• 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. 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. Eight of these measures were designated as "key" agency performance measures.
  
  Key Measures:
  
  Adult obesity rate. The rate during 2006 was 25.1 percent, which was the same as during 2005. VDH’s target is 20.5 percent, to be reached by the end of FY 2009, which is very ambitious. The Governor’s Health Reform Commission presented a number of recommendations designed to improve Virginia’s obesity prevention efforts. If implemented, those recommendations will strengthen VDH’s ability to meet this aggressive target.
  
  Prevalence of smoking. 19.3 percent of adults over age 18 smoked in 2006. This represents substantial progress towards the FY 2008 target of 19 percent. 15.5 % of middle and high-school age students smoked as of 2005. The target for youth is 14.5 percent by the end of FY 2009. The youth smoking data is collected biannually in odd-numbered years, with the next survey scheduled for the fall of 2007. VDH has determined and proposed that, for purposes of public reporting on Virginia Performs, that there should be separate performance measures for the adult and youth smoking rates.
  
  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 2007, the cumulative number of citizens reached 115,801. VDH is on target to reach its target of 124,805 by the end of FY 2009.
  
  Immunization rate for two-year old children. The immunization rate in FY 2006 was 80.7 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 2009. 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. The baseline value is 7.4 deaths per 1000 live births in 2004. The target is 7 deaths per 1000 live births by the end of FY 2009. There is a two-year lag in the data used to calculate the infant mortality rate. The target will reflect deaths occurring during 2006, with the data becoming available in 2008. The Governor’s Health Reform Commission presented a number of recommendations designed to improve Virginia’s infant mortality prevention efforts. If implemented, those recommendations will strengthen VDH’s ability to meet this aggressive target.
  
  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 1000 females age 10-19 in CY 2004. The target is 26.2 in CY 2006, with the data to be reported in 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 2007, the pressure ulcer rate was 10.03 percent. This represented some progress relative to the FY 2005 baseline of 10.5 percent, but did not reach the FY 2007 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 2007 was 69.1 percent. This represented modest progress relative to the FY 2006 baseline of 66.8 pecent. The target is 80 percent to be achieved by the end of FY 2009. The pneumococcal immunization rate in FY 2007 was 66.8 percent, representing minimal progress relative to the FY 2006 baseline of 66.5 percent. The target to be reached by the end of FY 2009 is 80 percent. VDH continues to develop and implement a number of different strategies in order to reach these targets. VDH has determined and proposed that, for purposes of public reporting on Virginia Performs, that there should be separate performance measures for the influenza and pneumococcal immunization rates.
  
  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 are trained in National Incident Management Systems (NIMS). Sixty four percent of applicable VDH staff had received NIMS training of the end of FY 2007, just short of the target of 65 percent. By contrast, only four percent of applicable VDH staff had received such training in FY 2005.
  
  Compliance with conditioned obligations of Certificates of Public Need. Recipients of COPN’s were in compliance with 56 percent of conditioned obligations (typically obligations to provide a certain level of charity care to indigent or uninsured individuals) during FY 2007. This was below the target rate of 60 percent.
  
  HIV infection incidence rate. The rate in FY 2007 was 11.33 cases per 100,000 population. VDH is on track to reach its target of 12 by the end of FY 2009.
  
  Percentage of individuals with newly diagnosed HIV infection who receive their HIV test results. Only 47 percent of such individuals received their test results in FY 2007. VDH is not on track to reach its target of 73 percent by the end of FY 2009. VDH believes that this is primarily attributable to incomplete post-test data submission, rather than failure to conduct the post test interview. VDH management plans to address this issue with program staff, as well as consider alternate ways to capture the data.
  
  Percentage of HIV-infected persons receiving optimal drug therapy. The FY 2007 percent was 98.9, exceeding the target of 96 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 2005, 90.3 percent had completed an adequate course of treatment within 12 months by the end of CY 2006. VDH’s target is 94 percent, to be achieved by the end of FY 2009.
  
