evolution of data management system for sars outbreak dr heston kwong principal medical officer...
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Evolution of Data Management Evolution of Data Management System for SARS OutbreakSystem for SARS Outbreak
Dr Heston Kwong
Principal Medical Officer
Department of Health
30 July 2003
IT in Health ForumIT in Health Forum
30 July 2003 Department of Health 2
AcknowlegementAcknowlegement
Hong Kong Police ForceHong Kong Police Force
Hospital AuthorityHospital Authority
30 July 2003 Department of Health 3
Outline of Presentation
• Principles of data management
• Overview
• Enhanced data management system
• Significant impacts
• Future challenge
30 July 2003 Department of Health 4
Data Management
• Data capture
• Problems detection
• Outbreak monitoring
• Data analysis
• Information extraction
• Alerts communication
• Response formulation
30 July 2003 Department of Health 6
Statutory Notification System• Statutory
notification system (Cap. 141)
• Statutory notification form, through fax and phone
30 July 2003 Department of Health 7
• Face to face interviews and field visits by field epidemiologists
30 July 2003 Department of Health 10
SARS Outbreak
• Unprecedented outbreak• Multiple foci• Requires timely response; demands immediate
public health measures• Traditional data management system not sufficient• No data and network sharing between DH and HA
systems• SHWF initiated online computer system to access
patient information directly by DH
30 July 2003 Department of Health 11
Enhanced Data Management System
eSARSeSARS
MIIDSSMIIDSS
SARS-CCISSARS-CCIS
30 July 2003 Department of Health 13
Hospitals and Clinics in Hong Kong
43 Public Hospitals 46 Specialist Outpatient
Clinics 64 general outpatient
clinics 12 private hospitals HA has an internal
network to connect public hospitals
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DH Broadband Secure Private NetworkDH Broadband Secure Private Network
IP/VPN network
30 July 2003 Department of Health 16
eSARS
• Two components:– Case list component– Contact tracing component
• Case list component: hospital admission, clinical information, clinical status
• Contact component: enable Designated Medical Centres conduct 10-day medical surveillance, capture information of close contacts
• Launched on 12 April 2003• Information downloaded to DH
30 July 2003 Department of Health 19
MIIDSS
• Requires a tool quickly identify linkage between cases and contacts
• Purpose for rapid implementation of public health measures
• MIIDSS-crime investigation programme, designed to identify linkage between people, between people and events
• Police produce regular “hotspot” on potential clustering
• Hotspot reports commenced on 13 April 2003
30 July 2003 Department of Health 20
Cluster RelationshipsOverview of the clustering of SARS cases in HK
An individual cluster of SARS cases
The largest cluster of SARS cases identified
30 July 2003 Department of Health 21
Cluster Relationships
•Among 6 cases of this cluster, the earliest onset date was 12 Mar of a 13-year-old girl (YIP) who visited Dr Lau’s clinic on 12 Mar. •Another case, a 3-year-old boy (CHU) visited Dr Lau’s clinic on 20 Mar. •Onset date of Dr LAU was 20 Mar and his wife got infected with the onset on 26 Mar.
Dr. LAU XX(4) Onset 20 Mar – PMH 22 Mar
Died 3 AprDoctor – Tsimshatsui - Clinic
DaughterYIP XX, 13 yrs
(1) Onset 12Mar – PMH 14MarDischarged 9Apr
MotherYAM XX, 52 yrs
(2) Onset 15Mar – PMH 22MarDischarged 24 Apr
Wife CHING XX
(6) Onset 26Mar – QMH 27MarDischarged 7May
Doctor – King’s Road Clinic
FatherYIP XX, 58 yrs
(3) Onset 16Mar – PMH 22MarDischarged 9Apr
SonCHU XX, 3yrs
(5) Onset 25Mar – PMH 28MarDischarged 30Mar
DaughterLAU XX, 22 yrs
•HCW student
Island Rd
FatherCHU XX
Wo Che Estate
Domestic Helper
Prince Ed Rd
Household contact Examination on 12 MarPatient
Examination on 20 Mar / Patient
LAU XX Cluster – onset 12 March(The first private medical practitioner died of SARS)
Patients
Close contacts
Death case
Remark
30 July 2003 Department of Health 22
Identify high risk locations
To maintain an overview of the overall geographical distribution of SARS cases in Hong Kong
30 July 2003 Department of Health 23
Identify high risk locations- Case study of Sau Mau Ping district
By the league table, MIIDSS facilitates the tracking of the accumulation of SARS cases in each district / housing estate / building to flag up high risk locations of SARS occurrence.
