Disease outbreak response times to improve

A person suffering extreme breathing difficulty and high feveris rushed to a hospital. The patient’s condition rapidlydeteriorates and a nurse at his bedside develops similar symptoms.Moments later a diagnosis confirms Toronto’s first human case ofavian flu.

Had this hypothetical incident occurred some years ago, it wouldhave thrown the province’s health system into disarray.

Today health professionals will likely be well equipped torespond to such an emergency, having being alerted beforehand.

Advance alerts are made possible thanks to a databank and casemanagement system rolled out in April 2005.

Dubbed iPHIS (Integrated Public Health Information System), itenables Ontario health professionals to better track thedevelopment of potential outbreaks.

Among other things, iPHIS provides a central database from whereOntario health organizations can enter, access and manageinformation on communicable diseases.

That’s a far cry from the situation just a few years ago.

For instance, when SARS (Severe Acute Respiratory Syndrome) hitToronto in 2003, health professionals were caught flatfooted -inundated with a barrage of case reports from across the city.

At the time, the city’s health authorities had no way of gettingimmediate updates on cases from outlying health units other than bycalling the concerned office. Information was often duplicated.

“It was extremely difficult to get a big picture of the completesituation,” reminisced Dr. Michael Finkelstein, associate medicalofficer at the Toronto Public Health.

Today, iPHIS offers health professionals this holistic picture.”It allows health workers to obtain an aggregate view of how anoutbreak might be progressing across the province,” said Bob Betts,manager for client services at the Smart Systems for Health Agency(SSHA) .

An Ontario Ministry of Health Agency, SSHA electronicallyconnects 95 per cent of the province’s hospitals and providesaccess to vital information and resources to more than 150,000health care workers. Betts said iPHIS has been deployed acrossOntario’s 36 health districts and is an integral part of thesecure, province-wide IT network.

Prior to iPHIS, Ontario health workers relied on a centralizedinformation system known as Reportable Diseases Information System(RDIS). Finkelstein said RDIS was based on a disk operating system(DOS) written in a language called MUMPS (Massachusetts GeneralHospital Utility Multi-Programming System). “The SARS outbreakhighlighted the deficiencies of the RDIS.”

These included:
o Difficulty in navigating the cumbersome DOS-based userinterface;
o No proper system for authenticating input and preventing doubleentries;
o No way to re-classify cases when the criteria for a diseasechanges;
o Absence of data sharing and real time data gathering across thehealth units; and,
o Inability to detect trends and outbreaks.

“RDIS became a mere reporting tool rather than a case managementsystem,” said Finkelstein.

By contrast, he said iPHIS – now connected to the SSHA managednetwork – uses Report Net business intelligence software fromOttawa-based Cognos Inc. Finkelstein also said the system runs on asecure network .

Stephanie Wolf, an epidemiologist at the Simcoe Muskoka DistrictHealth Unit said the software allows workers like her to extractdata and correlate cases with risk exposures. “If I were to getmultiple reports of salmonella cases across my district, I cansearch for a common link based on such factors as age, gender orlocation.”

Based on the data, health officials can warn the public to avoida certain area, or they can target action to a specific segement ofthe population, Wolf said.

She also likes the flexibility of the system. “The drop-downmenus make for faster searches, and also allow technicians to alterfields as disease criteria change.”

Because iPHIS is Web-based, Wolf said, workers are able totransmit and receive data almost instantaneously.

She said iPHIS is also interoperable with other health systemssuch as the Ontario Laboratory Information System (OLIS) whichallows health and lab workers to share laboratory test, specimen,and results information.

Last Fall, when an outbreak of more than 500 salmonella casesdid strike Toronto and surrounding regions – including Peel,Kingston, Hamilton, Simcoe and Muskoka – Finkelstein said iPHIS”was able to rapidly transmit information” among the districts.Still the system has its limits.

For one, it takes two weeks to fill all entry fields. That’sbecause it usually takes a couple of weeks for most lab results tocome back.

Because of this lag time, workers like Wolf make use of”detective work” to determine if an outbreak is imminent.

“Data enters the health network in various ways such as hospitalrecords, calls and faxes from units and the public. You can piecethese together to get an idea of what’s out there,” she said.

Wolf said iPHIS would still have been ideal for a long-drawnepisode like the SARS outbreak.
Finkelstein also confirmed that technicians are working on asoftware glitch that is barring workers from extracting data fromsome fields.



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