  Number of cadavers provided to Virginia medical schools and research centers. A total of 320 cadavers were provided in FY 2007, 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). During FY 2007 there were 23 newly designated areas, and 41 redesignated areas. This exceeded the target of 20 new designations and 20 redesignations. In order to better measure VDH’s efforts to promote access to care, VDH will be revising this measure for the 2008-2010 biennium. The revised measure will be 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.
  
  Number of children participating in the fluoride rinse program. During FY 2007, 50,500 chidren participated, exceeding the target of 48,000.
  
  Number of protective sealants placed on children's teeth at public health clinics. During FY 2007, 21,312 sealants were applied, compared to the target of 21,934. The number of children served has increased since FY 2005.
  
  Percentage of compliance with regulations by emergency medical services agencies. The compliance rate in FY 2007 was 87.7 percent, substantially below the target of 95 percent.
  
  Number of emergency medical services personnel trained in mass casualty incident management. During FY 2007, 1,135 new personnel received this training, exceeding the target of 1,000.
  
  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 2.4 days as of June 30, 2007, exceeding VDH’s FY 2007 target.
  
  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 2007, 15 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 2007, the website averaged 89,800 monthly visits, far exceeding 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 2007, VDH had a 64 percent on-time percentage, compared to the target of 65 percent.
• Summary of current productivity
  VDH's FY 2007 full-time equivalent (FTE) appropriation is 3,768. VDH has averaged 3,502 FTEs over the past five years.
  
  VDH’s FY 2008 budget is approximately $535 million. This is comprised of 32 percent general funds and 68 percent non-general funds. The non-general funds consist of federal funds (61 percent), local funds (16 percent) and earned revenue (23 percent). The percentage of state general funds appropriated to VDH has been declining since the 1992-94 biennium. At that time, general funds represented 1.67 percent, compared to 0.99 percent in the current biennium. The percentage of all state funds appropriated to VDH also declined during that same time period, from 2.11 percent to 1.53 percent.
  
  VDH strives to ensure that its programs and services are administered as efficiently and effectively as possible. The Governor’s Management Standards Scorecard measures existing and emerging standards of management operations within VDH. During FY 2007, VDH met expectations for the agency in 100 percent of the scorecard categories.

• Summary of Major Initiatives and Related Progress
  Worked closely with the Governor’s Health Reform Commission to provide requested information and analysis on a variety of issues pertaining to access, health workforce, long term care, quality, transparency and prevention.
  
  Played a leading role in responding to the April 2007 shootings at Virginia Tech through the work of the Office of the Chief Medical Examiner, Emergency Preparedness and Response Programs, the Office of Emergency Medical Services, and the Office of Communications.
  
  Strengthed public health capacity to prevent and control chronic disease through the award of nearly $1 million in competitive grant funding to local health districts. Those local health districts receiving funding developed measurable outcomes to be achieved and demonstrated effective partnerships within their community that will help to promote sustainability of prevention efforts beyond the end of the grant period.
  
  Continued development of a statewide obesity prevention plan as part of the CHAMPION initiative. VDH has identified community based obesity prevention programs that have been evaluated, proven to be cost effective and replicable in other communities.
  
  Collaborated with the Department of Education in order to received a $100,000 grant from the National Governor’s Association to support innovative child obesity prevention efforts between public health and public education at the local level.
  
  Developed the Saving Babies Initiative, with the goal of helping communities analyze their risk factors and implement innovative programs and strategies that will save the lives of at least 50 babies in 2007. Increasing screening (e.g., drugs, domestic violence, depression) for pregnant women, educating all child-bearing age women about the benefits of folic acid in prevention of neural tube defects, working closely with the March of Dimes Operation Preemie, and outreach education to all women on the importance of preconception care are some of the key activities taking place.
  
  Implemented the Pregnancy Risk Assessment Monitoring System. This will survey 100 mothers of newborns each month to learn why some babies are born healthy and some are not. This information will help VDH further understand causes of preventable infant deaths, and work with mothers to improve birth outcomes.
  
