based on EMS training and educational core content, the National Scope of Practice and educational standards.
  
  Virginia’s trauma system is benchmarked with national and state systems to ensure continuous adherence with recognized best practices in trauma care. A triennial review process of trauma centers will be conducted. Additionally, in conjunction with the JLARC study, an analysis of geographic gaps in trauma system coverage, by region will be conducted, recommendations and plans developed to meet identified gaps in trauma care services.
  
  There will be a greater emphasis on the safety, wellness and physical health of EMS providers. Compared to police and fire, ambulances experience the highest percentage of crashes with fatalities and injuries. Not being restrained in the back of an ambulance pose great risks. Motor vehicle crashes are the leading cause of work related deaths for EMS workers. There is a need to review current ambulance design and injury prevention and safety programs.
  
  Other threats to EMS providers range from blood borne pathogens, assault & homicides to back injuries and hearing loss. Overall occupational death rates per 100,000: police: 14.2; firefighters: 16.5; EMS: 12.7. The national average for all workers is 5.0.
  
  There will be an increasing role for lay interveners. The impact of 9/11 has resulted in the development of citizen corps and other volunteer groups, support for neighbors and family, new courses being developed and an increasing role of bystander care until EMS arrives. This will require greater coordination and management of information and resources by OEMS.
  
  Health care delivery issues such as declining on-call availability of physician specialists, diversion, hospital overcrowding, difficulty of access to primary care, uninsured patients and increasing EMS call volume will require EMS to play a significantly larger role in community health delivery and coordination of services. In addition, there is greater emphasis and attention related to planning and prepared activities related to pandemic flu (H1N1). This will place a greater demand on OEMS programs, services and financial resources.
  
  OEMS will play a critical role in assisting localities assess and evaluate EMS resources and capabilities. This will include monitoring the health of a community, surveillance, early detection; ensuring patients have access to appropriate care – all of which will require additional training for EMS providers, additional resources and more reliance on OEMS programs and services.
  
  New regulations governing the designation process and changing contractual requirements of Regional EMS Councils will place greater emphasis on performance and outcome measures for those designated regional councils to meet the needs and priorities of the EMS agencies and local governments within their designated service area.
  
