How can IT help fight
         pandemics
Public Health in response to Pandemic Influenza
              The case of Catalon...
Index

  Context

  Influenza Pandemic in Catalonia: IS & ICT

        Epidemiologic Surveillance

        Healthcare

   ...
Index

  Context

  Influenza Pandemic in Catalonia: IS & ICT

        Epidemiologic Surveillance

        Healthcare

   ...
Context
Autonomous Community of Spain – CATALONIA




   Catalonia is one of the 17 Autonomous Communities of Spain, and h...
Context
CATALONIA – The Healthcare System in Catalonia: universal and free



                                            ...
Context
CATALONIA – The Healthcare System in Catalonia




              Specialized
              Healthcare             ...
Index

  Context

  Influenza Pandemic in Catalonia: IS & ICT

        Epidemiologic Surveillance

        Healthcare

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




         Catalonia Pandemic Pl...
Influenza Pandemic in Catalonia: IS & ICT
CATALONIA - April 24, 2009 - initial statement to activate the protocol for surv...
Influenza Pandemic in Catalonia: IS & ICT
Fundamental ideas of the Pandemic Plan: Areas of preparedness




              ...
Index

  Context

  Influenza Pandemic in Catalonia: IS & ICT

        Epidemiologic Surveillance

        Healthcare

   ...
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance




   • April 24 – First WHO alert
        • Accordi...
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance




     1    EPIDEMIOLOGICAL SURVEILLANCE


        ...
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance




     1    EPIDEMIOLOGICAL SURVEILLANCE


        ...
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance




  PIDIRAC - Sentinel Surveillance System
        ...
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance




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




        ...
Index

  Context

  Influenza Pandemic in Catalonia: IS & ICT

        Epidemiologic Surveillance

        Healthcare

   ...
Influenza Pandemic in Catalonia: IS & ICT
Healthcare




             Healthcare Response Plans

                  Provide...
Influenza Pandemic in Catalonia: IS & ICT
Healthcare




 Organisational model: patient management
      Global population...
Influenza Pandemic in Catalonia: IS & ICT
Healthcare




     2       HEALTHCARE

         PIUC. Emergency plan to coordin...
Influenza Pandemic in Catalonia: IS & ICT
Healthcare




PIUC. One week emergency cases in a hospital
Influenza Pandemic in Catalonia: IS & ICT
Healthcare




Healthcare. Total severe patients diagnosed in Catalonia
 Healthc...
Influenza Pandemic in Catalonia: IS & ICT
Healthcare




        All PIUC information is analyzed by
             healthca...
Index

  Context

  Influenza Pandemic in Catalonia: IS & ICT

        Epidemiologic Surveillance

        Healthcare

   ...
Influenza Pandemic in Catalonia: IS & ICT
Prevention




   • Measures used to decrease infection
     transmission:
     ...
Influenza Pandemic in Catalonia: IS & ICT
Antivirals
Index

  Context

  Influenza Pandemic in Catalonia: IS & ICT

        Epidemiologic Surveillance

        Healthcare

   ...
Influenza Pandemic in Catalonia: IS & ICT
Communication




 • Communication plan focuses on
     • Citizens
     • Health...
Influenza Pandemic in Catalonia: IS & ICT
Communication




    4    COMMUNICATION - INTERNET
Influenza Pandemic in Catalonia: IS & ICT
Communication




    4    COMMUNICATION – MEDIA
Influenza Pandemic in Catalonia: IS & ICT
Turning threats into opportunities




       WHAT WE HAD                   WORK...
Index

  Context

  Influenza Pandemic in Catalonia: IS & ICT

        Epidemiologic Surveillance

        Healthcare

   ...
Conclusions
Global




   • Previous preparation efforts and existing coordination
     structures have been decisive to g...
Conclusions
Progress




   The development and implementation of new IS and ICT
   will have a substantial impact upon de...
Conclusions
Lessons learned




         The response to pandemic influenza in Catalonia
          has provided an opport...
THANK YOU !
                    Moltes gràcies!
                  ¡Muchas gracias!




