Case study: Connecting available data and systems to respond to COVID-19

Implications for real-time monitoring of hospitalisations and impact on public health decision making

At the onset of the pandemic, it was identified that an important indicator of the response would be COVID-19 morbidity and mortality and the impact on the NSW Health system. This data was necessary to inform public health policies and broader health system planning. Experience during the H1N1 pandemic identified that access to this information relied on manual and resource intensive processes and was not sustainable, particularly as case numbers increased. Existing systems were not designed for this purpose and a novel approach was required.

In early 2020, a cross-divisional project – the Rapid Critical Care Surveillance Project Control Group – was initiated to develop and systematise the use of available data and platforms to rapidly identify and report COVID-19 hospitalisations and ICU admissions. It was identified that the Patient Flow Portal (PFP) and the Notifiable Conditions Information Management System (NCIMS) held the information required and connecting these data would be an important tool in the response.

A pilot was implemented in February 2020 to test an automated linkage process between NCIMS and PFP patient data for historical influenza records. This would allow the application of COVID-19 test results on any matching patient within the PFP. In addition, a standard data linkage program was undertaken with the Centre for Health Record Linkage (located in the Centre for Epidemiology and Evidence) as an indicator of health system impacts of COVID-19 over time.

Following the initial pilot, the Project Control Group implemented the routine provision of COVID-19 patient data to PFP for real-time linkage and daily reporting on 16 March 2020. Several enhancements were implemented over the course of the pandemic as new requirements emerged, particularly driven by the surge in cases from mid-2021 during the Delta wave. This work involved:

• inclusion of people diagnosed with COVID-19 but not hospitalised to assist connection with clinical follow-up and release from isolation/quarantine
• use of triage questions via NCIMS to prioritise public health response and referral into clinical care through the PFP
• capture and use of rapid antigen test registration data via Service NSW, initially to support referral for priority clinical care and expanded to enhance understanding of community testing and case identification.

Connecting the available data from existing systems resulted in rapid automation and real-time visibility of health system impacts of COVID-19 and public reporting. In addition, hospitalisations and intensive care unit numbers for people diagnosed with COVID-19 were able to be reported in near-real-time to inform public health decision making.

As case numbers increased, the use of technology to prioritise triage of response and communication to COVID-positive people in the community was critical.

Use and connection of available data to inform response requires early engagement, appropriate governance arrangements, and investment to ensure successful implementation of solutions that are fit-for-purpose, scalable and supported. Operational implications in creating connections between the public health response and clinical care should be considered through governance and decision-making forums.