Page 76 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

74 Chapter 3
Although this was not the primary aim of the study, we identified the following facilitators and barriers related to timeliness outcomes of notification systems:
1. Concerning reporters (physicians, laboratories): facilitating factors: mo-
tivation, communication (between public health services and reporters), awareness raising, acceptance and simplicity of procedures and clinical guidelines, knowledge, training, phone call reminders, regular feedback [3, 9, 16, 25, 31, 32, 36, 38, 45, 54]. Barriers were lack of knowledge, lack of communication, uncertainty towards notification procedures [39, 45].
2. Available resources: availability of staff, technical facilities (fe fax) and rapid laboratory transport [25, 27, 42]. Barriers were different laboratory software among laboratories and using out-of-state laboratory facilities [38, 53, 57].
3. Notification procedures: unification of reporting times, legal adjustments of notification time, f.e. to frequency of reporting, a centralized data base, periodically evaluation of the system and analyses of delayed reports [15, 16, 18, 23, 24, 42, 47]. Barriers were administrative procedures and high volume of cases [39].
4. Others: higher number of notifiable cases during an epidemic was reported as barrier [28], but considered facilitating factor in others as extra support- ive staff was made available. [27, 47] Public education is a facilitator to reduce patient delay [16].
Although we cannot come to conclusions to which extent these barriers and facilitators influence the timeliness of notification systems, it is obvious that addressing these aspects contribute to optimized functionality of the system.
Over the last two decades, several studies demonstrated the value of elec- tronic reporting systems reducing notification delays [7]. However, over the last years, implementation of ER also revealed challenges. Gluskin et al. summarize in their systematic literature review that ELR, comparable with results of our study, reduces reporting time on average with 8.5 days (range 4-17 days) [59]. Besides increased volumes of incomplete notifications, coding of infectious dis- eases can be a challenge for laboratories when adjusting diagnostic tests, and for public health authorities whose computer systems have to keep up with de ELR codes. Also considerable information technology infrastructure, exper- tise and workforce need to be available for a good operating system, requiring substantial financial investments. The next step forward would be notifications through Electronic Medical Records (EMR), also requiring technical and finan- cial investments, but addressing the physician reporting delay (D3P), which had the lowest scores in timeliness in our review. This system also can combine