Is Improvement to Deliver Fast and Accurate information about H1N1 Influenza Epidemics in Spain Through a Coordination Effort Among Regional Healthcare Organisations
The document discusses how Catalonia responded to the H1N1 influenza pandemic using information systems (IS) and information and communication technologies (ICT). It summarizes how Catalonia used existing surveillance systems to monitor the outbreak, activated healthcare response plans to manage increased demand, implemented prevention strategies like hygiene practices and vaccines, and employed communication strategies targeting citizens and professionals. The pandemic provided an opportunity to improve IS integration and interoperability as well as data analysis and predictive capabilities for future health emergencies.
Presentation of original research given at the Disaster Information Symposium held at the National Institutes of Health, Bethesda MD on March 29-30th, 2011
Northern Illinois Public Health Consortium Overview ChrissyCarlson
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This document discusses the 2009 H1N1 pandemic. It describes how in April 2009, a novel H1N1 virus was detected in two unrelated children in Southern California, which had a unique combination of genes not previously seen in swine or human influenza viruses. This triggered increased surveillance and testing, which found retrospective evidence of outbreaks in Mexico in February/March. By June 2009 the WHO declared it a global pandemic of this novel H1N1 virus.
This document discusses emergency planning for at-risk groups and how organizations can get involved. It identifies groups that are at higher risk, such as the elderly, children, disabled, and economically disadvantaged. It emphasizes the importance of personal, organizational, and community preparedness. Organizations are encouraged to develop continuity of operations plans to continue serving clients during emergencies. They can also get involved through initiatives like a Special Needs Advisory Panel to provide input on emergency plans and ensure the needs of at-risk groups are addressed.
Study: The Future of VR, AR and Self-Driving CarsLinkedIn
We asked LinkedIn members worldwide about their levels of interest in the latest wave of technology: whether they’re using wearables, and whether they intend to buy self-driving cars and VR headsets as they become available. We asked them too about their attitudes to technology and to the growing role of Artificial Intelligence (AI) in the devices that they use. The answers were fascinating – and in many cases, surprising.
This SlideShare explores the full results of this study, including detailed market-by-market breakdowns of intention levels for each technology – and how attitudes change with age, location and seniority level. If you’re marketing a tech brand – or planning to use VR and wearables to reach a professional audience – then these are insights you won’t want to miss.
eHealth Governance in a Heterogeneous Regional Scenario like Catalonia. How to Manage a Highly Distributed eHealth Network. Guanyabens J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
1) The document discusses chronic care in Spain, providing background on the country's demographics, health care system structure, and strategies for chronic care. It notes Spain's decentralized health system and regional autonomy over delivery.
2) It then examines chronic care approaches in Catalonia, including case management, integrated home care, and hospital at home programs. Catalonia's use of ICT and shared policies between primary and specialized care are highlighted.
3) In conclusions, the document states there is no single chronic care model in Spain. While pilot programs achieved good results, they had little overall system impact. ICT is not systematically used. Chronic care is considered a "wicked problem" requiring interdisciplinary collaboration and persever
Presentation of original research given at the Disaster Information Symposium held at the National Institutes of Health, Bethesda MD on March 29-30th, 2011
Northern Illinois Public Health Consortium Overview ChrissyCarlson
The Northern Illinois Public Health Consortium was formed in 2002 when local health department directors in Northern Illinois began meeting to realize their shared goals of promoting public health. It was incorporated as a 501(c)(4) organization with 8 founding member counties. Membership has since grown. The consortium aims to share information, advocate for policies and resources, coordinate activities, and enhance capacities through a regional approach. Its strategic plan includes ensuring responsive policies, taking a regional approach to infrastructure development, and developing a regional policy agenda. It is governed by a board and committees.
This document discusses the 2009 H1N1 pandemic. It describes how in April 2009, a novel H1N1 virus was detected in two unrelated children in Southern California, which had a unique combination of genes not previously seen in swine or human influenza viruses. This triggered increased surveillance and testing, which found retrospective evidence of outbreaks in Mexico in February/March. By June 2009 the WHO declared it a global pandemic of this novel H1N1 virus.