  Improved capacity to communicate with diverse, and non-English speaking, populations. Influenza prevention outreach efforts were developed with messages targeted at individuals with unique cultural and ethnic backgrounds. VDH entered into a new, agency wide contract for translation and interpretation services. VDH continued implementation of its Culturally and Linguistically Appropriate Health Care Services (CLAS Act) program, including development of a language needs assessment for local health districts, and publication of an on-line resource guide for health care providers. VDH also established a new Office of Minority Health and Public Health Policy.
  
  Used recently appropriated state funds to upgrade dental equipment in district health departments. A motor-home sized mobile unit featuring two operatories, and two smaller vans each equipped with a patient chair, are now available for use wherever there is a need. Other modular and fixed dental suites have been modernized with new x-ray units, autoclaves and other equipment.
  
  Implemented an expanded Virginia Nursing Scholarship program focused on graduate level nursing students who plan to become nursing educators
  
  Developed a Rational Service Area Plan for primary care. The plan identifies potential primary care Health Professional Shortage Areas (HPSA) using primary care service area analysis. This process has helped identify small areas of the Commonwealth where a shortage of primary care physicians may exist, and enables VDH to assess HPSA designation potential.
  
  Worked collaboratively with stakeholders in order to develop proposed revisions to the State Medical Facilities Plan, the first comprehensive revision of the plan in 15 years. The proposed revisions were approved by the State Board of Health in February 2007, and are currently undergoing Executive Branch review prior to being published and issued for public comment.
  
  Participated in the Advancing Excellence in America’s Nursing Homes campaign via the Local Area Network for Excellence sponsored by the Virginia Health Quality Center. This is a two-year effort to improve the quality of care and quality of life for nursing home residents. The current area of specific focus is pressure ulcer reduction.
  
  In response to 2006 federal legislation, the Division of Vital Records (DVR) collaborated with the Department of Medical Assistance Services and the Department of Social Services in order to help provide clients with assistance in obtaining documentation necessary to demonstrate proof of citizenship. DVR has responded to nearly 62,000 requests for assistance.
  
  Received an EMS Partnership Grant from the U.S. Health Resources and Services Administration, enabling the transfer of the EMS for Children Program to the Office of Emergency Medical Services. This program works to assure that the pediatric population is well represented in all matters of emergency medical care, and seeks to ensure that adequate pediatric equipment and training are available to those caring for children.
  
  Responded to numerous disease outbreaks including two high profile multi-state food borne outbreaks investigated by the U.S. Centers for Disease Control and Prevention: E. Coli O157:H7 associated with spinach, and Salmonella Tennessee associated with peanut butter
  
  The Electronic Surveillance System for the Early Notification of Community Based Epidemics (ESSENCE) added data from 18 additional facilities and expanded coverage to the Soutwest Region. The National Electronic Disease Surveillance System (NEDDS) expanded to incorporate all 35 local health districts.
  
  Pilot tested 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 allowed for the sharing of electronic immunization data, which will be used to assist with the accurate and timely administration of immunizations.
  
  Responded to water system failure in Town of Goshen in June 2007. Approximately 450 people were without access to drinking water for nearly two weeks due to a series of leak’s in the town’s water system. The VDH Office of Drinking Water, VDH Emergerncy Preparedness and Response Programs, and the Office of Communications coordinated the response. This included issuance of a Boil Water Advisory, coordinating with contractors to find and repair the leaks, managing media relations and public outreach, and identifying potential funding options for replacing the town’s aging water system.
  
  Received commendation from U.S. Environmental Protection Agency (EPA) in May 2006 for its continued effective management of the Drinking Water State Revolving Fund Program. EPA commended VDH for its outstanding record of providing assistance to small and disadvantaged drinking water systems.
  
  Coordinated with Southside Virginia Community College to establish a training center that offers continuing education in the onsite sewage and water supply program. The training is designed for VDH environmental health staff, Authorized Onsite Soil Evaluators, professional engineers and contractors.
  
