Appl Clin Inform 2011; 02(01): 75-85
DOI: 10.4338/ACI-2010-05-RA-0030
Research Article
Schattauer GmbH

Healthcare Information Systems to Assess Influenza Outbreaks

An analysis of the 2009 H1N1 Epidemic in Buenos Aires
S. Figar
1   Division of Epidemiology, Department of Internal Medicine
V. Aliperti
1   Division of Epidemiology, Department of Internal Medicine
E. Salazar
2   Divison of Infectiology, Department of Internal Medicine
C. Otero
3   Department of Health Infomatics, Hospital Italiano de Buenos Aires, Argentina
M. Schpilberg
3   Department of Health Infomatics, Hospital Italiano de Buenos Aires, Argentina
V. Taliercio
3   Department of Health Infomatics, Hospital Italiano de Buenos Aires, Argentina
P. Otero
3   Department of Health Infomatics, Hospital Italiano de Buenos Aires, Argentina
F. González Bernaldo de Quirós
3   Department of Health Infomatics, Hospital Italiano de Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History

received: 01 July 2010

accepted: 01 February 2011

Publication Date:
16 December 2017 (online)


Objective: To determine whether a private HIS could have detected the influenza epidemic outbreaks earlier through changes in morbidity and mortality patterns.

Methods: Data Source included a health information system (HIS) from an academic tertiary health care center integrating administrative and clinical applications. It used a local interface terminology server which provides support through data autocoding of clinical documentation. Specific data subsets were created to compare the burden of influenza during the epidemiological week (EW) 21 to 26 for years 2007 to 2009 among 150,000 Health Maintenance Organization members in Argentina. The threshold for identifying an epidemic was considered met when the weekly influenza-like illness (ILI) rate exceeded 200 per 100,000 visits. Case fatality rates and mortality rates of severe acute respiratory infection (SARI) from 2007 to 2009 were retrospectively compared. Case fatality rates and mortality rates for A/H1N1 influenza 2009 also were estimated.

Results: The HIS detected the outbreak in EW 23 while the government Ministry of Health (MoH) gave a national epidemic alert during EW 25. The number of visits for ILI increased more than fourfold when comparing 2009 to the period 2007-2008. The SARI mortality rate in 2009 was higher than in 2008 (RR 2.8; 95%CI 1.18-6.63) and similar to that of 2007 (RR 1.05; 95%CI 0.56-1.49). 2009 was the first year with mortalities younger than 65 years attributable to SARI. The estimated A/H1N1 case fatality rate for SARI was 6.2% (95%CI 2.5 to 15.5) and A/H1N1 mortality rate was 6 per 100,000 (95%CI 0 to 11.6).

Conclusion: Our HIS detected the outbreak two weeks before than the MoH gave a national alert. The information system was useful in assessing morbidity and mortality during the 2009 influenza epidemic H1N1 outbreak suggesting that with a private-public integration a more real-time outbreak and disease surveillance system could be implemented.