This document discusses emergency planning for at-risk groups and how organizations can get involved. It identifies groups that are at higher risk, such as the elderly, children, disabled, and economically disadvantaged. It emphasizes the importance of personal, organizational, and community preparedness. Organizations are encouraged to develop continuity of operations plans to continue serving clients during emergencies. They can also get involved through initiatives like a Special Needs Advisory Panel to provide input on emergency plans and ensure the needs of at-risk groups are addressed.
Study: The Future of VR, AR and Self-Driving CarsLinkedIn
We asked LinkedIn members worldwide about their levels of interest in the latest wave of technology: whether they’re using wearables, and whether they intend to buy self-driving cars and VR headsets as they become available. We asked them too about their attitudes to technology and to the growing role of Artificial Intelligence (AI) in the devices that they use. The answers were fascinating – and in many cases, surprising.
This SlideShare explores the full results of this study, including detailed market-by-market breakdowns of intention levels for each technology – and how attitudes change with age, location and seniority level. If you’re marketing a tech brand – or planning to use VR and wearables to reach a professional audience – then these are insights you won’t want to miss.
eHealth Governance in a Heterogeneous Regional Scenario like Catalonia. How to Manage a Highly Distributed eHealth Network. Guanyabens J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
1) The document discusses chronic care in Spain, providing background on the country's demographics, health care system structure, and strategies for chronic care. It notes Spain's decentralized health system and regional autonomy over delivery.
2) It then examines chronic care approaches in Catalonia, including case management, integrated home care, and hospital at home programs. Catalonia's use of ICT and shared policies between primary and specialized care are highlighted.
3) In conclusions, the document states there is no single chronic care model in Spain. While pilot programs achieved good results, they had little overall system impact. ICT is not systematically used. Chronic care is considered a "wicked problem" requiring interdisciplinary collaboration and persever
The document discusses e-Health initiatives in Catalonia. It provides background on the Catalan healthcare system and challenges it faces from aging and other demographic trends. It then outlines Catalonia's ICT strategy, key e-Health projects including a shared clinical history system, electronic prescribing, telemedicine and more. The Fundació TICSalut is described as coordinating e-Health efforts and contributing to standards, projects, and international collaboration to advance e-Health in Catalonia.
The document discusses Catalonia's transition from a chronic care program to an integrated health and social care model. It describes Catalonia's healthcare system and the aging population it serves. It outlines strategic projects from the 2011-2015 Health Plan including developing integrated care pathways and classifying complex chronic patients. The chronic care program aims to identify these complex patients and develop shared intervention plans incorporating health and social needs. Risk stratification tools are used to segment the population and identify those at high risk of hospitalization. [/SUMMARY]
A journey from the Chronic Condition Care Program to a new health and social integrated care model.
Deck available in link:
http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
This document discusses how telemedicine and technology could help improve European healthcare systems. It notes that Americans have developed military strength through technology while Europeans have stronger healthcare, but are aging. Telemedicine could help address issues like an older population. Successful telemedicine requires overcoming challenges like different priorities between medical and tech staff. Recent projects in Catalonia show telemedicine's potential. Living labs that involve users can also drive healthcare innovation. With the economic crisis, Europe has incentive to innovatively redesign its welfare systems using information and communication technologies.
The Veneto region of Italy faces challenges of an aging population, rising healthcare costs, and budget constraints. It is addressing these issues through local telemedicine and eHealth initiatives that aim to [1] rationalize the hospital network, [2] reorganize territorial health services, and [3] invest in innovation and ICT. Examples of projects include connecting general practitioners to hospitals, sharing patient records across regions, and remote patient monitoring for disease management. The goals are to improve care quality, reduce costs, and empower healthcare workers through technology.
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Toni Dedeu: accelerating reform of primary care deliveryNuffield Trust
This document discusses primary care in Europe and ways to reform primary care delivery and organization. It touches on several key topics:
1. Policy levers that can successfully drive change, including payment/incentives and enabling new professional roles.
2. A health policy triangle framework involving context, actors/players, and content/process for developing and implementing primary care policies.
