Internetbased Disease Surveillance System in China

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Internet-based Disease Surveillance System in
China
Jin Shuigao Chinese Center for Disease Control
and Prevention
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• In the aftermath of SARS outbreak in 2003,
  Chinese government strengthened its disease
  surveillance system, taking advantage of modern
  information technology to build an integrated,
  effective and reliable case reporting system.

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Outlines

• 1. Disease surveillance system in China before
  2003
• 2. China information system for disease control
  and prevention
• 3. Future considerations

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Notifiable Disease Surveillance System in
China before 2003
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Infrastructure of the Health System in China
MOH
China CDC
Provincial Health Bureau
Provincial Hospital
Provincial CDC
Prefecture Health Bureau
Prefecture-level Hospital
Prefecture CDC
County Health Bureau
County CDC
County-level Hospital
Township
Township Health Center
Township Health Center
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37 Notifiable Infectious Dis. Required to report

• ? Group A(2)
• plague, cholera
• ? Group B (25)
• SARS, AIDS, hepatitis, polio, human avian flu,
  measles, whooping cough, typhoid, HIV, STD,
  meningitis encephalitis, etc
• ? Group C(10)
• flu, rubella, leprosy

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Evolution of Notifiable Disease Reporting System
before 2004 in China

• 1950-1986
• County-based monthly report by paper with
  post-mail system

1987-2003 Electronic reporting system through
Internet
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Data flow for infectious diseases (mid80s-2003)
Central Data Bank
Monthly
MOH
China CDC
County-Aggregated
Monthly
Provincial GOV
Provincial HLTH Bureau
Provincial CDC
County-Aggregated
Monthly
Prefecture/city GOV
Prefecture/city HLTH Bureau
Prefecture/cityCDC
County-Aggregated
Monthly
County GOV
County HLTH Bureau
County CDC
Township Hospitals
Hospitals
Manual report
????
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Report through internet
Village Clinics
Cases
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Disadvantages of the systemand major lessons
from the SARS outbreak

• ? Information delay monthly report
• ? Blockage of information from all directions
• ? Less transparency lack of information
  dissemination mechanism
• ? No individual cases aggregated data
  transferred

Weak capacity of detecting emergencies Less value
for policy-making
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• China information system for disease control
• and prevention

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1. How high is the wall for protecting us?
2. What to be collected? 3. How to collect? 3.
How to use the data?
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Urgent demand from the Central Government in
China

• General goals set for the new system
• To achieve early detection of
• ? Outbreak of infectious and,
• ? Public health emergencies

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Urgent demand from the Central Government in
China

• Specifically,
• ? No time delay
• ? Cased-based
• ? All health facilities covered
• ? 5-level network for data collection, management
  and disease control.
• ? 3-level platform national, provincial
  prefecture

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Integrated platform

• ? Includes surveillance systems
• -- Notifiable diseases
• -- Public health emergencies
• -- Risk factors
• -- Non-communicable diseases
• -- Specific diseases (e.g. TB, HIV/AIDS, etc)
• -- Others
• ? Central Data Bank in China CDC
• ? Web-based data transfer

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Framework of China Public Health Information
System (PHIS)
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(No Transcript)
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Regional Public Health Information System
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WEB-basedCase Reporting System
MOH
Daily, weekly,
monthly, annually
Utilization
Utilization
National CDC
Provincial HLTH Bureau
Alert
Feedback
Central Data Bank
Alert
Provincial CDC
City/prefecture HLTH Bureau
Maintenance
Reports, Events, Cases
Auditing
Prefecture CDC
Statistics
County HLTH Bureau
Statistics
Case detected
County CDC
Hospitals
Township HLTH Centers
Other HLTH Facilities

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Concept of Case Auditing
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Options
District Codes
Users Codes
Password
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Application Systems Finished Till now

• Main Operation System
• Diseases Reporting Information System
• Emergency Public Reporting System
• Special Diseases Management Information System
• Plague Epidemic Disease Forecasting Information
  System
• Tuberculosis Management Information System
• HIV/AIDS Reporting System
• Basic Information System for Disease Control and
  Prevention. etc

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Features of the system
? Coverage 50 000 report points including 95
more hospitals at county level and above 70
more township health centers It is the world
largest electronic disease surveillance system.
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Features of the system
? Connection all health facilities including 3
000 more health bureaus from central to local 3
000 more CDCs at different levels 3 000 more
health inspection centers -- Data could be shared
broadly around the country
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Impact Achievements
? Increase in timeliness accuracy of data
Real-time, case-specific direct report decreases
the time delay and reduces missing reports,
increases accuracy of data. ? Make the early
detection of outbreak possible All human avian
flu cases were detected by this system ?
Milestone in case-based reporting system in
Chinas disease control prevention
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Daily /Weekly /Monthly/ Yearly Analysis
Daily Analysis
Diseases
regions
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Daily Report
Weekly Report
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Using and Feedback of Information
Data Collection
Feedback
Daily Report
Data Verification
MOH
Weekly Report
Monthly Report
CDC
Data Analysis and Report
Yearly Report
Other Units
Some Special Analysis Issues when necessary
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Real-Time GIS Display
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Future considerations
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Future consideration

• A comprehensive disease surveillance system is
  under consideration
• 1) To cover the whole lifetime, from pre-birth
  to death
• 2) To include the health-related factors
  environment, food, drug, and behavior, and
• 3) Syndromic surveillance

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Future consideration

• 2. To link all information systems including
• 1) different systems (such HIS)
• 2) link with labs
• 3) link with surveillance on animals
• 3. Regional health information system to be
  considered
• 4. Data sharing and standardization

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Thanks