The COVID-19 pandemic presented additional data-related challenges to healthcare systems globally, so Slovenia was no exception. The key to avoiding massive, economically ruinous lockdowns is effective testing, isolation, and contact tracing to control viral spread. Since this is a new virus, the swift generation and dissemination of knowledge, epidemiological data, treatment guidelines, and the screening of results are all necessary to cope with it successfully. Data from screening tests, locations of confirmed positive cases, the denominator of total tests administered, evolving case definitions, and many other data streams must flow as freely as possible without sacrificing privacy or other essential ethical care research elements.
Slovenian national eHealth infrastructure (known as the Interoperability backbone) made possible the country's swift, targeted response to COVID-19. Although the system was not designed to stop a pandemic but based on openEHR and IHE document-based exchange, it was elegant enough to be reoriented towards one.
Working with the Slovenian Ministry of Health and the Slovenian National Institute of Public Health (NIPH), Better delivered a national COVID-19 screening data management solution in just 14 days in December 2020.
The availability of almost immediate data for patients on screening and testing allows them to act accordingly and can dramatically reduce Covid-19 spread and contributing to shortening extensive lockdown. Real-time screening data also permit proactive interventions to improve the quality of care, not only in a pandemic but also in routine maintenance. Data sharing across platforms and with patients is essential, especially during a disease outbreak. With these features, data is used to give physicians timely feedback on patient status affecting their quality of care and providing important patient safety.
To improve the response to the pandemic, the Slovenian Ministry of Health needed to establish:
- a collection of COVID-19 screening data;
- an improved information flow of testing results to medical personnel, as well as to the population being tested;
- central epidemiologic monitoring of COVID-19;
- data available for research and secondary uses;
- support for storing COVID-19 vaccination data enriched with adverse reaction data.
The goal was to provide real-time data for COVID-19 infections and screening to improve and more efficiently control Slovenia's pandemic.
Features and Services
- Individuals are informed by SMS text message about their test results when the central system receives their result from a COVID-19 testing point – so they can take immediate action to prevent the further spread of the virus.
- Aggregated and filtered data is sent to COVID-19 testing points so that individuals who were not successfully notified of their result via SMS text message can be informed by telephone.
- Data is transferred in real-time to the national infectious disease database for epidemiological monitoring.
- Information on an individual's positive test result is available to healthcare providers as a time-limited alert through the Patient Summary document.
- The secondary use of data for research focuses on population-based healthcare monitoring and an analysis of how effective different test types are.
- Better deployed solution in 14 days.
- 250,000+ records were collected in 30 days.
- Successfully notified 150,000+ individuals within 30 days.
- Sent 500,000+ SMS texts were sent total in 30 days.
- Information on positive patients is available to healthcare providers as a time-limited alert through the Patient Summary document, thus contributing to better care – a timely response is crucial for successful pandemic control.
- Communication and notification solutions are reducing the burden on epidemiological service personnel.
- The display of test results in the electronic medical record contributes to the protection of medical teams.
- The upgrade of eHealth enables a more up-to-date statistical monitoring of the spread of the virus.
- Since the end of December 2020, data screening has been complemented with vaccination records and information on potential adverse reaction events, which improves patient safety.
- The secondary use of the data has made it possible to compare the effectiveness of PCR vs HAGT.
The Foundation: A Modular and Open, Data-Driven Backbone for the Infrastructure
The Slovenian healthcare system already had the national eHealth infrastructure needed to support Slovenia's health and care services. It enables document level sharing and the mobilization of documents already produced by legacy systems and ensures the capacity to put data into an open, structured format that is technology and vendor-neutral. It provides a shared care record service (a centralized registry of patient data), including 60 million structured and unstructured records for more than 2 million individuals.
The digital health platform enables the Ministry for Health to carry out a rapid response, whether to meet clinicians' needs and requirements or is driven by unexpected events and situations. The modular and open, data-driven infrastructure enabled Better to deploy a COVID-19 screening data management solution on a county-wide level in a mere 14 days.
The test Notification Process
In cooperation with the Slovenian National Institute of Public Health (NIPH), Better upgraded the national, interoperable eHealth backbone so that it now enables the automatic and uniform notification of individuals regarding test results. The procedure is carried out as follows: all health care providers send the test results to the central point at the NIPH, and from there, the individual who was tested (and provided his or her mobile phone number) receives an SMS text message notification.
Informing individuals about their COVID-19 test results, which had previously been done through a personal physician or entry point, is now moving to an automated and uniform notification method. This is done via SMS text messages received by the individuals who have taken the test from the NIPH. When the new coronavirus is spreading intensely, more accessible testing and the introduction of rapid tests, and the prompt communication of results, are all key to preventing the further spread of new infections.
The procedure takes place in two stages:
- individuals must first identify themselves by replying to the message received (with one of the data known to him);
- When an identification is made, individuals receive the results of their test on their mobile phones.
Notification Services as a Means for Controlling the Pandemic
With this automatic notification, epidemiological services will be greatly relieved, as it will only be necessary to inform those who did not provide their mobile phone numbers. Another essential advantage of automatic notification is the time saved, as test results will reach individuals much faster. The latter is key to effectively preventing the spread of new coronavirus infections. Entering a test result (i.e., a TAN code) into the #OstaniZdrav (Stay Healthy) application also makes an essential contribution to limiting the spread of infections, as the application automatically notifies any close contacts of an individual who has received a positive result.
The service provided will reduce the burden on epidemiological services, and the time saved will reduce the spread of infections. Finally, displaying test results in the electronic medical record will contribute to the protection of medical personnel.
The eHealth Interoperability backbone upgrade also included displaying the test results in the individual's electronic health record for three weeks – for as long as the individual is infected. The displayed alert provides additional protection to healthcare professionals who may treat this patient at different levels. Finally, the eHealth upgrade enables more up-to-date and statistical monitoring of the spread of the pandemic.