Page 200 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

198 Chapter 9
Background
Chapter 2 describes notification delays in the Netherlands in 2003-2009, in- cluding an inventory of local notification procedures. Hepatitis B notifications of MHS with covenants allowing laboratories to notify on behalf of physicians, were much faster than MHS without covenants (5.3 days, p<0.05), which was shown on regional level before (22). MHS receiving most notifications by fax showed on average 3.3 days shorter notification delays (p<0.05) than MHS receiving notifications by post. E-mail procedures were not faster than other notification methods. MHS encountered problems with security of in house electronic mail systems, therefore we recommended in 2009 to develop secure e-mail approaches or automated electronic laboratory reporting (ELR) which is shown to improve timeliness of notification (15, 23).
Literature review
Chapter 3 describes which factors in notification systems are associated with timely notification; the outcomes of a systematic literature review. From includ- ed articles, published between 2000 and 2017, delays and notification systems were retrieved and assessed according our notification and reporting frame- work (Figure 1, this thesis). We identified the following facilitating factors, relat- ed to timeliness of notification systems according to the authors:
A. Concerning reporters: (physicians, laboratories): provision of regular feed- back by MHS, training, knowledge, acceptance and simplicity of procedures and clinical guidelines.
B. Availability of resources: sufficient staff, technical facilities (e.g. fax) and rapid transport of laboratory specimens.
C. Notification procedures: standardization, simplification of reporting times, legal adjustments of notification time, periodical evaluation of notification procedures and analyses of delayed reports.
D. Others: public education decreases patient delay.
The importance of providing feedback on the performance of the surveillance system to the reporting health professionals is well known, as well as simplicity and acceptability being important attributes of a surveillance system (11, 12). We conclude that these factors also contribute to timeliness of surveillance systems.
Furthermore, we found that notification procedures involving laboratories were associated with sufficient timeliness of notification. Although in compar- ative studies electronic notification was impressively faster than conventional notification and WHO sets an interoperable, interconnected electronic tool as standard for early-warning surveillance, timeliness outcomes in our study were