  Implemented a community needs assessment program in several regions, called Mobilizing for Action through Planning and Partnership (MAPP). This will help local health departments share successful programs and, ideally, help all sectors of the community collaborate more strategically on unique public health challenges.
  
  Led a statewide public health exercise, FLUEX 06, to evaluate the state’s response and recovery operations in the event of a pandemic influenza outbreak. Through this exercise, VDH assessed its preparedness plans and communication and coordination through the various levels of government. VDH also assessed its ability to share critical information with participating entities throughout a pandemic influenza response.
  
  Worked to establish the Cities Readiness Initiative (CRI) program in cities throughout Virginia. This is a program to aid cities by increasing their capacity to quickly deliver medicine and medical supplies during a large scale public health emergency. The primary goal of CRI is to minimize the loss of life by providing needed drugs to 100 percent of a city’s population within a 48 hour time frame.
  
  Updated Continuity of Operations Plans, in compliance with Governor’s directive, for all VDH work units.
• 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 21st among all the states in 2006, which represents an improvement from 2005 when it was 24th. 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 2006 rankings, Virginia’s strengths include a high immunization coverage rate for children age 19-35 months, few poor physical health days per month, a low percentage of children in poverty, a good high school graduation rate, and a low rate of motor vehicle deaths. Challenges include a high infant mortality rate at 7.2 deaths per 1,000 live births and a low per capita public health spending amount of $97. The rankings also noted the continuation of certain health care disparities within Virginia. For example, the percentage of pregnant women receiving prenatal care varies from 70 percent among Hispanics to 91 percent among Caucasians.
  
  Also in 2006, 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 colonoscopy/sigmoidoscopy rates, pap smear rates, limited use of physical restraints in nursing homes, and mobility of Medicare home health patients. Virginia ranked weakest in terms of pressure ulcer rates among nursing home patients, and patient satisfaction with Medicare managed care providers.
  
  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 a high national ranking for readiness to respond to bioterrorism and other pubic health emergencies during 2006. The Trust for America’s Health is a national non-profit, nonpartisan public health organization. Virginia is one of only 14 states that achieved eight or more of the 10 key indicators used to gauge state preparedness and determine overall readiness to respond to terrorism attacks and other health emergencies. Only two states, Oklahoma and Kansas, scored higher than Virginia. Half of the states received a score of six or less. The report points out that Virginia has made progress in many areas, such as health and medical emergency response planning, enhanced emergency communication technology, and dramatic upgrades in its public health laboratory. Virginia also recently achieved ‘green’ status 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.
  
  According to the report, the two key indicators that Virginia had not met were 1) two weeks of hospital bed surge capacity in the event of a moderate pandemic and 2) does not have a nursing shortage. The Commonwealth’s nursing shortage is an issue that is being addressed by the Governor’s Health Reform Commission . VDH is continuing to address the need for medical surge capacity through expansion of hospital capabilities, as well as acquisition of portable medical capabilities.
• Summary of Customer Trends and Coverage
  All 7.6 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 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 will continue to increase, and in some areas of the state the growth will be 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 an 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.
  
  Growning 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.
  
  Continued increase in the annual number of Certificate of Public Need requests originating from physicians and physician practice groups, as well as from hospitals, is anticipated.
  
  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.

• Summary of Future Direction and Expectations
  Address the growing impact of chronic disease. The State Board of Health has made chronic disease prevention and control its top priority. 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 68 percent of VDH’s FY 2008 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. VDH received an additional $1.3 million in funding to support dental services beginning in FY 2006. These funds are being used to expand the loan repayment program to recruit additional dentists to practice in underserved areas, obtain new dental equipment for use in VDH clinics, and increase the salaries of dentists employed by VDH.
  
  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 povides 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. Pursuant to 2007 legislation enacted by the General Assembly, VDH will be developing a program to identify and improve water systems that are chronically noncompliant with regulatory provisions intended to protect public health.
  
  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.
  
