Is Improvement to Deliver Fast and Accurate information about H1N1 Influenza Epidemics in Spain...

How can IT help fight

pandemics

Public Health in response to Pandemic Influenza

The case of Catalonia

Antoni Plasencia , MD, MPH, PhD

General Director of Public Health

Government of Catalonia, Spain

March 16, 2010

Index

Influenza Pandemic in Catalonia: IS & ICT

Context

Conclusions:

Epidemiologic Surveillance

Healthcare

Prevention

Communication

Index


Context

Conclusions


Healthcare

Prevention

Communication

ContextAutonomous Community of Spain – CATALONIA

Government: Generalitat de Catalunya

Area: 32.106,5 km2

Population (2009): 7.475.420

Life expectancy (2009): 80,55 years

Birth rate (2008): 12,2

Gross Mortality rate (2007): 8,28

Infant mortality (2007): 2,65

GDP/Capita (2007): 24.445€

High urban concentration

Own official language and cultureSource: IdesCat

Catalonia is one of the 17 Autonomous Communities of Spain, and has

full powers regarding citizens’ health care, including public health.

The Healthcare System in Catalonia

ContextCATALONIA – The Healthcare System in Catalonia: universal and free

Public Healthcare

Network

395 basic health areas

807 out-patient offices

65 specialized care

hospitals (17.851 beds)

38 psychiatric care

(4.704 beds)

84 long stay care

(9.164 beds)

102 middle stay care

(2.661 beds)

Source: IdesCat 2008

ContextCATALONIA – The Healthcare System in Catalonia

Universal coverage and free access based on general taxes

Fragmented Information System for most healthcare suppliers due

to the healthcare system diversification

Multiple sources of information

Specialized

Healthcare

Emergency

care

Public

Health Units

Citizens

Pharmacies

Research

centers

Primary

care

IS

Offic

es

ICT

Ne

two

rkThe IS & ICT used are:• Shared Medical Record

• Electronic Prescription

• Clinical units (eCap)

• ...

Offices involved include:• AIAQS

• TicSalut

• Standards office

• ...

Index


Context

Conclusions


Healthcare

Prevention

Communication

Influenza Pandemic in Catalonia: IS & ICT New flu H1N1, ongoing strategies in Catalonia

Executive Committee

of Catalonia

Coordination

Committee

Management Board

Scientific Advisory

Board

Catalonia Pandemic Plan*

Surveillance and early detection

Emergency response

Vaccines

Treatment of infected and exposed prophylaxis (antiviral)

Non-pharmacological measures and social distancing

Schools - Work - Community

Communication

Organizational structure

* Created on 2005 and reviewed on 2008

Influenza Pandemic in Catalonia: IS & ICTCATALONIA - April 24, 2009 - initial statement to activate the protocol for surveillance

and control of influenza A-H1N1 virus

1st case - Virus A (H1N1)

Mexico - March 20091

Infection in 2 children

Southern California

USA – April 20092

Late April

Margaret Chan, the

WHO's director-general,

declared a "public health

emergency of

international concern"

under the rules of the

WHO's new International

Health Regulations when

the first two cases of the

H1N1 virus were reported

in the United States,

followed by hundreds of

cases in Mexico

Public health emergency

of international concern

USA – Late April 20093

On April 24, initial statement

declares activation of

surveillance protocol and

existence of the new

influenza A-H1N1 virus

On April 25, first two cases

are detected in Catalonia

On April 26, the Department

of Health of Catalonia

activates the Coordination

Committee to monitor and

evaluate the new outbreak of

flu.

http://en.wikipedia.org/wiki/WHO

Healthcare

CommunicationPrevention

Epidemiologic

Surveillance

IS & ICT

Influenza Pandemic in Catalonia: IS & ICT Fundamental ideas of the Pandemic Plan: Areas of preparedness

Index


Context

Conclusions


Healthcare

Prevention

Communication

• April 24 – First WHO alert

• According to the plans of surveillance preparedness

and response to emergencies, healthcare system

responsible for the emergencies was alerted only a

few hours after the first WHO alert.

• Within 48 hours a small set of guidelines for

healthcare professionals were released, containing

relevant information about the new virus and

suspected case management.

Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance

ODR: Occupational

Disease Record

IRDS: Individualized

Reportable Disease

System

MRS: Microbiological

Reporting System

STIR: Sexually

transmitted infection

(STI) Record

RDS: Reportable

Disease System

EPIDEMIOLOGICAL SURVEILLANCE

EPIDEMIOLOGICAL SURVEILLANCE1


XX

X

XSSS: Sentinel

Surveillance System

Alerts &

Outbreak

EPIDEMIOLOGICAL SURVEILLANCE

EDCR: Emerging

Disease Registry

EPIDEMIOLOGICAL SURVEILLANCE1

DATA ANALYSIS

COMMUNICATION


Alerts &

Outbreak

ODR: Occupational

Disease Record

IRDS: Individualized

Reportable Disease

System

MRS: Microbiological

Reporting System

STIR: Sexually

transmitted infection

(STI) Record

RDS: Reportable

Disease System

SSS: Sentinel

Surveillance System

May

July

All cases

Only severe cases


PIDIRAC - Sentinel Surveillance System

Distribution of the 33 (8 in

BCN) centers with sentinel

primary care practices

VGA(H3)ADV

A(H1N1)v

Parainfluenza 3 EnterovirusVGC

Parainfluenza 4

Parainfluenza 2

Parainfluenza 1

Rinovirus

VRS

0

100

200

300

400

500

600

21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19

Setmanes

Ta

xa

/ 1

00

.00

0 h

ab

ita

nts

0

10

20

30

40

50

60

70

VGA VGB A(H1N1)v 2009_2010 2008_2009 llindar basal


0

5

10

15

20

25

30

21 24 27 30 3 6 9 12 15 18 21 24 27 30 2 5 8 11 14 17 20 23 26 29 2 5 8 11 14 17 20 23 26 29

April May June July

April 24. Launch of

surveillance protocol

June 11. WHO

declares fase 6

A(H1N1).

