The document discusses how Catalonia responded to the H1N1 influenza pandemic using information systems (IS) and information and communication technologies (ICT). It summarizes how Catalonia used existing surveillance systems to monitor the outbreak, activated healthcare response plans to manage increased demand, implemented prevention strategies like hygiene practices and vaccines, and employed communication strategies targeting citizens and professionals. The pandemic provided an opportunity to improve IS integration and interoperability as well as data analysis and predictive capabilities for future health emergencies.

1. How can IT help fight
pandemics
Public Health in response to Pandemic Influenza
The case of Catalonia
Antoni Plasencia , MD, MPH, PhD
General Director of Public Health
Government of Catalonia, Spain
March 16, 2010

2. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions:

3. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions

4. Context
Autonomous Community of Spain – CATALONIA
Catalonia is one of the 17 Autonomous Communities of Spain, and has
full powers regarding citizens’ health care, including public health.
Government: Generalitat de Catalunya
Area: 32.106,5 km2
Population (2009): 7.475.420
Life expectancy (2009): 80,55 years
Birth rate (2008): 12,2
Gross Mortality rate (2007): 8,28
Infant mortality (2007): 2,65
GDP/Capita (2007): 24.445€
High urban concentration
Own official language and culture
Source: IdesCat

5. Context
CATALONIA – The Healthcare System in Catalonia: universal and free
Public Healthcare
The Healthcare System in Catalonia Network
 395 basic health areas
 807 out-patient offices
 65 specialized care
hospitals (17.851 beds)
 38 psychiatric care
(4.704 beds)
 84 long stay care
(9.164 beds)
 102 middle stay care
(2.661 beds)
Source: IdesCat 2008

6. Context
CATALONIA – The Healthcare System in Catalonia
Specialized
Healthcare Pharmacies
The IS & ICT used are:
• Shared Medical Record
IS • Electronic Prescription
•
Network
Clinical units (eCap)
Primary Offices Emergency • ...
care Citizens care
Offices involved include:
• AIAQS
ICT • TicSalut
• Standards office
Research
centers
Public • ...
Health Units
 Universal coverage and free access based on general taxes
 Fragmented Information System for most healthcare suppliers due
to the healthcare system diversification
 Multiple sources of information

7. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions

8. Influenza Pandemic in Catalonia: IS & ICT
New flu H1N1, ongoing strategies in Catalonia
Catalonia Pandemic Plan* Organizational structure
 Surveillance and early detection
 Executive Committee
 Emergency response of Catalonia
 Vaccines
 Coordination
 Treatment of infected and exposed Committee
prophylaxis (antiviral)
 Management Board
 Non-pharmacological measures and
social distancing  Scientific Advisory
Board
 Schools - Work - Community
 Communication
* Created on 2005 and reviewed on 2008

9. Influenza Pandemic in Catalonia: IS & ICT
CATALONIA - April 24, 2009 - initial statement to activate the protocol for surveillance
and control of influenza A-H1N1 virus
1 1st case - Virus A (H1N1)
Mexico - March 2009
Public health emergency  On April 24, initial statement
3 of international concern
USA – Late April 2009
declares activation of
surveillance protocol and
Late April existence of the new
Margaret Chan, the
WHO's director-general, influenza A-H1N1 virus
declared a "public health
emergency of  On April 25, first two cases
international concern" are detected in Catalonia
Infection in 2 children
2 Southern California
USA – April 2009
under the rules of the
WHO's new International  On April 26, the Department
Health Regulations when of Health of Catalonia
the first two cases of the activates the Coordination
H1N1 virus were reported
in the United States, Committee to monitor and
followed by hundreds of evaluate the new outbreak of
cases in Mexico flu.

10. Influenza Pandemic in Catalonia: IS & ICT
Fundamental ideas of the Pandemic Plan: Areas of preparedness
Epidemiologic Healthcare
Surveillance
IS & ICT
Prevention Communication

11. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions

12. Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
• April 24 – First WHO alert
• According to the plans of surveillance preparedness
and response to emergencies, healthcare system
responsible for the emergencies was alerted only a
few hours after the first WHO alert.
• Within 48 hours a small set of guidelines for
healthcare professionals were released, containing
relevant information about the new virus and
suspected case management.

13. Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
1 EPIDEMIOLOGICAL SURVEILLANCE
EPIDEMIOLOGICAL SURVEILLANCE
STIR: Sexually
transmitted infection
(STI) Record
X IRDS: Individualized
Reportable Disease
System
X MRS: Microbiological
Reporting System
RDS: Reportable
Disease System
X ODR: Occupational
Disease Record
Alerts &
X
SSS: Sentinel
Surveillance System
Outbreak

14. Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
1 EPIDEMIOLOGICAL SURVEILLANCE
EPIDEMIOLOGICAL SURVEILLANCE
STIR: Sexually IRDS: Individualized
MRS: Microbiological
transmitted infection Reportable Disease
Reporting System
(STI) Record System
RDS: Reportable ODR: Occupational EDCR: Emerging
Disease System Disease Record Disease Registry
May All cases
SSS: Sentinel Alerts &
Surveillance System July Only severe cases
Outbreak
DATA ANALYSIS
COMMUNICATION

15. Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
PIDIRAC - Sentinel Surveillance System
Parainfluenza 4
VGCEnterovirus
Parainfluenza 3
Parainfluenza 2 ADV VGA(H3)
Parainfluenza 1
Rinovirus A(H1N1)v
VRS
600 70
60
Taxa/ 100.000 habitants
500
50
400
40
300
30
200
20
100 10
0 0
21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19
Distribution of the 33 (8 in Setmanes
VGA VGB A(H1N1)v 2009_2010 2008_2009 llindar basal
BCN) centers with sentinel
primary care practices

16. Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Reportable Disease System
30
July 29.
25 Surveillance of
June 11. WHO severe cases
20
April 24. Launch of declares fase 6 A(H1N1).
surveillance protocol A(H1N1).
15
10
5
0
21
24
27
30
12
15
18
21
24
27
30
11
14
17
20
23
26
29
11
14
17
20
23
26
29
3
6
9
2
5
8
2
5
8
April May June July

17. Influenza Pandemic in Catalonia: IS & ICT
Match between epidemiologic surveillance and healthcare information
Value added information
EPIDEMIOLOGIC
HEALTHCARE
SURVEILLANCE IS & ICT
INFORMATION INFORMATION
The Public Health Department use IS & ICT in order to
integrate information coming from epidemiologic
surveillance and healthcare suppliers.

18. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions

19. Influenza Pandemic in Catalonia: IS & ICT
Healthcare
Healthcare Response Plans
Provide effective and efficient response to the increase in
OBJECTIVES healthcare demand, especially oriented to critical cases,
among all the healthcare centers of Catalonia
• In the event of a crisis, identify responsible
• Additional beds (critical and non critical)
ACTIONS • Action Plan provision to offset uncovered services
• Increase telephone assistance
• Strengthen home healthcare

20. Influenza Pandemic in Catalonia: IS & ICT
Healthcare
Organisational model: patient management
Global population
and children
HOME
C A P
Critical groups
PHONE CALLING
HOSPITAL
Pregnant Chronic Obese
patients
Critical patients HOSPITAL

21. Influenza Pandemic in Catalonia: IS & ICT
Healthcare
2 HEALTHCARE
PIUC. Emergency plan to coordinate all
actions from different levels of healthcare
services
• Information System monitors healthcare activity and bed
occupation together with scaling and improving resources
• It facilitates:
• Implementation of prevention plans
• Adjustment of resources to the demand
• Prediction of future demand
• It informs:
• Healthcare professionals and citizenship

22. Influenza Pandemic in Catalonia: IS & ICT
Healthcare
PIUC. One week emergency cases in a hospital

23. Influenza Pandemic in Catalonia: IS & ICT
Healthcare
Healthcare. Total severe patients diagnosed in Catalonia
Healthcare Region Inhabitants Severe patients Rate (per 100.000 pop.)
BCN 5.056.683 523 10,3
GIR 739.070 65 8,8
CT 609.547 97 15,9
CC 511.815 51 10,0
LL 363.612 21 5,8
TE 193.819 13 6,7
APA 77.313 1 1,3
TOTAL 7.551.859 771 10,2

24. Influenza Pandemic in Catalonia: IS & ICT
Healthcare
All PIUC information is analyzed by
healthcare and Public Health
professionals in order to monitor the
epidemic and predict future trends and
demand and to adjust resources
efficiently.

25. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions

26. Influenza Pandemic in Catalonia: IS & ICT
Prevention
• Measures used to decrease infection
transmission:
• Hygienic practices
• Vaccines and antivirals
• Social distancing
• Other non-pharmacological
New ICT were used to disseminate and
monitor all the measures.

27. Influenza Pandemic in Catalonia: IS & ICT
Antivirals

28. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions

29. Influenza Pandemic in Catalonia: IS & ICT
Communication
• Communication plan focuses on
• Citizens
• Healthcare professionals
• Media
• Main objectives
• Avoid citizenship alarm
• Provide precise information about
• Influenza’s evolution
• Best prevention and treatment measures
• Communication principles
• Transparency
• Coherence
• Empathy

30. Influenza Pandemic in Catalonia: IS & ICT
Communication
4 COMMUNICATION - INTERNET

31. Influenza Pandemic in Catalonia: IS & ICT
Communication
4 COMMUNICATION – MEDIA

32. Influenza Pandemic in Catalonia: IS & ICT
Turning threats into opportunities
WHAT WE HAD WORK IN PROCESS WHAT WE WILL HAVE
• Fragmented IS • IS connected through • Fully integrated IS
• No communication Interoperability • Easy and fluent
between applications Standards communication
• Need for updated IT • Modernized IT between applications
• Management • Integrated information • Shared strategies
difficulties and data • Easier and faster data among healthcare
analysis problems analysis providers and agents
• Uncovered areas of
knowledge

33. Index
Context
Influenza Pandemic in Catalonia: IS & ICT
Epidemiologic Surveillance
Healthcare
Prevention
Communication
Conclusions

34. Conclusions
Global
• Previous preparation efforts and existing coordination
structures have been decisive to give a rapid response
to this new pandemic
• But it has been crucial to
• Adapt surveillance systems
• Coordinate and manage all levels of health care
• Update training programs
• Tailor informative messages

35. Conclusions
Progress
The development and implementation of new IS and ICT
will have a substantial impact upon decision management:
 More information and with more quality
Flexibility
2004
2010
Timeliness Data quality
Simplicity Prediction

36. Conclusions
Lessons learned
 The response to pandemic influenza in Catalonia
has provided an opportunity to improve and
innovate in IS and ICTs.
 Barriers are more organizational than technical or
technological.
 Involvement of different agents in the process.
 Better management tools for future collective health
emergencies.

37. THANK YOU !
Moltes gràcies!
¡Muchas gracias!
dgsp.salut@gencat.cat