  The Preventive Health and Health Services Block Grant, which is proposed for elimination in the President’s FY 2008 Federal Budget, is an example of a federal funding source on which VDH has become increasingly dependent for delivery of a wide range of services. Federal funding for Emergency Preparedness and Response is also being cut, which could greatly impact the positions created and staff hired with the public health preparedness funds received from the Centers for Disease Control and Prevention. If VDH loses these positions, it will have a significant negative impact on public health preparedness in the Commonwealth.
  
  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. 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 42 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 influenzae 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 school age, maternal, early child and adult/older adult populations,
  Developing, administering and monitoring 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 dentistry through site reviews, recruitment and orientation of staff.
  Providing clinical services for indigent patients with chronic diseases (offered by some local health departments).
  
  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.
  Provide 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 home health services (offered by two local health districts).
  
  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 20 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 will require 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. This will require the Office of EMS to examine new technologies for the collection, validation, and evaluation of data.
  
  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.
  
  There is an increasing emphasis nationally on the significance of mental health in the child’s overall health status, and a push throughout Virginia for incorporating mental health in programs funded by the Maternal Child Health Block Grant.
  
  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 which have an impact on students’ ability to learn. For example, the nutritional environment in many schools is inadequate.
  
  In 2005, the infant mortality rate (death within the first year of life) was 7.4 deaths per 1,000 live births, the same rate as in 2004. The leading causes of death were related to short gestation and low weight birth, complications of labor and delivery, and Sudden Infant Death Syndrome. The infant mortality rate is expected to gradually rise largely due to the inability to reduce low weight births.
  
  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 slowly 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 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 all well child visits. This significantly raises the standard of care for child health.
  
  Congress did not reauthorize funding for abstinence education in 2007, in response to a federal study concluding that abstinence education is ineffective.
  
  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 problems.
  
  Lack of dedicated funding for chronic disease prevention and control directly impacts products and services. Money controls both the availability of staff to develop and conduct programming and the necessary materials to do so. Without dedicated funding, neither those staff positions nor the provision of organized programming would be available to provide consistent population-based preventive services in the community.
  
  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 15 of the 40 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 impact recruitment and retention.
  
  Much of VDH’s dental equipment has been replaced over the past two years. Clinic items replaced in all fixed facilities include xray unit, delivery unit, compressor, autoclave, film processor, chair, and light. Many mobile units received similar upgrades.
  
  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. However, this public health dentistry service delivery model relies on the availability of dental hygienists, who are in short supply.
  
  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.
  
  The demand for COPNs has increased significantly since 1999. The increase is due to a combination of factors that includes advances in the capability and affordability of technology, population growth, continued growth in consumer demand for service, physician desire to vertically integrate their practices, and competition.
  
  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 lead to VDH having to increase time spent on 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 Drinking Water State Revolving Fund grant allotment received by VDH from the U.S. Environmental Protection Agency (EPA) will decline by about $2.65 million for federal fiscal years 2006-2009. The new allotment amount will be for $8.89 million. The EPA allots funds to states based on a national needs assessment done every four years. The 2003 Needs Survey shows that Virginia’s recorded drinking water needs are up from the 1999 Needs Survey; however, Virginia’s drinking water needs did not rise at the same pace as the total national need. Based on the national assessment performed by EPA, Virginia received a lower percentage of the national need than in 1999. While Virginia continues to show an increased need for funding to support the drinking water construction projects, the funds allotted by EPA have continued to decrease.
  
  Vital Records and Health Statistics
  
  With the increase in crime (i.e. fraud, identify theft, forged vital records) more requests for vital records are expected from law enforcement agencies.
  
  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 supplies are severely challenged to handle the daily services required by the current population. 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.
  
  Existence of an anthrax screening devices in large postal facilities will necessitate the ability to quickly respond to predicted number of false positives.
  
  Community-based organizations may take a larger role in partner counseling and referral services for newly diagnosed persons with HIV.
  
