Local Action from Integrated Data: Presentation of
Laboratory Test Result Data for Informed
Management of Sexually Transmitted Infections
eHealth 2013
May 29
Jim Tom
Partnership with Canada Health Infoway
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Who is Public Health Ontario?
• Crown corporation
• Dedicated to protection and promotion of health of Ontarians
• Wellness of communities and populations
• Provides expert scientific and technical support to
government, local public health agencies, healthcare
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Communicable & infectious diseases
Infection prevention and control
Environmental and occupational health
Health promotion, chronic disease and injury prevention
Public health laboratory services
• Surveillance, epidemiology, research, professional
development
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Data-Driven Decision Support in
Public Health
• Timeliness
• Data on other factors such as anti-microbial resistance
• Localization
• Meaning
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The Challenge in STI Practices
• Current STI data available includes
• Reportable diseases database (e.g. iPHIS)
• Lacks information about denominator
• End users cannot easily compare data to other jurisdictions
• Lacks trend of antibiotic susceptibilities
• STI laboratory data
• Reference laboratory testing data often used for national guideline
development (e.g. N. gonorrhoeae resistance patterns)
• Aggregated to provincial level
• Often 1-2 years delayed
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Examples of Questions …
• There is an increase in the total # of chlamydia diagnoses in my health
unit among women aged 15-24.
• Does this reflect a change in testing practices?
• Are men of this same age group seeing an increase? And in percent positivity?
• Are more people being tested for Chlamydia trachomatis? Are more infections
detected? Does the percent positivity change as a result?
• There are recent reports of increasing antimicrobial resistance of
Neisseria gonorrhoeae in Toronto.
• What is the rate of resistance in my health unit?
• What percentage of infections are diagnosed by culture? How representative is
this of the population of the health unit?
• Are there certain populations that appear more vulnerable to drug resistant
gonorrhea?
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STI Laboratory Data Tool:
Project Objectives
• To provide STI laboratory data to Boards of Health and MOHLTC
• Use Public Health Ontario laboratory STI test data
• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Web-based platform and visualization tool
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Data refreshed once a month
Aggregated by health unit
Denominators (# samples submitted)
Resistance data
Supplementary tools and information
• Inform decisions about
• Whom to test
• Which infections to test for
• Which antibiotics to use, before individual results available
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High Level Architecture
“Online Services
Delivery” Platform
User interface
Analytic tools
No personally
identifiable
info
Restricted Access
Lab Info
System
Data
marts
Refresh process
Analytic
database
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Organization of Data Queries
• Six Primary queries
• Slicer combinations
• Report reference sheets
• Ensure data logic
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Home page of
STI laboratory
data platform
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The Six Queries
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Query #1
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Query #1
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Query #1
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Query #1
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Query #1
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Query #1
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Query #1
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Other views
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Public Health Ontario
Views of antibiotic
susceptibility
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Public Health Ontario
Links to STI Guidelines
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Tool Instructions
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Additional Tools
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STI Publications
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Report caveats
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Chronology of Testing Methods
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Legend
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Data Quality
• Integrated with PHO Laboratory Surveillance Program
• Core Initiatives:
• Data quality protocols and procedures in development – key
infrastructure component for the program
• Analysis of laboratory data quality using various tools
- How is the data pulled (what do we get?)
- How is the data reconciled (what are the gaps, reasons for gaps, validity of
data exclusion)
- What is needed to “fix” the data
- Involve subject matter experts in the review
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Improving and Integrating
Feedback
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Benefits Evaluation
• Assessment of benefits is a critical Infoway requirement
• Next step beyond pilot and “go-live”
• Anticipated outcomes include:
• Short-term:
• More informed decisions for heightened screening in regions with high
incidence
• More informed treatment changes based on localized data about
antimicrobial resistance
• Long-term:
• Potential decrease in burden of STI
• More informed decisions on decreased antibiotic resistance in Neisseria
gonorrhoeae
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Comments or Questions?
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