  • References

  • 1 German RR, Lee LM, Horan JM, Milstein RL, Pertowski CA, Waller MN. Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep 2001; 50 RR-13 1-35 quiz CE1-7.
  • 2 Pina J, Turner A, Kwan-Gett T, Duchin J. Task analysis in action: the role of information systems in communicable disease reporting. AMIA Annu Symp Proc 2009; 2009: 531-535.
  • 3 Haux R. Health information systems –past, present, future. Int J Med Inform 2006; 75 3-4 268-281. doi:10.1016/j.ijmedinf.2005.08.002 PMid:16169771.
  • 4 Koo D, O’Carroll P, LaVenture M. Public health 101 for informaticians. J Am Med Inform Assoc 2001; 8 (06) 585-597. PMid:11687565 PMCid:130068.
  • 5 Ward M, Brandsema P, van Straten E, Bosman A. Electronic reporting improves timeliness and completeness of infectious disease notification, The Netherlands, 2003. Euro Surveill 2005; 10 (01) 27-30. PMid:15701937.
  • 6 Emergency department chief complaint syndromic surveillance system pilot project: technical evaluation. In: Care OMoHaL-T, editor. 2006
  • 7 National Electronic Disease Surveillance System (NEDSS): a standards-based approach to connect public health and clinical medicine. J Public Health Manag Pract 2001; 7 (Suppl. 06) 43-50. PMid:11713753.
  • 8 Espino JU, Wagner M, Szczepaniak C, Tsui FC, Su H, Olszewski R. et al. Removing a barrier to computer-based outbreak and disease surveillance –the RODS Open Source Project. MMWR Morb Mortal Wkly Rep 2004; 53 Suppl. 32-39. PMid:15714624.
  • 9 Espino JU, Wagner MM, Tsui FC, Su HD, Olszewski RT, Lie Z. et al. The RODS Open Source Project: removing a barrier to syndromic surveillance. Stud Health Technol Inform 2004; 107 Pt 2 1192-1196. PMid:15361001.
  • 10 Panackal AA, M‘Ikanatha N M, Tsui FC, McMahon J, Wagner MM, Dixon BW. et al. Automatic electronic laboratory-based reporting of notifiable infectious diseases at a large health system. Emerg Infect Dis 2002; 8 (07) 685-691. PMid:12095435 PMCid:2730325.
  • 11 Moore KM, Edgar BL, McGuinness D. Implementation of an automated, real-time public health surveil-lance system linking emergency departments and health units: rationale and methodology. Cjem 2008; 10 (02) 114-119. PMid:10165364.
  • 12 Parsons DF, Garnerin P, Flahault A, Gotham IJ. Status of electronic reporting of notifiable conditions in the United States and Europe. Telemed J 1996; Winter 2 (Suppl. 04) 273-284.
  • 13 Grant AD, Eke B. Application of information technology to the laboratory reporting of communicable disease in England and Wales. Commun Dis Rep CDR Rev 1993; 3 (06) R75-R78. PMid:18172157 PMCid:2376898.
  • 14 Overhage JM, Grannis S, McDonald CJ. A comparison of the completeness and timeliness of automated electronic laboratory reporting and spontaneous reporting of notifiable conditions. Am J Public Health 2008; 98 (02) 344-350. doi:10.2105/AJPH.2006.092700.
  • 15 Luna D. et al. Implementación de una Historia Clínica Electrónica Ambulatoria. Buenos Aires, Argentina. 6to Simposio de Informática en Salud –32 JAIIO. Buenos Aires –Argentina 2003.
  • 16 Luna D. et al. Informatización de la capa clínica de un sistema de salud metropolitana: el proyecto itálica. Tecnologías en Información en salud; 2006; Chile: 2006
  • 17 Quiros FG. SNOMED CT and ICPC-2E cross mapping: coding to facilitate the access to information. 2004 p. 17th World Conference of Family Doctors. Orlando, FL. 168, PMid:17911820
  • 18 Osornio AL, Luna D, Gambarte ML, Gomez A, Reynoso G, de Quiros FG. Creation of a local interface terminology to SNOMED CT. Stud Health Technol Inform 2007; 129 Pt 1 765-769. PMid:17911791.
  • 19 Gambarte ML, Osornio AL, Martinez M, Reynoso G, Luna D, de Quiros FG. A practical approach to advanced terminology services in health information systems. Stud Health Technol Inform 2007; 129 Pt 1 621-625. PMid:14708275.
  • 20 Human infection with pandemic (H1N1) 2009 virus:updated interim WHO guidance on global surveil-lance. In: Organization WH editor.; 2009.
  • 21 Situación de la Influenza A (H1N1). Parte diario N° 3. Fecha: 01/05/09, Ministerio de Salud de la Naci-ón Ministerio de Salud de la Naciòn.
  • 22 Situación de la Influenza A (H1N1). Parte periódico Nº 62. Fecha: 09/07/09. Minsiterio de Salud de la Nación.
  • 23 Alerta por el Cambio de Fase 4 a Fase 5 para Pandemia de Influenza Actualización de la Situación Mun-dial sobre Brotes de Nuevo virus de Influenza Alerta J10-J18 6.2009. 2009 Ministerio de Salud de la Nación.
  • 24 Campos AGF, Martínez M, Mauro A, Luna D, Soriano E. Quiros FGBd.. Georeferenciamiento en un Sistema de Información en Salud geore-fer_aaim_com_ar_orales_77_pdf.pdf. INFOLAC2008 –AAIM © 2008
  • 25 Matejic PMM, Vázquez R, Gil N, Tejerizo JC. Nueva gripe A. [Internet]. Como enfrentó la crisis el Hospital XXX de Buenos Aires. Rev. Hosp. B. Aires. http://wwwhospitalxxxorgar/docencia/nexo/indexphp?contenido=ver_actualidadphp&id_actualidad.
  • 26 Goddard NL, Kyncl J, Watson JM. Appropriateness of thresholds currently used to describe influenza activity in England. Commun Dis Public Health 2003; 6 (03) 238-245. PMid:19564633.
  • 27 Overview of Influenza Surveillance in the United States. 2007
  • 28 Chowell G, Bertozzi SM, Colchero MA, Lopez-Gatell H, Alpuche-Aranda C, Hernandez M. et al. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med 2009; 361 (07) 674-679. doi:10.1056/NEJMoa0904023 PMid:18371248.
  • 29 Rickham PP. Human Experimentation. Code of Ethics of the World Medical Association. Declaration of Helsinki. Br Med J 1964; 2 5402 177. PMid:14150898 PMCid:1816102.