Pan-Canadian pandemic preparedness

The pandemic clock is ticking. Somewhere in our global ecosystem, scientists say, a virus is quietly mutating.

The SARS epidemic three years ago provided a dress rehearsal for a full-blown pandemic. And there were some key stumbling points.

One of the lessons from SARS is that communication across the healthcare workforce is paramount. Christopher Jyu, an emergency room physician at the Scarborough General Hospital in Toronto, recalls the initial chaos when SARS hit: “We didn’t know who was coming or going, or even what door to use to come in.”

Without an established system, head nurses had to resort to phones and paper bulletins to inform staff. When it became available, information was presented in large, undifferentiated documents instead of selective briefs.

“Under stress, you’re not interested in reading calmly through a Web site,” says Jyu, pointing out there was no one definitive reference Web site to go to in any case.

Mobilizing and organizing the entire workforce is also crucial. Medical specialists typically work in multiple hospitals and other institutions, raising the issue of cross-contamination unless they’re assigned to one only.

This roving could have spread SARS, says Jan Kasperski, CEO at the Ontario College of Family Physicians of Canada. “We were just lucky SARS was a stupid virus that didn’t know how to jump as quickly as most viruses.”

In addition, there were difficulties communicating with family doctors, who deliver the bulk of primary care but aren’t typically set up on hospital systems, and organizing them to man SARS clinics and back up hospital staff, she says.

“You have to know who’s out there and how to reach them, and then you need a system in place to make decisions with them about who wants to do what in an emergency situation.”

To tackle pandemic issues, Canada Health Infoway Inc. recently launched a major initiative to develop a pan-Canadian Public Health Surveillance System. The intent is to replace the existing patchwork of systems with one comprehensive national system.

“This is the most ‘pan’ project we’ve ever funded,” says Tim Beasley, program director at Infoway, pointing out CIOs and public health decision-makers from every province are overseeing the program.

IBM Canada Ltd. and its partners were selected to develop the system from existing commercial products and to integrate the components. Comprised of six modules to cover management of functional categories such as communicable disease patient cases, outbreaks, alerts, vaccine supplies and work scheduling, the final release for implementation at the provincial level is slated for early 2008, says Beasley.

Although the system is designed to work together as a whole, adoption of some or all of the modules by the provinces will be optional, depending on whether they want to retain whatever systems they already have in place, says Jeffrey Betts, business development manager at IBM Canada in Markham.

Provincial health ministries need to do preparatory work to determine which pieces they want to implement, and muster the resources needed to fund and execute the IT projects in their jurisdictions.

Betts points out that the system’s users will be primarily public health workers in community clinics. “You won’t be seeing it as much in acute care settings such as hospitals,” he says, although they would still be users of the system, collecting information about emerging diseases from the frontlines. He says the alert system provides a community bulletin board where facts on emerging diseases will be maintained, with management tools to help find relevant information.

While the workforce module could be adopted by hospitals for routine management if they so choose, Betts acknowledges the system is geared towards public health management and not designed to organize staff to minimize cross-contamination.

“I don’t think the system addresses that, but it would be good public health practice for hospitals to do that – they would have their own sets of procedures to identify risks and to change patterns of physician assignment.”

Public health is a third healthcare domain, with family doctors providing primary care and hospitals providing acute care, explains Betts.

While there is overlap in these three areas when tracking and treating communicable disease, each jurisdiction handles it differently and will need to make decisions about how they want to use the system and who should have access. Betts says the authorizations needed for high-security healthcare systems have been a barrier to technology adoption historically. “The sociology of adoption is a key issue to address in family practice.”

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