  Because of the increasing demand for services and decreases in funding, additional limitations on access to HIV treatment services are anticipated. Impact is expected to be greatest on primary medical care, which is already experiencing a prolonged wait for access to services in some parts of the state.
  
  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.
  
  Rapid 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
  
  Reductions in federal funding for emergency preparedness and response will result in lessened ability to maintain and update public health infrastructure improvements achieved since September 11, 2001.
  
  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 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. 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 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.
  
  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 Family Planning Medicaid Waiver limiting service coverage to two years post pregnancy 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 has been eliminated from the proposed 2008 federal budget and, if not restored, 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.
  
  In anticipation of the USDA's approval of food package changes, the WIC program will develop a food package change implementation plan. This will affect the types of food WIC participants may receive.
  
  Absent additional funding for the WIC program, current efforts to address obesity prevention across the lifespan will have to be reduced to focus strictly on childbearing women and children up to 18.
  
  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 allocated to evaluation of engineering reports, plans and specifications as a result of increased regulation and upgrades for replacing aging facilities or for expanded waterworks.
  
  Focus will be placed on identifying and improving those waterworks that are chronically noncompliant with regulations intended to protect public health.
  
  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 or static funding sources will erode ability to maintain present services as well as to create new assistance.
  
  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.
  
  Future reports produced by the Division for Health Statistics will include more information concerning Virginia’s Hispanic and Asian populations.
  
  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
  
  The tuition at VCU School of Dentistry continues to increase. As tuition increases the overall number of scholarship and loan repayment contracts will decline long term.
  
  New awards in the Virginia Medical Scholarship Program will be phased out by 2008, 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 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 approximately 46 service areas and fund appropriations. The specific breakdown of all sources of the agency budget is: federal grants and contracts (41 percent); general funds (32 percent); local government funds for local health departments (11 percent); fees and charges for services (13 percent); dedicated special revenues (three percent); and private grants, donations, and gifts (less than one 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 95 federal grants and 36 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, and Safe Drinking Water.
  
  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 surcharge on motor vehicle registrations earmarked for Emergency Medical Services and repayments on loans.
• Financial Breakdown:

  	FY 2009			FY 2010
  	General Fund	Nongeneral Fund		General Fund	Nongeneral Fund
  Base Budget	$176,455,380	$415,467,480		$176,185,603	$414,344,934
  Change To Base	$-7,380,778	$-2,845,519		$-12,403,833	$-2,596,098
  Agency Total	$169,074,602	$412,621,961		$163,781,770	$411,748,836

  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 113 roles and 227 job working titles. As of June 30, 2007, VDH had an appropriated level of 3,768 salaried FTEs, with 3,663 positions filled.
  
  Agency demographics are similar to the Commonwealth’s workforce profile. As of June 30, 2007, the average age of VDH employees was 48 years, with a median age of 50 years, compared with an average age of 45 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-two percent of the state workforce. Five percent of the VDH workforce is currently eligible for full retirement, compared with nine 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. Twenty-nine percent of VDH's employees are members of minority groups.
• Human Resource Levels

  Effective Date	6/30/2007
  Total Authorized Position level	3768
  Vacant Positions	-105
  Current Employment Level	3,663.0
  Non-Classified (Filled)	2
  Full-Time Classified (Filled)	3619		breakout of Current Employment Level
  Part-Time Classified (Filled)	44
  Faculty (Filled)	0
  Wage	564
  Contract Employees	225
  Total Human Resource Level	4,452.0		= 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.
  
  Declining enrollment in post-secondary educational institutions will result in increased competition for graduates to staff the public health workforce. 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, 2007, 38.9 percent of the VDH workforce was 50 years or older and eligible for retirement, with 5.3 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.

• Narrative overview of the current state of IT in the agency:
  VDH continues to experience challenges associated with transforming the IT infrastructure to one managed by the Virginia Information Technologies Agency and Northrop Grumman (VITA/NG) partnership. These challenges are operational and financial. Though progress has been made, some uncertainty will remain until the transformation process has been completed over the next two years.
  
  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 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.
  