The league table indicated that Sau Mau Ping (SMP) district had the highest number of accumulative SARS cases on 20 April 2003, most of which came from Amoy Gardens.
30 July 2003 Department of Health 24
Identify high risk locations- Case study of Sau Mau Ping district
SARS Case Distribution in Ngau Tau Kokas at 20 April 2003
(Source: Hospital Authority)
COLOUR ESTATE COUNT
AMOY GARDENS 330
NTK LOWER ESTATE 46
LEE KEE BUILDING 14
WANG KWONG BUILDING
9
TELFORD GARDEN 7
TAK BO GARDEN 4
JADE FIELD GARDEN 1
30 July 2003 Department of Health 25
Identify high risk locations- Case study of Tai Po district
MIIDSS league table of 20 April indicated that Tai Po district had the second highest number of accumulative SARS cases after Sau Mau Ping at that time.
30 July 2003 Department of Health 26
Remarks Bus Route Hospital
Tai Wo KCR station
Shopping Arcade
Tai Po Hospital
Alice Ho Miu Ling Nethersole Hospital
1. Tai Wo Estate
2. Tai Yuen Estate
4. Fu Shin Estate
3. Kwong Fuk Estate
SARS Distribution in Tai Po dd 2003-06-12
30/0409/0327Fu Shin Estate4
29/0405/0316Kwong Fuk Estate3
07/0508/0316Tai Yuen Estate2
31/0513/0313Tai Wo Estate1
Last Case1st CaseCountEstateS/N
Identify high risk locations- Case study of Tai Po district
30 July 2003 Department of Health 27
Spread pattern analysis
A noticeable spread pattern of SARS on consecutive floors of the same vertical stack of units, particularly units 07 and 08
Spread pattern was also tracked by the onset dates and address locations of the SARS cases in Block E, Amoy Gardens with a colour scheme to indicate the sequence of onset dates (from darker colours to lighter ones).
Investigation efforts were promptly steered to look into the environmental factors possibly transmitting the disease along the same vertical stacks of buildings in Amoy Gardens.
30 July 2003 Department of Health 28
Spread pattern analysisAccumulativeSARS cases Continuous
monitoring of the latest spread pattern
30 July 2003 Department of Health 31
SARS Command Centre under the Department of Health (supported by Police manpower for case investigation,
outbreak detection & contact tracing)(by aid of MIIDSS)
Hospital Authority (HA)
Hospital patient data of Cases Under Observation / Suspected and Confirmed SARS cases (via HA’s e-SARS information system)
Two rounds of Interviews
Link Analysis of MIIDSS
Household contacts
Homeconfinement
Close Contacts to confirmed / suspected
SARS patients
Potential clusters of SARS
Designated Medical Centres
Social contacts
Proactive Investigative and Remedial Actions
Multi-disciplinaryResponse Team
30 July 2003 Department of Health 32
SARS Command Centre under the Department of Health (supported by Police manpower for case investigation,
outbreak detection & contact tracing)(by aid of MIIDSS)
Hospital Authority (HA)
Hospital patient data of Cases Under Observation / Suspected and Confirmed SARS cases (via HA’s e-SARS information system)
Two rounds of Interviews
Link Analysis of MIIDSS
Household contacts
Homeconfinement
Close Contacts to confirmed / suspected
SARS patients
Potential clusters of SARS
Designated Medical Centres
Social contacts
Proactive Investigative and Remedial Actions
Multi-disciplinaryResponse Team
30 July 2003 Department of Health 36
SARS-CCIS
• EPIINFO v.6 not run on shared network• Few opportunities to efficiently consolidate and
compare information kept at separate dataset at Regional Offices
• Enhance existing data management system to provide common dataset and common questionnaire in electronic format
• Enable construction of cluster trees• Launched on 2 May 2003
30 July 2003 Department of Health 42
Data Analysis
• Geographical information extracted from central dataset
• Produce hotspot report
• Identify potential clustering
Place
30 July 2003 Department of Health 47
Data Analysis
• Need to identify linked up cases and contacts in cluster
• Cluster tree• Cluster records for
epidemiological analysis
PersonS0300963
YOUNG XXX XXX
YXX's nearbypatients
S0301217WONG XXX XXX
WXX's nearbypatients
S0301586CHAN XXX XXX
S0301754LAM XXX XXX
LXX's hcw
S0301744MOK XXX XXX
LXX's nearby patients
S0301755LI XXX XXX
S0301760CHAN XXX XXX
S0301770CHUI XXX XXX
S0301798FUNG XXX XXX
S0301804POON XXX XXX
WTS PXX's nearbypatients
S0301799LAI XXX XXX
S0301803LAM XXXX XXX
S0301775WONG XXX XXX
WSF's nearbypatients' visitor
S0301710TANG XXX XXX
S0301312LAW XX XXX S0301539
CHUI XXX XXXS0301567
LEE XXX XXX
30 July 2003 Department of Health 48
Cluster Tree
S0300963
YOUNG XXX XXX
YXX's nearby
patients
S0301217
