Page 201 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

not related with notification methodology (8, 23, 24). Our results might be in- fluenced by the fact that conventional (postal mail, telephone, e-mail) and elec- tronic (online) systems cannot be separated completely. MHS for example might receive notifications through secured conventional e-mails, originating from an automated electronic laboratory data system. In that way conventional report- ing systems might show short delays actually resulting from electronic systems.
One should also take into account that electronic notification systems only influence the last administrative part of the total local notification delay, not in- cluding the most extensive, disease identification delay (D1X). As these systems need considerable investment, both financial as well as in staff time, for ICT main- tenance, and to verify whether (incomplete) notifications fulfill case definitions, we conclude that decisions on applying those systems should be taken cautious- ly. However, there might be other reasons to invest in electronic systems, such as completeness of notifications, completeness of data entries or efficiency (6, 16, 23). In the future, electronic reporting from medical records (EMR) might be a better alternative, as this can provide clinical and epidemiological information.
Legislation and alert systems
Chapter 5 showed that the median notification delay decreased from 2 to 0 days between periods 2003-2008 and 2013-2017, and the average across the medi- ans per infectious disease from 1.4 to 0.4 days. This decrease started already since 2003, probably due to the installment of covenants between laboratories and physicians (Chapter 5, Figure 3) (22). However, the law change, obliging both physicians and laboratories to notify group B and C diseases probably con- tributed to the further reduction of delay as nowadays the fast majority of no- tifications is made electronically by laboratories instead of physicians (personal communication regional consultants communicable disease).
With the new law, the reporting timeframe for some diseases was adjusted as well. The median reporting delay decreased from 1 to 0 days between 2003- 2008 and 2009-2013. The main improvement was in 2009, the year following the law change, and shows that MHS are capable of swiftly adjusting their pro- cedures. As pertussis reflects the majority of notifications, its timeframe adjust- ment from 1 month to 1 week had considerable influence on the percentage of total timely notifications. However, as the average of 28/30 is 93.7% in 2016- 2017, we conclude that the decrease reflects the complete MHS reporting sys- tem. The influence of law adjustment on timeliness has been observed by other studies as well, as we described in Chapter 3. However, a notification timeframe of one working day for all diseases is quite tight compared with other studies.
General discussion 199
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