New system enables timely response to disease outbreaks

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A person suffering extreme breathing difficulty and high fever is rushed to a hospital. The patient’s condition rapidly deteriorates and a nurse at his bedside develops similar symptoms.

Moments later a diagnosis confirms Toronto’s first human case of avian flu .

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

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

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

Dubbed iPHIS (Integrated Public Health Information System), it enables Ontario health professionals to better track the development of potential outbreaks.

Among other things, iPHIS provides a central database from where Ontario health organizations can enter, access and manage information on communicable diseases.

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

For instance, when SARS (Severe Acute Respiratory Syndrome) hit Toronto 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 getting immediate updates on cases from outlying health units other than by calling the concerned office. Information was often duplicated.

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

Today, iPHIS offers health professionals this holistic picture. “It allows health workers to obtain an aggregate view of how an outbreak 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 electronically connects 95 per cent of the province’s hospitals and provides access to vital information and resources to more than 150,000 health care workers. Betts said iPHIS has been deployed across Ontario’s 36 health districts and is an integral part of the secure, province-wide IT network.

Prior to iPHIS, Ontario health workers relied on a centralized information 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 General Hospital Utility Multi-Programming System). “The SARS outbreak highlighted the deficiencies of the RDIS.”

These included:

• Difficulty in navigating the cumbersome DOS-based user interface;

• No proper system for authenticating input and preventing double entries;

• No way to re-classify cases when the criteria for a disease changes;

• Absence of data sharing and real time data gathering across the health units; and,

• Inability to detect trends and outbreaks.

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

By contrast, he said iPHIS – now connected to the SSHA managed network – uses Report Net business intelligence software from Ottawa-based Cognos Inc. Finkelstein also said the system runs on a secure network .

Stephanie Wolfe, an epidemiologist at the Simcoe Muskoka District Health Unit said the software allows workers like her to extract data and correlate cases with risk exposures. “If I were to get multiple reports of salmonella cases across my district, I can search for a common link based on such factors as age, gender or location.”

Based on the data, health officials can warn the public to avoid a certain area, or they can target action to a specific segement of the population, Wolfe said.

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

Because iPHIS is Web-based, Wolfe said, workers are able to transmit and receive data almost instantaneously.

The system will also be interoperable with other health systems such as the Ontario Laboratory Information System (OLIS) which allows health and lab workers to share laboratory test, specimen, and results information.

Last Fall, when an outbreak of more than 500 salmonella cases did 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’s because it usually takes a couple of weeks for most lab results to come back.

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

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

Wolfe said iPHIS would still have been ideal for a long-drawn episode like the SARS outbreak.

Finkelstein also confirmed that technicians are working on a software glitch that is barring workers from extracting data from some fields.

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