WONG XXX XXX
WXX's nearby
patients
S0301586
CHAN XXX XXX
S0301754
LAM XXX XXX
S0301775
WONG XXX XXX
WSF's nearby
patients' visitor
S0301710
TANG XXX XXX
S0301312
LAW XX XXXS0301539
CHUI XXX XXX
S0301567
LEE XXX XXX
30 July 2003 Department of Health 49
Cluster Tree
LXX's hcw
S0301744
MOK XXX XXX
LXX's nearby patients
S0301755
LI XXX XXX
S0301760
CHAN XXX XXX
S0301770
CHUI XXX XXX
S0301798
FUNG XXX XXX
S0301804
POON XXX XXX
WTS PXX's nearby
patients
S0301799
LAI XXX XXX
S0301803
LAM XXXX XXX
30 July 2003 Department of Health 54
Notification of SARS
• SARS diagnosed• Doctors fill up
electronic medical record
• Immediately accessed by field epidemiologists at Department of Health
eSARS
30 July 2003 Department of Health 55
Contact Tracing
SARS-CCIS
• Contact data collected through interview,
• Updated central dataset through online computer screen
• Field epidemiologist can review and update information collected by other field epidemiologist at other location
56Department of Health30 July 2003
Regional office
Command Post
Statistics Unit
Case databaseComplete records (transferred to Epi Info for further analysis)Incomplete records filled up by regional offices through central electronic form at Lotus Notes
Wan Chai Police Data Centre
Case Questionnaires (written form)
Case Questionnaires (electronic form)
eSARS
Command post assign investigation number and Regional offices start case investigation and update the case investigation form at Lotus Notes
MIIDSS Analysis Unit
Hotspots reports
Cases admitted to SARS cohort wards in
Hospital Authority
Clinical information transmitted to eSARS
30 July 2003 Department of Health 57
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30 July 2003 Department of Health 58
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30 July 2003 Department of Health 59
eSARS database
SARS-CCIS (database)
MIIDSS
hotspot report
IP/VPN internal private network
SARS-CCIS
interface
eSARS web
interface
INSPIREWeb interface
30 July 2003 Department of Health 60
Significant Impacts (1)
Timely access of patient informationInstantaneous updating of confirmed and
suspected casesSaved at least one dayone day between
identification of cases in wards and notification to DH
Saved at least one dayone day
30 July 2003 Department of Health 61
Significant Impacts (2)
Hotspots report from MIIDSS facilitate early identification of potential clusteringpotential clustering of confirmed and suspected cases
Enables to plan field visits and proactively deploy resources to handle potential problems
early identification of potential clusteringpotential clustering
30 July 2003 Department of Health 62
Significant Impacts (3)
Real time dataset enable assessment of outbreak development in terms of time, time, place and personplace and person
Daily situation report on epidemic curve and summary of public health measures: response formulationresponse formulation
Timely generation of action lists: alerts alerts communicationcommunication
time,time,place and personplace and person
response formulationresponse formulation
alertsalertscommunicationcommunication
30 July 2003 Department of Health 63
Significant Impacts (4)
Updated statistics and outbreak situation reported in SARS bulletinSARS bulletin and published on SARS website
SARS affected buildingSARS affected building published on SARS website
SARS bulletinSARS bulletin
SARS affected buildingSARS affected building
30 July 2003 Department of Health 64
Data Dissemination
• Effective data disseminationShorten time to initiate investigationFacilitate other departmental teams assist to
implement public health measuresInform public on outbreak situation
30 July 2003 Department of Health 65
Communication & public education
• > 89,000 calls answered by telephone hotline
30 July 2003 Department of Health 67
Data Dissemination
SARS-CCISCentral dataset
Building lists of SARS cases
SARS bulletin
Regular press conference
30 July 2003 Department of Health 68
Future Challenge
• Establishment of data exchange network– Data alignment, standardisation
• Data dictionary
• XML Schema and repository
• Intelligence exchange among cities and countries in neighbourhood
• Real time detection alert system– Syndromic surveillance
• Mathematical modelling and data mining
30 July 2003 Department of Health 69
Data Management
• Data capture
• Problems detection
• Outbreak monitoring
• Data analysis
• Information extraction
• Alerts communication
• Response formulation
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