  OEMS highly anticipates the incorporation of designated cardiac centers in Virginia. Like stroke center and trauma center designation, cardiac designation will likely incorporate a larger volume of hospitals that serve a larger population of patients annually. The addition of a third type of specialty care hospitals will create an increased burden upon OEMS to coordinate, regulate and educate the hospital and EMS systems.
• Listing of Products and/or Services
  • EMS Education, Training and Medical Direction - Regulatory authority to establish certification and re-certification qualifications and standards for EMS personnel: EMT Basic Life Support curriculum and competency standards; Advanced Life Support curriculum and competency standards; EMS Instructor curriculum and competency standards; and certification examinations. Maintain certification records of EMS personnel: Initial certification candidates and re-certification candidates. Maintain accreditation criteria and standards for training sites/programs. Perform accreditation site visits of training centers/programs.
  • Critical Care, Stroke Center, and Trauma - Trauma Center Regulatory Authority: Designation criteria development and designation inspections. Trauma System Planning (State Trauma System Plan): Oversight & Management Committee; Statewide Trauma Triage Plan Development & Compliance Monitoring; and Regional Trauma Triage Plan monitoring/administration. Trauma Center Fund Administration Emergency Medical Services Patient Care Information System data collection and analysis: Statewide Trauma Registry administration; participation in the Crash Outcomes Data Evaluation System (CODES); and Poison Control Center Network contract administration.
  • Emergency Operations - OEMS is responsible for developing a comprehensive and coordinated response during a declared “state of emergency”. This is achieved through Health and Medical Emergency Response Teams (HMERT) and the training of EMS personnel and other first responders. Disaster Response Teams: Health and Medical Emergency Response Teams (HMERT) and Disaster Task Forces. Training Programs: Public Safety Response to Terrorism – Awareness; Heavy and Tactical Rescue; HMERT Team Member; HMERT Team Leader; and Mass Casualty Incident Management - Modules I -V.
  • Emergency Medical Services for Children (EMSC) - Integrate EMSC within the EMS system in Virginia. Incorporate pediatric issues in all aspects of clinical care through outreach and education in the prehospital setting, emergency departments and primary care offices. Administer and maintain a EMSC program to provide coordination and support for emergency pediatric care. Assess the existence of a statewide, territorial, or regional system that recognizes hospitals that are able to stabilize and/or manage pediatric emergencies. Assess the percentage of Virginia licensed hospitals that have written interfacility transfer agreements, and written guidelines for effecting interfacility transfers. Improve and expand pediatric emergency care education systems. Improve EMS/EMSC systems development. Ensure that integration of health services meets children’s needs by increasing the availability of pediatric injury prevention, first aid and CPR programs throughout Virginia. Develop broad-based support for prevention activities. Increase both unintentional and intentional injury prevention programs. Increase community linkages between EMSC and the Children with Special Health Care Needs (CSHCN) program. Identify and recommend pediatric equipment for EMS vehicles.
  • EMS System Evaluation & Research - Assist all areas of EMS system development with supportive data from the EMS Patient care Information System to ensure prehospital emergency care is developed in an evidence based fashion. EMS Research can contribute to high quality EMS and to drive improvements in patient outcome. Vast amounts of money are being spent for patient care with little rigorous evaluation of the effectiveness of that care. Methodologically sound research must be incorporated into all facets of the EMS system. EMS Research can assure new technologies and therapeutic approaches are scientifically and rapidly evaluated prior to or at the initiation of their use and for continued monitoring.
  • Human Resources Management and Technical Assistance - Technical Assistance – OEMS will coordinate with regional EMS councils and other state organizations to assist local EMS and government officials with specific system issues. Technical Resources – Develop, produce and distribute manuals, tool kits, curriculums, and self assessment guides to help local EMS and government officials to identify solutions to their own retention, leadership and management related issues. Resource Coordination - Partner with regional EMS councils and statewide EMS organizations and agencies to pool resources and assist volunteer and governmental EMS agencies. Financial Support - Promote the Rescue Squad Assistance Fund grant program to localities to help fund management and leadership and recruitment programs. Workshop and Seminars - Sponsor leadership and management workshops and seminars at EMS Symposium and other state-wide conferences.
  • Public Information and Education - Provide public education and awareness programs to increase interest, knowledge and participation in Virginia’s emergency medical services system; promote and publicize Office of EMS programs and services identified under the Service Area Description of this plan; assist EMS agencies in recruitment efforts; coordinate Virginia’s Durable Do Not Resuscitate (DNR) program; and education of the public, EMS providers and health care facilities on EMS rules and regulations.
  • EMS Regulation and Compliance - EMS Agency Licensure and Vehicle Permits: Inspect and license new and existing EMS agencies and inspect and permit EMS vehicles. Compliance and review of EMS Regulations; conduct investigations of EMS agencies and/or personnel; periodic review and revision of EMS regulations; and review and evaluate EMS agency or personnel requests for variances and exemptions to regulations. EMS Field Services: coordinate and administer certification examinations and provide technical assistance to EMS personnel, agencies, local governments and organizations; and verification of RSAF grant awards and service as a technical assistance resource for EMS personnel and agencies.
  • Critical Incident Stress Management: - Establish and maintain a process for crisis intervention and peer support services for emergency medical services and public safety personnel, including statewide availability and accreditation of critical incident stress management teams.
  • Communications - Establish and maintain a program to improve dispatching of emergency medical services including establishment of and support for emergency medical dispatch training, accreditation of 911 dispatch centers, and public safety answering points; and coordinate FCC licensure authorization for EMS agency radio communication.
  • EMS Registry - Conduct regular statewide EMS system needs assessments and report the results through the appropriate committees of the EMS Advisory Board; perform monitoring of the quality of emergency medical care being provided in both the out of hospital and in hospital environments; submission to the National EMS Information System (NEMSIS) database hosted at the National Highway Traffic Safety Administration (NHTSA). OEMS signed an MOU with NEMSIS in 2004 to use the NHTSA 2.2 dataset and submit to the national database; support the Code mandated monitoring of patient transfer patterns of trauma patients throughout the Commonwealth. Conduct regular evaluations of EMS System performance and support requests for analysis of system resources to improve Commonwealth preparedness, homeland security, and other functions.
  • Regional EMS Councils - Develop, coordinate and improve the delivery of EMS in the region through implementation of Regional EMS Plan, Regional EMS protocols, Regional Mass Casualty Incident Plan, regional coordination of basic and continuing education of EMS providers and , other services as defined in the performance based contract with the Office of Emergency Medical Services.

