Information technology for surveillance Can information tools improve surveillance? Denis Coulombier ECDC

New information technologies The technology paradox A new technology may have a negative impact on productivity if used without a change of approach New technologies require a change of practices to give their full benefit

The technology paradox Examples

Pre computer ages

The technology paradox How it applies to information? Epiinfo 1, 1985Epiinfo 2/3, 1987Epiinfo 6, 1994 From data compilation … to decision-making

Information technologies and data collection Benefit –Computerised data entry –Fast data transfer –Structured data Prerequisites –Case definitions –Appropriate data models

Information technologies and data analysis Benefits –Fast compilation –Computation of indicators (rates, standardized rates…) –Thresholds Prerequisites –Appropriate hypotheses –Defined plan of analysis

Information technologies and data presentation Benefits –Tables, maps and charts –Automated reports Prerequisites –A guide to data review –A decision-making approach

The Serbia Alert Project March 2003 –Request to WHO to computerised the early warning system –73 diseases under mandatory notification –20 agegroups –Monthly aggregation at national level –No computerized analysis

The Serbia Alert Project May 2003: in-depth assessment –Need for prioritization of CD under early warning surveillance: workshop –Need for syndromic case definitions –Need for guidelines on investigation and control measures –Need for change in surveillance regulations

The Serbia Alert Project Strengthening Strategy A structured and integrated approach to epidemiological surveillance and response strengthening Prioritization Implementation In-depth assessment Monitoring and evaluation Plan of action Risk assessment

The Serbia Alert Project Risk Assessment Public health risks change over time Emerging and re-emerging diseases Changes in epidemiological profile New strains (meningitis W135) Antibiotic resistance Advanced technology, improved knowledge New vaccines, control programmes Demographic changes Environmental changes Output: risk assessment fact sheets

Risk Assessment Fact Sheets

Prioritization of Communicable Diseases Changing risks and priorities Limited human and financial resources Priority to diseases of public health importance Short list of diseases for efficiency Consensus process 3 day workshop Output: list of priorities for surveillance and EWARS

Prioritization Reaching a Consensus on Priorities

Assessing National Capacities for Surveillance and Response In-depth assessment helps to identify Strengths and weaknesses of a system Meeting the priorities identified Areas for improved coordination Areas for integration Ways for improvement Baseline information to allow measurement of progress Output: assessment report and recommendations

: Development of National Surveillance PoA Objective: Effective national multi-diseases (integrated) system with an early warning component Involvement of key stakeholders in surveillance Ensuring coordination Prioritized strategic plan (3-5 years) with annual operational plans Costing and identification of funding source Output: a framework in which donors and partners can buy in

Implementation of EWARS Prerequisites to implementation of EWARS Defining functional specifications: EWARS core functions Defining technical specifications: EWARS support functions Defining the implementation plan Implementing EWARS Output: an efficient early warning system WHO Guidelines on Implementation of National Early Warning and Response Systems EWARS June 2004

Reporting districts by Week Early Warning System in Albania, 2000

Conclusion Information technologies are just tools! If not part of a strengthening process, they will fail in improving the early warning function Monitoring and evaluation is required