Ontario's Integrated Public Health Information System (iPHIS) is being heralded as hugely successful in co-ordinating previously disparate ways of controlling epidemic outbreaks, but the system may be overlooking thousands within the province's Aboriginal community.
A policy advisor has cautioned that Ontario's First Nations communities must be linked to the management system for contagious diseases before another outbreak similar to SARS hits the province.
"We have to get First Nations communities involved in iPHIS before disaster strikes," says Barry Silver of the Ontario Secretariat for Aboriginal Affairs.
Silver's comment followed a presentation on the iPHIS program by the Ontario Ministry of Health, titled "Government of the Future," at Showcase Ontario in Toronto recently.
He noted the Secretariat for Aboriginal Affairs was taking part in the Ontario Avian Influenza Working Group that's preparing contingency plans on handling a possible bird flu outbreak.
"This is the best time to find out how native communities can be included in iPHIS - before we have an outbreak," he said.
Marie Muir, manager of business improvement and knowledge management at the Ministry of Health and Long-Term Care, agrees with Silver. "One painful lesson we learned during the SARS crisis was that you cannot change a system in a crisis, when external conditions are already changing it for you."
During her group's presentation, titled "SARS Wars: How iPHIS is Winning the Battle against Infectious Disease," Muir said at the height of the SARS outbreak in 2003, they attempted but failed to change Ontario's contagious disease reporting system.
Muir said the Public Health Agency of Canada had approached her department at the time and offered to help them deploy iPHIS, which was already being used in British Columbia.
"We managed to install the system in 10 days, but we couldn't get any contact and quarantine management capability to the people on the frontlines," said Muir.
She said at one time public health units were keeping tabs on about 10,000 people who were quarantined in their own homes by calling these families three times a day and "keeping track of the situation by using sticky notes."
Muir said Ontario's health units operated different reporting systems that made it difficult for workers to make sense of data being gathered.
"We might think we did things the same way, but when we sat down to talk it over, we found we had our own unique twist on the matter."
Catalina Trevizan, senior manager of systems development and maintenance at the Ontario Ministry of Health, noted that after the crisis the government took immediate steps to deploy iPHIS. The project was launched in the fall of 2003 and deployed by December 2005.
The system is a central database that enables health units to collect and manage information on communicable diseases. It is deployed across Ontario's health districts and linked to the province-wide IT network set up by the Smart Systems for Health Agency (SSHA), affiliated to the Ontario Ministry of Health.
SSHA electronically connects 95 per cent of Ontario's hospitals and provides access to vital information and resources to more than 150,000 healthcare workers. "The system allows health workers to gain a province-wide view of an outbreak and to get a better idea of how it is progressing across the area," said Trevizan.
The system helps avoid the chaos that prevailed during the SARS outbreak when health units had no way to share data in real-time or any means of eliminating redundant reporting.
The use of iPHIS in recent outbreaks of salmonella, Legionnaire's disease and rubella in the province had proven very effective, Muir said. "The real power of the system is in helping detect trends and to link cases to risk exposures."
These are the capabilities that Silver hopes Aboriginal communities across the province will also have access to. He said health information coverage over reserves and other First Nations communities was patchy. "Some communities are linked to an automated health database and some are not."
Silver said the Secretariat for Aboriginal Affairs wanted to discuss with the Health Ministry how these communities could be linked to iPHIS.
According to Health Ministry spokesperson John Letherby, discussions are ongoing with the First Nations communities in Ontario, as well as at the federal level regarding infectious disease surveillance.
- with files from Lisa Williams
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