• Provide standards of education and training curricula and certification requirements for Emergency Medical Services Personnel and Emergency Medical Services Physicians
  Objective Description
  The Commonwealth regulates the qualifications for certification and recertification of emergency medical services personnel.
  Alignment to Agency Goals
  • Agency Goal: Drive operational excellence in the design and delivery of health department services and provide exceptional services to all customers.
  • Agency Goal: Lead and collaborate with partners in the health care and human services systems to create systems, policies and practices that assure access to quality services.
  • Agency Goal: Promote systems, policies and practices that facilitate improved health for all Virginians.
  • Agency Goal: Respond in a timely manner to any emergency impacting public health through preparation, collaboration, education and rapid intervention.
  Objective Strategies
  • Promote and certify accreditation standards for EMS educational programs.
  • Assist localities and EMS entities to collaboratively produce EMS education that optimizes available resources.
  • Redesign process for educational program approval incorporating accreditation standards.
  • Identify and approve educational programs eligible to conduct courses for continuing education credits towards recertification of EMS credentials.
  • Develop in concert with VDH and local EMS components the ability to provide improved accessibility to the EMT Instructor Institute and ALS Coordinator Seminar by using web applications.
  • Produce programs of appropriate continuing education utilizing state of the art technology and alternative sources of education (i.e., web based, video streaming, etc) to allow for greater access to continuing education.
  • Develop and provide a support network and educational systems that supports the recruitment, retention and role of EMS physicians.
  • Coordinate and support a Statewide EMS for Children program for emergency pediatric care, availability of pediatric emergency medical care equipment, and pediatric training of medical care providers.
  Link to State Strategy
  • nothing linked
  Objective Measures
  • Number of accredited EMS training programs in Virginia
    Measure Class:

    Other

    Measure Type:

    Output

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    17

    Date:

    7/1/2005

    Measure Baseline Description: Number of accredited EMS training programs at the Advanced Life Support Training (intermediate and paramedic) level

    Measure Target Value:

    32

    Date:

    6/30/2012

    Measure Target Description: Number of accreditation program at the Advanced Life Support Training levels with a minimum of one accredited site in each of the 11 Regional EMS Council service areas

    Data Source and Calculation: Data maintained through the Virginia OEMS in the course enrollment and certification database.

• Establish regulations and monitor compliance of Emergency Medical Services agencies and personnel.
  Objective Description
  The Commonwealth licenses and regulates EMS agencies through inspection and licensure of EMS agencies, permitting of EMS vehicles and investigation of complaints alleged against EMS agencies or personnel.
  Alignment to Agency Goals
  • Agency Goal: Drive operational excellence in the design and delivery of health department services and provide exceptional services to all customers.
  • Agency Goal: Lead and collaborate with partners in the health care and human services systems to create systems, policies and practices that assure access to quality services.
  • Agency Goal: Promote systems, policies and practices that facilitate improved health for all Virginians.
  • Agency Goal: Respond in a timely manner to any emergency impacting public health through preparation, collaboration, education and rapid intervention.
  Objective Strategies
  • Conduct scheduled and unscheduled inspections of EMS agencies to verify licensed EMS agencies comply with regulations pertinent to EMS vehicles, EMS staffing requirements for EMS vehicles and, levels of care provided.
  • Conduct investigations of complaints against EMS agencies or personnel in accordance with regulations and OEMS approved standards for investigative proceedings.
  • Conduct ongoing review and revision of existing regulations. Complete a general revision of existing regulations with NOIRA process every four years.
  • Review and submit recommendations on all variance and exemption requests, noting any patterns.
  • Provide educational resources, technical assistance, coordination and funding support to assist EMS agencies and local governments strengthen their leadership and management programs.
  • Develop and establish a disciplinary review process and identify an adjudication officer to review investigative findings and make recommendations on appropriate enforcement actions.
  • Work with the EMS Workforce Development Committee of the State EMS Advisory Board to establish leadership and management competencies and knowledge areas for EMS leaders as part of the development of a voluntary EMS agency accreditation program referred to as "Standards of Excellence".
  • Work with the Medevac Committee of the State EMS Advisory Board to develop a standard of medical necessity to be utilized by Virginia Medevac Services to assure the appropriate utilization of air medical services.
  Link to State Strategy
  • nothing linked
  Objective Measures
  • Percent compliance of Emergency Medical Services agencies with state EMS regulations
    Measure Class:

    Other

    Measure Type:

    Output

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    91.7

    Date:

    6/30/2004

    Measure Baseline Description: Percent

    Measure Target Value:

    96

    Date:

    6/30/2012

    Measure Target Description: Percent

    Data Source and Calculation: Regulations governing EMS agency licensure, vehicle classifications, EMS Personnel requirements, EMS Education and certification, EMS Physicians, Regional EMS Councils, and financial assistance. Data maintained by the Office of EMS in its regulation and compliance database. The percentage rate is obtained from the number of enforcement actions taken in a fiscal year compared to the number of licensed EMS agencies.

