Local Action from Integrated Data: Presentation of Laboratory Test Result Data for Informed Management of Sexually Transmitted Infections LabWare CEC Conference May 22, 2014 Lost Pines, Texas Jim Tom, Chief Information Officer Public Health Ontario
Ontario Facts Land area about the size of California and Texas combined Thinly populated about 13.5 Million people Most population concentrated in the south Need to serve the north Overall provision of health services governed by Ministry of Health and Long-Term Care (MOHLTC) Public health services provided by regional Boards of Health (also knowns as Health Units) 2
Who is Public Health Ontario? Crown corporation Dedicated to protection and promotion of health of Ontarians Wellness of communities and populations Provides expert scientific and technical support to government, local public health agencies, healthcare Communicable & infectious diseases Infection prevention and control Environmental and occupational health Health promotion, chronic disease and injury prevention Public health laboratory services Surveillance, lab services, epidemiology, research, professional development 3
Timeliness Data-Driven Decision Support in Public Health Data on other factors such as anti-microbial resistance Localization Meaning Partnership with Canadian federal agency: Canada Health Infoway: funding, project guidance, support, etc. 4
The Challenge in STI Practices Current STI data available includes Reportable diseases database (e.g. Integrated Public Health Information System) Lacks information about denominator End users cannot easily compare data to other jurisdictions Lacks trend of antibiotic susceptibilities STI laboratory data Reference laboratory testing data often used for national guideline development (e.g. N. gonorrhoeae resistance patterns) Aggregated to provincial level Collection often 1-2 years delayed 5
Examples of Questions There is an increase in the total # of chlamydia diagnoses in my health unit among women aged 15-24. Does this reflect a change in testing practices? Are men of this same age group seeing an increase? And in percent positivity? Are more people being tested for Chlamydia trachomatis? Are more infections detected? Does the percent positivity change as a result? There are recent reports of increasing antimicrobial resistance of Neisseria gonorrhoeae in Toronto (major, dense city). What is the rate of resistance in my health unit? What percentage of infections are diagnosed by culture? How representative is this of the population of the health unit? Are there certain populations that appear more vulnerable to drug resistant gonorrhea? 6
Project Objectives To provide STI laboratory data to Boards of Health and Ministry of Health Use Public Health Ontario laboratory STI test result data Neisseria gonorrhoeae Chlamydia trachomatis Web-based platform and visualization tool Data refreshed once a month Aggregated by health unit Denominators Resistance data Supplementary tools and information Inform decisions about Whom to test Which infections to test for Which antibiotics to use, before individual results available 7
High Level Architecture Online Services Delivery Platform User interface Analytic tools Restricted Access No personally identifiable info Lab Info System Data marts Refresh process Analytic database 8
Organization of Data Queries Three primary queries Slicer combinations Report reference sheets Ensure data logic 9
Live Demonstration www.publichealthontario.ca 10
DEMO 11
Back-Up Slides In case of connection issues with demo 12
Home page of STI laboratory data platform 13
Visualizations 14
Query #1 15
Query #1 16
Query #1 17
Query #1 18
Query #1 19
Query #1 20
Query #1 21
Query 2- Chlamydia and Gonorrhea Co-infections (NAAT Only) 22 Public Health Ontario
Query 3 - Antibiotic Susceptibilities of Neisseria gonorrhoeae Total Number and Percentage of Resistant Neisseria gonorrhoeae Isolates 23 Public Health Ontario
Query 3 - Antibiotic Susceptibilities of Neisseria gonorrhoeae Total Number of Resistant Neisseria gonorrhoeae Isolates 24 Public Health Ontario
Query 3 - Antibiotic Susceptibilities of Neisseria gonorrhoeae Antibiotic Susceptibilities and Distribution of Neisseria gonorrhoeae by Minimum Inhibitory Concentration (MIC) 25 Public Health Ontario
Packaged with information Not just visualizations and data Also provides access to explanatory and other information Links to recent relevant publications Metadata 26
Links to STI Guidelines 27
Tool Instructions 28
Additional Tools 29
STI Publications 30
Report caveats 31
Chronology of Testing Methods 32
Legend 33
Resume After Demo Return to slide deck 34
Data Quality Integrated with PHO Laboratory Surveillance Program Core Initiatives: Data quality protocols and procedures in development key infrastructure component for the program Analysis of laboratory data quality using various tools - How is the data pulled (what do we get?) - How is the data reconciled (what are the gaps, reasons for gaps, validity of data exclusion) - What is needed to fix the data - Involve subject matter experts in the review 35
Benefits Evaluation Assessment of benefits is a critical Infoway project requirement Anticipated outcomes include: Short-term: More informed decisions for heightened screening in regions with high incidence More informed treatment changes based on localized data about antimicrobial resistance Long-term: Potential decrease in burden of STI More informed decisions on decreased antibiotic resistance in Neisseria gonorrhoeae 36
Importance of the project One of the first demonstrations of health system use of lab result data in Canada Helped set up the architecture and processes (lab result data is complex!) Proved the importance of an end-to-end approach: lab tests data end-user presentation action Established the foundation for similar tools for other diseases: e.g. Respiratory (flu, etc.) and Enterics 37
Comments or Questions? 38