dgsp.salut@gencat.cat
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Is Improvement to Deliver Fast and Accurate information about H1N1 Influenza Epidemics in Spain Through a Coordination Effort Among Regional Healthcare Organisations

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Is Improvement to Deliver Fast and Accurate information about H1N1 Influenza Epidemics in Spain Through a Coordination Effort Among Regional Healthcare Organisations. Plasencia A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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Is Improvement to Deliver Fast and Accurate information about H1N1 Influenza Epidemics in Spain Through a Coordination Effort Among Regional Healthcare Organisations

  1. 1. 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
  2. 2. Index Context Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Healthcare Prevention Communication Conclusions:
  3. 3. Index Context Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Healthcare Prevention Communication Conclusions
  4. 4. Context Autonomous Community of Spain – CATALONIA Catalonia is one of the 17 Autonomous Communities of Spain, and has full powers regarding citizens’ health care, including public health. 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 culture Source: IdesCat
  5. 5. Context CATALONIA – The Healthcare System in Catalonia: universal and free Public Healthcare The Healthcare System in Catalonia 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
  6. 6. Context CATALONIA – The Healthcare System in Catalonia Specialized Healthcare Pharmacies The IS & ICT used are: • Shared Medical Record IS • Electronic Prescription • Network Clinical units (eCap) Primary Offices Emergency • ... care Citizens care Offices involved include: • AIAQS ICT • TicSalut • Standards office Research centers Public • ... Health Units  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
  7. 7. Index Context Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Healthcare Prevention Communication Conclusions
  8. 8. Influenza Pandemic in Catalonia: IS & ICT New flu H1N1, ongoing strategies in Catalonia Catalonia Pandemic Plan* Organizational structure  Surveillance and early detection  Executive Committee  Emergency response of Catalonia  Vaccines  Coordination  Treatment of infected and exposed Committee prophylaxis (antiviral)  Management Board  Non-pharmacological measures and social distancing  Scientific Advisory Board  Schools - Work - Community  Communication * Created on 2005 and reviewed on 2008
  9. 9. Influenza Pandemic in Catalonia: IS & ICT CATALONIA - April 24, 2009 - initial statement to activate the protocol for surveillance and control of influenza A-H1N1 virus 1 1st case - Virus A (H1N1) Mexico - March 2009 Public health emergency  On April 24, initial statement 3 of international concern USA – Late April 2009 declares activation of surveillance protocol and Late April existence of the new Margaret Chan, the WHO's director-general, influenza A-H1N1 virus declared a "public health emergency of  On April 25, first two cases international concern" are detected in Catalonia Infection in 2 children 2 Southern California USA – April 2009 under the rules of the WHO's new International  On April 26, the Department Health Regulations when of Health of Catalonia the first two cases of the activates the Coordination H1N1 virus were reported in the United States, Committee to monitor and followed by hundreds of evaluate the new outbreak of cases in Mexico flu.
  10. 10. Influenza Pandemic in Catalonia: IS & ICT Fundamental ideas of the Pandemic Plan: Areas of preparedness Epidemiologic Healthcare Surveillance IS & ICT Prevention Communication
  11. 11. Index Context Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Healthcare Prevention Communication Conclusions
  12. 12. Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance • 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.
  13. 13. Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance 1 EPIDEMIOLOGICAL SURVEILLANCE EPIDEMIOLOGICAL SURVEILLANCE STIR: Sexually transmitted infection (STI) Record X IRDS: Individualized Reportable Disease System X MRS: Microbiological Reporting System RDS: Reportable Disease System X ODR: Occupational Disease Record Alerts & X SSS: Sentinel Surveillance System Outbreak
  14. 14. Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance 1 EPIDEMIOLOGICAL SURVEILLANCE EPIDEMIOLOGICAL SURVEILLANCE STIR: Sexually IRDS: Individualized MRS: Microbiological transmitted infection Reportable Disease Reporting System (STI) Record System RDS: Reportable ODR: Occupational EDCR: Emerging Disease System Disease Record Disease Registry May All cases SSS: Sentinel Alerts & Surveillance System July Only severe cases Outbreak DATA ANALYSIS COMMUNICATION