  VDH has almost completed the process of centralizing application development and maintenance to ensure that all applications use standard methodology such as configuration management and quality assurance, and to better manage risk through cross training and standard architecture. This process is complicated by federal requirements and/or federally required or developed applications.
  
  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 almost 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. Challenges continue as many of the programmers remain contract employees.
  
  VDH is in the process of moving its disaster recovery site to the Southside Mental Health campus to eliminate the challenges faced with its current location and to move it farther from Richmond. This new location will also add increased continuation of operations capabilities.
• Narrative description of the factors impacting agency IT:
  Like all executive branch agencies, much of VDH’s IT issues are complicated by VITA, the proposed service based fees, and the proposals received pursuant to the Public-Private Educational Facilities and Infrastructure Act (PPEA). These initiatives add substantial uncertainty, unknown administrative hurdles, and potential costs.
  
  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 requirements of syndromic surveillance (tracking data such as emergency room chief complaint, i.e. the reason for admission) have expanded the need for acquisition and processing of externally generated data in real time. Again, this adds additional acuity to the traditional VDH mission.
  
  Internal customers are increasingly demanding wireless solutions. As much of VDH data is covered by HIPAA, data security is a constant concern. VDH does not currently permit 802.11 devices to be connected to the network.
• Describe any anticipated or desired changes to agency IT:
  Much of the uncertainty associated with VITA should decrease over the next two years.
  
  VDH anticipates that the IT Staff Augmentation Operational Review will provide avenues to address the issue of long-term reliance on IT contractors.
  
  VDH plans to enhance the functionality of the data warehouse and to add the number of data sources being captured. Providing enhanced accounts receivable reporting is a high short term priority. 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. Immunization Registry - The Virginia Immunization Information System (VIIS) will allow VDH to fulfill the requirement of § 32.1-46.01 of the Code of Virginia requiring the Board of Health to establish VIIS, a statewide immunization registry that consolidates patient immunization histories from birth to death into a complete, accurate, and definitive record that may be made available to participating health care providers throughout Virginia. The purpose of VIIS is to protect the public health of all citizens, prevent under and over immunizations of children, ensure up-to-date recommendations for immunization scheduling to health care providers, generate parental reminder and recall notices, identify areas of under-immunized population, and to provide, in the event of a public health emergency, a mechanism for tracking the distribution and administration of immunizations.
  
  2. 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.
  
  3. Health Statistics Data Warehouse Conversion - The Division of Health Statistics data warehouse conversion will move archived vital statistics files from their storage in a flat file data system at VITA to relational databases within VDH’s data warehouse. The systems involved are birth, deaths, fetal deaths, induced terminations of pregnancy, marriages, and divorces. This migration of data will make vital statistics information much more readily available to the data using community and enhance data sharing.
  
  4. The Rescue Squad Assistance Fund (RSAF) project will allow the Office of Emergency Medical Services (OEMS) to fulfill the requirement of § 32.1-111.12. The Virginia RSAF provides financial assistance to rescue squads and other emergency medical services organizations in the Commonwealth. This project will enable OEMS to provide a web-based application for the RSAF Program and will link the information to other software programs and databases.
  
  5. The Prehospital Patient Care Reporting Program will replace the current legacy system with one that will fully meet the current Code requirements, allow web-based submission of reports by the over 700 EMS agencies, and provide near real-time data.
  
  6. VDH’s efforts to adopt an electronic health record (EHR) for its own patients have experienced a number of obstacles during previous planning efforts. VDH recently received a $250,000 Productivity Investment Fund grant to implement a pilot project and is in the very early planning stages of this effort.
  
  7. VDH has recognized the many benefits of Electronic Document Management and is in the planning phase of a project to automate many internal processes using the enterprise application selected by the Department of Environmental Quality on behalf of the Commonwealth.
  