3. Barriers and facilitators to primary care reform, including cultural, political, and international factors.
The Journey from a Chronic Care Program toward an Integrated Health and Social Care Model
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This document announces an online symposium hosted by the Young Neurosurgeons Forum on providing neurosurgical services during disasters. The symposium will discuss concepts like telemedicine, telesurgery, and mobile emergency/neurosurgical units. Speakers will include leaders from the World Federation of Neurosurgical Societies on training neurosurgeons in developing areas and addressing public health issues. The document provides background on recent major earthquakes in Haiti and Chile to illustrate the need for rapid neurological response during disasters when infrastructure is damaged and communications fail.
The document summarizes Tic Salut Foundation, a Catalan organization that promotes telemedicine and teleassistance. It has several boards and councils that provide advisory, business, scientific, and citizen perspectives. It also has an observatory that maps trends in ICT usage in health organizations. Tic Salut promotes projects and adoption of standards to improve interoperability and continuity of care through telemedicine and digital tools. Its goals include remote diagnosis, management of chronic diseases, and teleconsultations.
The European, Chinese, and United States healthcare markets are a study of contrasts, each of which face a unique set of challenges and issues for their combined 2.4 billion citizens. Despite their differences, there are a number of opportunities for organizations to learn and profit through intercontinental collaboration on their paths to a more connected healthcare ecosystem. Panelists representing the three regions will provide an overview of their country’s unique healthcare landscape and offer a vision for a future of collaboration and progress.
• Brian O'Connor - Chair, European Connected Health Alliance
• Millard Chiang - Chairman, China Connected Health Alliance; Chair, Pegasus Holdings Group
• Julien Venne - Strategic Advisor & European Project Team Leader, European Connected Health Alliance
• David Whitlinger - Executive Director, New York eHealth Collaborative
New York eHealth Collaborative Digital Health Conference
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The document provides Malaysia's monthly infectious disease report for May 2005, listing the number of reported cases and deaths from various infectious diseases by state. It aims to strengthen disease surveillance in Malaysia by mandatorily notifying cases of 26 specified infectious diseases to the Ministry of Health under the Prevention and Control of Infectious Diseases Act 1988. The analysed surveillance data is intended to provide public health officials and policymakers with evidence-based information for decision making and early detection of disease outbreaks.
Multidisciplinary care: a perspective from diagnosis and treatment of rare cancers. Casali P. Technical Conference: Multidisciplinary Care in Cancer as a model of health care quality (Madrid: Ministry of Health and Social Policy, 2010)
La mejor evidencia junto a la mejor organización: el reto de la coordinación profesional en atención oncológica. Sánchez de Toledo J. Jornada Técnica: Atención Multidisciplinar en Cáncer como modelo de calidad asistencial (Madrid: Ministerio de Sanidad y Política Social, 2010)
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The document discusses e-Health initiatives in Catalonia. It provides background on the Catalan healthcare system and challenges it faces from aging and other demographic trends. It then outlines Catalonia's ICT strategy, key e-Health projects including a shared clinical history system, electronic prescribing, telemedicine and more. The Fundació TICSalut is described as coordinating e-Health efforts and contributing to standards, projects, and international collaboration to advance e-Health in Catalonia.
The document discusses Catalonia's transition from a chronic care program to an integrated health and social care model. It describes Catalonia's healthcare system and the aging population it serves. It outlines strategic projects from the 2011-2015 Health Plan including developing integrated care pathways and classifying complex chronic patients. The chronic care program aims to identify these complex patients and develop shared intervention plans incorporating health and social needs. Risk stratification tools are used to segment the population and identify those at high risk of hospitalization. [/SUMMARY]
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Parameters-It is used to describe the properties of an entire population.
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- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
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4. Describe the influences of the Pneumotaxic and Apneustic centers
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Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
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In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
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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. 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. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions:
3. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions
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. 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. 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. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions
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. 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. Influenza Pandemic in Catalonia: IS & ICT
Fundamental ideas of the Pandemic Plan: Areas of preparedness
Epidemiologic Healthcare
Surveillance
IS & ICT
Prevention Communication
11. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions
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. 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. 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. 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. 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. 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. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions
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. 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. 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. Influenza Pandemic in Catalonia: IS & ICT
Healthcare
PIUC. One week emergency cases in a hospital
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. 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. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions
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.
28. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions
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
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. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions
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. 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. 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. THANK YOU !
Moltes gràcies!
¡Muchas gracias!
dgsp.salut@gencat.cat