• Provide planning, coordination and evaluation of acute patient care delivery services between EMS agencies and hospitals.
  Objective Description
  OEMS is the state agency responsible to plan, coordinate and integrate a system of care that encompasses all aspects of emergency medical care.
  Alignment to Agency Goals
  • Agency Goal: Drive operational excellence in the design and delivery of health department services and provide exceptional services to all customers.
  • Agency Goal: Lead and collaborate with partners in the health care and human services systems to create systems, policies and practices that assure access to quality services.
  • Agency Goal: Promote systems, policies and practices that facilitate improved health for all Virginians.
  • Agency Goal: Respond in a timely manner to any emergency impacting public health through preparation, collaboration, education and rapid intervention.
  Objective Strategies
  • OEMS will maintain a system of designated trauma centers that will continue to decrease morbidity and mortality of injured person in Virginia.
  • OEMS will organize teams to perform trauma centers site reviews to ensure compliance with the Virginia Statewide Trauma Center Criteria.
  • Review and revise the Virginia Statewide Trauma Center Designation Program Resource Manual for Hospitals.
  • Review and revise the State Trauma System Plan & Trauma Triage Plan.
  • Schedule and conduct stakeholder meetings with designated trauma centers, non-designated hospitals and pre-hospital agencies.
  • OEMS will distribute, to designated trauma centers, the Trauma Center Fund on a quarterly schedule using an electronic means of distribution. OEMS will elicit stakeholder involvement in the annual review and/or revision of the Trauma Center Fund Distribution Method.
  • Provide education as needed to support the mission of the Virginia Poison Control Network (VPCN). Support the maintenance of funding needed by the VPCN to improve services and increase poison injury prevention efforts. Pave the way towards a system of toxosurveillance within the VPCN.
  • Utilize Prehospital Patient Care Reporting and Trauma Registry data to perform EMS Research.
  • Convert the PPCR data elements to comply with the National EMS Information System data element standards approved by the National Highway Traffic Safety Administration.
  • Participate as an active stakeholder in the development of a national trauma registry data set with the National Trauma Data Bank.
  Link to State Strategy
  • nothing linked
  Objective Measures
  • Percentage of Virginia licensed hospitals that provide emergency care that report patient care data to the Statewide Trauma Registry.
    Measure Class:

    Other

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    80

    Date:

    6/30/2004

    Measure Baseline Description: Percent

    Measure Target Value:

    100

    Date:

    6/30/2012

    Measure Target Description: Percent

    Data Source and Calculation: Data maintained through the Virginia Office of EMS Emergency Medical Services Patient Care Information System which includes the Virginia Statewide Trauma Registry and the EMS Registry.

  • Percentage of licensed EMS agencies submitting data that are required to submit patient care data to the EMS Registry.
    Measure Class:

    Other

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    70

    Date:

    6/30/2004

    Measure Baseline Description: Percent

    Measure Target Value:

    96

    Date:

    6/30/2012

    Measure Target Description: Percent

    Data Source and Calculation: Data maintained through the Virginia Office of EMS Emergency Medical Services Patient Care Information System which includes the Virginia Statewide Trauma Registry and the EMS Registry.

• Provide emergency operations, training, and response.
  Objective Description
  No state is immune from mass casualty events. The EMS System in Virginia must increase its efforts to plan for and mitigate the special types of events that consume both local and regional resources. These continue to increase at alarming rates, and many agencies are not prepared or equipped to respond in a timely or adequate manner. Effective response to major events, natural disasters or acts of terrorism is critical to the provision of EMS to the citizens of the Commonwealth.
  Alignment to Agency Goals
  • Agency Goal: Drive operational excellence in the design and delivery of health department services and provide exceptional services to all customers.
  • Agency Goal: Lead and collaborate with partners in the health care and human services systems to create systems, policies and practices that assure access to quality services.
  • Agency Goal: Promote systems, policies and practices that facilitate improved health for all Virginians.
  • Agency Goal: Respond in a timely manner to any emergency impacting public health through preparation, collaboration, education and rapid intervention.
  Objective Strategies
  • Identify and maintain deployable Office of EMS emergency response teams and resources.
  • Increase the knowledge of Health Medical Emergency Response Teams capabilities with local government officials, emergency managers and emergency supervisors.
  • Identify and validate electronic systems that effectively and efficiently alert, deploy and monitor HMERT resources during events.
  • OEMS will support and maintain a position to coordinate team development and response.
  • Educate the HMERT on the availability of financial assistance for non profit EMS organizations and localities.
  • Increase communications interoperability between EMS agencies and other public safety organizations and agencies at the local, state and federal levels. Increase number of communications centers employing Emergency Medical Dispatch programs.
  Link to State Strategy
  • nothing linked
  Objective Measures
  • Number of EMS personnel trained in Mass Casualty Incident Response
    Measure Class:

    Other

    Measure Type:

    Output

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    5300

    Date:

    7/1/2004

    Measure Baseline Description: Number of EMS personnel trained annually

    Measure Target Value:

    6500

    Date:

    6/30/2012

    Measure Target Description: Additional number of EMS personnel trained annually

    Data Source and Calculation: Data maintained through the Virginia Office of EMS in the course enrollment and certification database.

• Provide statewide regional planning for Virginia’s Emergency Medical Services System.
  Objective Description
  Effective planning and coordination is essential to the success of Virginia’s EMS system. Such plans should facilitate the development and coordination of effective and efficient delivery of EMS in each region. Virginia’s Regional EMS Councils provide overall coordination and leadership in establishing and maintaining EMS related plans, which are approved by the Virginia Department of Health Office of EMS.
  Alignment to Agency Goals
  • Agency Goal: Drive operational excellence in the design and delivery of health department services and provide exceptional services to all customers.
  • Agency Goal: Lead and collaborate with partners in the health care and human services systems to create systems, policies and practices that assure access to quality services.
  • Agency Goal: Promote systems, policies and practices that facilitate improved health for all Virginians.
  • Agency Goal: Respond in a timely manner to any emergency impacting public health through preparation, collaboration, education and rapid intervention.
  Objective Strategies
  • Maintain stakeholder forums to facilitate the development and coordination of an effective and efficient regional EMS system.
  • Establish and maintain advisory structures that are comprised of a governing Board of Directors and committee structures.
  • Promote and act as an advocate for issues that are important and beneficial to the EMS system.
  • Create a process by which stakeholders can review and, when appropriate, adopt policies, procedures and plans to enhance the regional delivery of EMS.
  • Develop, implement and maintain regional EMS Plans.
  • Develop, implement and maintain formal regional Trauma Triage Plans.
  • Develop, implement and maintain regional Mass Casualty Incident Plans.
  • Develop, implement and maintain regional EMS Hospital Diversion Plans.
  • Conduct regional educational sessions for EMS stakeholders on plans.
  • Provide evaluation and guidance on Virginia’s Regulations Governing EMS
  Link to State Strategy
  • nothing linked
  Objective Measures
  • Percent completion of the total number of contracted services within the performance based contract for each Regional EMS Council.
    Measure Class:

    Other

    Measure Type:

    Output

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Frequency Comment: Annually

    Measure Baseline Value:

    88

    Date:

    6/30/2004

    Measure Baseline Description: Percent

    Measure Target Value:

    97

    Date:

    6/30/2012

    Measure Target Description: Percent

    Data Source and Calculation: By contract with the Virginia Department of Health, each region must submit reports on a quarterly and annual basis that summarizes the progress and completion of the scope of services.

• Factors Impacting the Products and/or Services:
  Due to the rising expenses (which include the rise of gas prices, body transport, and embalming fluid price increases) related to running the program, the Anatomical Program anticipates increasing its charge to schools for cadavers during during the 2010-2012 biennium (FY 2010).
  
  New advances in embalming practices and and increased need of school programs for quicker delivery will result in increased expenses (e.g., gasoline, rapid body transport, and embalming) for the service area.
• Anticipated Changes to the Products and/or Services
  To increase donations to meet the customer demands, the Anatomical Program is planning on providing more educational programs and mailings to assisted living facilities and hospice programs.
• Listing of Products and/or Services
  • Obtaining donor consent
  • Mailing brochures and information
  • Keeping a donor database
  • Storing complete records on each donor
  • Coordinating transport of deceased donors from the location of death to Richmond
  • Embalming cadavers
  • Preparing cadavers for medical school or research program delivery
  • Filing the death certificate for donors
  • Obtaining information from families
  • Relaying information to schools if family requests the return of cremated remains
  • Transporting prepared cadavers to medical schools and research centers
  • Invoicing the schools per cadaver for expenses
  • Ensuring the schools and research centers are educated in the program guidelines and the laws governing the program