July 29.

Surveillance of

severe cases

A(H1N1).

Reportable Disease System

Influenza Pandemic in Catalonia: IS & ICT Match between epidemiologic surveillance and healthcare information

EPIDEMIOLOGIC

SURVEILLANCE

INFORMATION

HEALTHCARE

INFORMATION

The Public Health Department use IS & ICT in order to

integrate information coming from epidemiologic

surveillance and healthcare suppliers.

Value added information

IS & ICT

Index


Context

Conclusions


Healthcare

Prevention

Communication

Influenza Pandemic in Catalonia: IS & ICT Healthcare

Healthcare Response Plans

• In the event of a crisis, identify responsible

• Additional beds (critical and non critical)

• Action Plan provision to offset uncovered services

• Increase telephone assistance

• Strengthen home healthcare

Provide effective and efficient response to the increase in

healthcare demand, especially oriented to critical cases,

among all the healthcare centers of Catalonia

OBJECTIVES

ACTIONS


Organisational model: patient management

HOSPITAL

Critical groups

Pregnant Chronic

patients

Obese

HOSPITAL

HOME

Global population

and children

CA

P

PHONE CALLING

Critical patients

PIUC. Emergency plan to coordinate all

actions from different levels of healthcare

services• Information System monitors healthcare activity and bed

occupation together with scaling and improving resources

• It facilitates:

• Implementation of prevention plans

• Adjustment of resources to the demand

• Prediction of future demand

• It informs:

• Healthcare professionals and citizenship


HEALTHCARE2


PIUC. One week emergency cases in a hospital


Healthcare Region Inhabitants Severe patients Rate (per 100.000 pop.)

BCN 5.056.683 523 10,3

GIR 739.070 65 8,8

CT 609.547 97 15,9

CC 511.815 51 10,0

LL 363.612 21 5,8

TE 193.819 13 6,7

APA 77.313 1 1,3

TOTAL 7.551.859 771 10,2

Healthcare. Total severe patients diagnosed in Catalonia


All PIUC information is analyzed by

healthcare and Public Health

professionals in order to monitor the

epidemic and predict future trends and

demand and to adjust resources

efficiently.

Index


Context

Conclusions


Healthcare

Prevention

Communication

Influenza Pandemic in Catalonia: IS & ICT Prevention

• Measures used to decrease infection

transmission:

• Hygienic practices

• Vaccines and antivirals

• Social distancing

• Other non-pharmacological

New ICT were used to disseminate and

monitor all the measures.

Influenza Pandemic in Catalonia: IS & ICT Antivirals

Index


Context

Conclusions


Healthcare

Prevention

Communication

• Communication plan focuses on

• Citizens

• Healthcare professionals

• Media

• Main objectives

• Avoid citizenship alarm

• Provide precise information about

• Influenza’s evolution

• Best prevention and treatment measures

• Communication principles

• Transparency

• Coherence

• Empathy

Influenza Pandemic in Catalonia: IS & ICT Communication


COMMUNICATION - INTERNET4

COMMUNICATION – MEDIA4


WHAT WE HAD WHAT WE WILL HAVE

• Fragmented IS

• No communication

between applications

• Need for updated IT

• Management

difficulties and data

analysis problems

• Uncovered areas of

knowledge

• IS connected through

Interoperability

Standards

• Modernized IT

• Integrated information

• Easier and faster data

analysis

• Fully integrated IS

• Easy and fluent

communication

between applications

• Shared strategies

among healthcare

providers and agents

Influenza Pandemic in Catalonia: IS & ICT Turning threats into opportunities

WORK IN PROCESS

Index


Context

Conclusions


Healthcare

Prevention

Communication

• Previous preparation efforts and existing coordination

structures have been decisive to give a rapid response

to this new pandemic

• But it has been crucial to

• Adapt surveillance systems

• Coordinate and manage all levels of health care

• Update training programs

• Tailor informative messages

ConclusionsGlobal

Flexibility

Data quality

PredictionSimplicity

Timeliness

20042010

The development and implementation of new IS and ICT

will have a substantial impact upon decision management:

More information and with more quality

ConclusionsProgress

ConclusionsLessons learned

The response to pandemic influenza in Catalonia

has provided an opportunity to improve and

innovate in IS and ICTs.

Barriers are more organizational than technical or

technological.

Involvement of different agents in the process.

Better management tools for future collective health

emergencies.

THANK YOU !

Moltes gràcies!

¡Muchas gracias!

[email protected]

mailto:[email protected]

Is Improvement to Deliver Fast and Accurate information about H1N1 Influenza Epidemics in Spain...

Health & Medicine

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