evolution of data management system for sars outbreak dr heston kwong principal medical officer...

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


Outline of Presentation

• Principles of data management

• Overview

• Enhanced data management system

• Significant impacts

• Future challenge


Data Management

• Data capture

• Problems detection

• Outbreak monitoring

• Data analysis

• Information extraction

• Alerts communication

• Response formulation


Overview of Notification SystemOverview of Notification System


Statutory Notification System• Statutory

notification system (Cap. 141)

• Statutory notification form, through fax and phone


• Face to face interviews and field visits by field epidemiologists


EPI-INFO v.6 for storage and analysis


SARS Outbreak

• 1755 SARS cases• March to June


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


Enhanced Data Management System

eSARSeSARS

MIIDSSMIIDSS

SARS-CCISSARS-CCIS


eSARSeSARS

Network Network CommunicationCommunication


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

Network connection between HA and DHNetwork connection between HA and DH


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


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


Cluster RelationshipsOverview of the clustering of SARS cases in HK

An individual cluster of SARS cases

The largest cluster of SARS cases identified


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


Identify high risk locations

To maintain an overview of the overall geographical distribution of SARS cases in Hong Kong


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.


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


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.


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


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.


Spread pattern analysisAccumulativeSARS cases Continuous

monitoring of the latest spread pattern


Patients categorization

Infected Persons by Category

MIIDSS targets atMIIDSS targets atResponse ManagementResponse Management


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


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


Data Analysis

Place

Person

Time


Data AnalysisTime


Data Analysis

• Geographical information extracted from central dataset

• Produce hotspot report

• Identify potential clustering

Place


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


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


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


Notification of SARS

• SARS diagnosed• Doctors fill up

electronic medical record

• Immediately accessed by field epidemiologists at Department of Health

eSARS


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


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eSARS database

SARS-CCIS (database)

MIIDSS

hotspot report

IP/VPN internal private network

SARS-CCIS

interface

eSARS web

interface

INSPIREWeb interface


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



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



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



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


Data Dissemination

• Effective data disseminationShorten time to initiate investigationFacilitate other departmental teams assist to

implement public health measuresInform public on outbreak situation


Communication & public education

• > 89,000 calls answered by telephone hotline


Communication & public education

• Daily media briefings


Data Dissemination

SARS-CCISCentral dataset

Building lists of SARS cases

SARS bulletin

Regular press conference


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


Data Management

• Data capture

• Problems detection

• Outbreak monitoring

• Data analysis

• Information extraction

• Alerts communication

• Response formulation


Thank YouThank You

evolution of data management system for sars outbreak dr heston kwong principal medical officer...

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