  8. 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 Current Services:

  	Cost - Year 1		Cost - Year 2
  	General Fund	Non-general Fund	General Fund	Non-general Fund
  Projected FY2010 VITA Service Fees	$0	$0	$0	$0
  Changes (+/-) to VITA Infrastructure	$0	$0	$0	$0
  Estimated VITA Infrastruture	$0	$0	$0	$0
  Specialized Infrastructure	$0	$0	$0	$0
  Agency IT Staff	$0	$0	$0	$0
  Non-agency IT Staff	$0	$0	$0	$0
  Other Application Costs	$4,968,904	$4,294,345	$4,968,904	$4,294,345
  Agency IT Current Services	$4,968,904	$4,294,345	$4,968,904	$4,294,345

  Comments:
  [Nothing entered]
• Proposed IT Investments

  	Cost - Year 1		Cost - Year 2
  	General Fund	Non-general Fund	General Fund	Non-general Fund
  Major IT Projects	$0	$4,166,320	$0	$1,568,431
  Non-major IT Projects From $100,000 - $1 Milliona Total Cost	$0	$675,000	$0	$175,000
  Non-major IT Projects Below $100,000 Total Cost	$0	$0	$0	$0
  Major IT Procurements - Stand-alone	$0	$0	$0	$0
  Non-major IT Procurements - Stand-alone	$495,000	$272,760	$495,000	$0
  Total Proposed IT Investments	$495,000	$5,114,080	$495,000	$1,743,431

• Projected Total IT Budget

  	Cost - Year 1		Cost - Year 2
  	General Fund	Non-general Fund	General Fund	Non-general Fund
  Agency IT Current Services	$4,968,904	$4,294,345	$4,968,904	$4,294,345
  Total Proposed IT Investments	$495,000	$5,114,080	$495,000	$1,743,431
  Agency Projected Total IT Budget	$5,463,904	$9,408,425	$5,463,904	$6,037,776

• 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.

  Objective Measures

  • 90% of two-year old children in Virginia will be appropriately immunized
    Measure Class:

    Governor's Key

    Measure Type:

    Outcome

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Key Summary: We will increase the percentage of two-year old children in Virginia who are appropriately immunized to 90 percent by June 30, 2009.

    Measure Baseline Value:

    84

    Date:

    6/30/2004

    Measure Baseline Description: Percent of children

    Measure Target Value:

    90

    Date:

    6/30/2010

    Measure Target Description: Percent of children

    Data Source and Calculation: Centers for Disease Control and Prevention - National Immunization Survey

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.

• Factors Impacting the Products and/or Services:
  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
  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 2008-2010 biennium (FY09).
  
  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

• Increase the number of donor cadavers available to medical schools and research centers in Virginia, in order to provide sufficient anatomical material to properly teach anatomy of the human body.
  Objective Description
  This service area provides donated cadavers to medical schools and research centers in the Commonwealth of Virginia for anatomical study. The nonprofit State Anatomical Program, supervised by the Office of the Chief Medical Examiner (OCME) within the Virginia Department of Health, is the only program in Virginia authorized to receive donation of human bodies for scientific study for the teaching of anatomy, surgery, and performing research in Virginia’s medical schools, colleges, universities, and research facilities.
  Objective Strategies
  • Conduct an outreach program to 75 assisted living facilities to educate potential donors on the process and benefits of the donation program. This will increase the donor base with individuals that are at a time in their lives when they are planning for their eventual death. The outreach will include a mailing of informational brochures and on site presentations at facilities.
  • Distribute materials for funeral directors to give to families who may want to use the program as an alternative to funeral services when family financial resources are limited.
  Objective Measures
  • Number of cadavers provided to Virginia medical schools and research centers.
    Measure Class:

    Other

    Measure Type:

    Output

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    310

    Date:

    6/30/2005

    Measure Baseline Description: Number of cadavers

    Measure Target Value:

    360

    Date:

    6/30/2010

    Measure Target Description: Number of cadavers

    Data Source and Calculation: The data source for this calculation is the numbering system used by the anatomical program each year to number the cadavers to protect their identities. • This can also be measured by calculating the amount the recipient medical schools and research centers have been billed for cadavers.