Information management system transforms public health

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What if, one day – it hits.

Someone is taken to hospital with severe breathing problems, high fever and inflamed eyes. His health rapidly deteriorates. A nurse providing him with bedside care develops similar symptoms. The diagnosis is confirmed – the first cases of avian flu have arrived in Ontario.

This chilling scenario may or may never happen. Fortunately, Ontario has a comprehensive pandemic plan. This includes iPHIS, or the Integrated Public Health Information System – which was not available during the Severe Acute Respiratory Syndrome (SARS) crisis.

iPHIS is a central database that allows Public Health Units and the Ministry of Health and Long-Term Care’s Public Health Division to collect, share and manage communicable and reportable disease information. It also helps in the early detection of outbreaks and has contact tracking and quarantine management.

“This is a big first for public health,” says Dr. Michael Finkelstein, an Associate Medical Officer of Health with Toronto Public Health. “We now have a real-time central database where we can track, store, and ultimately manage the reportable diseases and outbreaks we are investigating. Prior to iPHIS, reportable disease information was housed separately at each unit. Linking cases and determining whether an outbreak was actually occurring was difficult because we only had access to one pot of information.”

Ontario’s Public Health Division and the 36 public health units are working with Smart Systems for Health Agency (SSHA), which is hosting iPHIS in its data centres. SSHA also provides the networks over which information about infectious diseases is sent. Access is restricted to approved users.

“One of the problems during SARS,” Finkelstein continues, “was managing the huge workload of reporting so we could understand who had been exposed, and get them into quarantine to stop the transmission. The system we were using could not be adapted to collect the type of data that was emerging. We were manually downloading information from a paper registry, photocopying and faxing reports to different offices and investigators – some got the material, some didn’t. We also had difficulties tracking the rapidly changing information. Multiple versions of reports were circulating; we would have to search through pages of information to find which section had changed to make sure we were dealing with the most recent version. iPHIS will make reporting much faster and more accurate – which will ultimately allow us to reduce outbreaks because we can get to people quicker.”

iPHIS can be easily adapted for new situations. For instance, if Ontario is faced with an unfamiliar disease or outbreak scenario, new fields and drop down lists can be added for the 1,500 public health users to immediately start recording data or checking off symptoms. This will enable public health experts to collect information faster and in a standard way, allowing them to see pockets and patterns of disease quickly.

Another advantage is that iPHIS will help track sources of disease more effectively. If someone gets E. coli from unpasturized milk and it is traced to a supplier, public health officials can track the product and issue a public health notice to warn consumers.

“We had a salmonella outbreak in the Halton region relating to a Mother’s Day brunch,” says Brenda Guarda, Epidemiologist, Simcoe Muskoka District Health Unit. “There were more than 40 cases across five public health units. At the time, Halton Region Health Department was not connected to iPHIS, so my unit created the exposure information on their behalf. Once this information was entered, all five jurisdictions were able to understand what was going on and quickly link their cases to the source. We had never been able to do this before. iPHIS makes it easier for us to identify potential outbreaks. We now have the ability to detect outbreaks that might otherwise be missed and are able to implement control measures more readily and educate individuals who have fallen ill, with more specific information.”

So whether a case of avian flu invades the province, or a local food poisoning outbreak occurs, iPHIS will help public health professionals get ready to make the best decisions to protect our health.