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
Influenza Pandemic in Catalonia: IS & ICT
Context
Conclusions
Epidemiologic Surveillance
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
Influenza Pandemic in Catalonia: IS & ICT
Context
Conclusions
Epidemiologic Surveillance
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.
Healthcare
CommunicationPrevention
Epidemiologic
Surveillance
IS & ICT
Influenza Pandemic in Catalonia: IS & ICT Fundamental ideas of the Pandemic Plan: Areas of preparedness
Index
Influenza Pandemic in Catalonia: IS & ICT
Context
Conclusions
Epidemiologic Surveillance
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
Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance
XX
X
XSSS: Sentinel
Surveillance System
Alerts &
Outbreak
EPIDEMIOLOGICAL SURVEILLANCE
EDCR: Emerging
Disease Registry
EPIDEMIOLOGICAL SURVEILLANCE1
DATA ANALYSIS
COMMUNICATION
Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance
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
Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance
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
Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance
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
Influenza Pandemic in Catalonia: IS & ICT
Context
Conclusions
Epidemiologic Surveillance
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
Influenza Pandemic in Catalonia: IS & ICT Healthcare
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
Influenza Pandemic in Catalonia: IS & ICT Healthcare
HEALTHCARE2
Influenza Pandemic in Catalonia: IS & ICT Healthcare
PIUC. One week emergency cases in a hospital
Influenza Pandemic in Catalonia: IS & ICT Healthcare
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
Influenza Pandemic in Catalonia: IS & ICT Healthcare
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
Influenza Pandemic in Catalonia: IS & ICT
Context
Conclusions
Epidemiologic Surveillance
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
Influenza Pandemic in Catalonia: IS & ICT
Context
Conclusions
Epidemiologic Surveillance
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
Influenza Pandemic in Catalonia: IS & ICT Communication
COMMUNICATION - INTERNET4
COMMUNICATION – MEDIA4
Influenza Pandemic in Catalonia: IS & ICT Communication
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
Influenza Pandemic in Catalonia: IS & ICT
Context
Conclusions
Epidemiologic Surveillance
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.