  15. 15. Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance PIDIRAC - Sentinel Surveillance System Parainfluenza 4 VGCEnterovirus Parainfluenza 3 Parainfluenza 2 ADV VGA(H3) Parainfluenza 1 Rinovirus A(H1N1)v VRS 600 70 60 Taxa/ 100.000 habitants 500 50 400 40 300 30 200 20 100 10 0 0 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 Distribution of the 33 (8 in Setmanes VGA VGB A(H1N1)v 2009_2010 2008_2009 llindar basal BCN) centers with sentinel primary care practices
  16. 16. Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Reportable Disease System 30 July 29. 25 Surveillance of June 11. WHO severe cases 20 April 24. Launch of declares fase 6 A(H1N1). surveillance protocol A(H1N1). 15 10 5 0 21 24 27 30 12 15 18 21 24 27 30 11 14 17 20 23 26 29 11 14 17 20 23 26 29 3 6 9 2 5 8 2 5 8 April May June July
  17. 17. Influenza Pandemic in Catalonia: IS & ICT Match between epidemiologic surveillance and healthcare information Value added information EPIDEMIOLOGIC HEALTHCARE SURVEILLANCE IS & ICT INFORMATION INFORMATION The Public Health Department use IS & ICT in order to integrate information coming from epidemiologic surveillance and healthcare suppliers.
  18. 18. Index Context Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Healthcare Prevention Communication Conclusions
  19. 19. Influenza Pandemic in Catalonia: IS & ICT Healthcare Healthcare Response Plans Provide effective and efficient response to the increase in OBJECTIVES healthcare demand, especially oriented to critical cases, among all the healthcare centers of Catalonia • In the event of a crisis, identify responsible • Additional beds (critical and non critical) ACTIONS • Action Plan provision to offset uncovered services • Increase telephone assistance • Strengthen home healthcare
  20. 20. Influenza Pandemic in Catalonia: IS & ICT Healthcare Organisational model: patient management Global population and children HOME C A P Critical groups PHONE CALLING HOSPITAL Pregnant Chronic Obese patients Critical patients HOSPITAL
  21. 21. Influenza Pandemic in Catalonia: IS & ICT Healthcare 2 HEALTHCARE 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
  22. 22. Influenza Pandemic in Catalonia: IS & ICT Healthcare PIUC. One week emergency cases in a hospital
  23. 23. Influenza Pandemic in Catalonia: IS & ICT Healthcare Healthcare. Total severe patients diagnosed in Catalonia 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
  24. 24. 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.
  25. 25. Index Context Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Healthcare Prevention Communication Conclusions
  26. 26. 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.
  27. 27. Influenza Pandemic in Catalonia: IS & ICT Antivirals
  28. 28. Index Context Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Healthcare Prevention Communication Conclusions
  29. 29. Influenza Pandemic in Catalonia: IS & ICT 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
  30. 30. Influenza Pandemic in Catalonia: IS & ICT Communication 4 COMMUNICATION - INTERNET
  31. 31. Influenza Pandemic in Catalonia: IS & ICT Communication 4 COMMUNICATION – MEDIA
  32. 32. Influenza Pandemic in Catalonia: IS & ICT Turning threats into opportunities WHAT WE HAD WORK IN PROCESS WHAT WE WILL HAVE • Fragmented IS • IS connected through • Fully integrated IS • No communication Interoperability • Easy and fluent between applications Standards communication • Need for updated IT • Modernized IT between applications • Management • Integrated information • Shared strategies difficulties and data • Easier and faster data among healthcare analysis problems analysis providers and agents • Uncovered areas of knowledge
  33. 33. Index Context Influenza Pandemic in Catalonia: IS & ICT Epidemiologic Surveillance Healthcare Prevention Communication Conclusions
  34. 34. Conclusions Global • 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
  35. 35. Conclusions Progress The development and implementation of new IS and ICT will have a substantial impact upon decision management:  More information and with more quality Flexibility 2004 2010 Timeliness Data quality Simplicity Prediction
  36. 36. Conclusions Lessons 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.
  37. 37. THANK YOU ! Moltes gràcies! ¡Muchas gracias! dgsp.salut@gencat.cat

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