To:Chair and Members, Board of Health

From:Dr. Sheela Basrur

Date:July 12, 1999

Subject:Attached Report to Policy and Finance Committee

Due to time constraints, the attached report has been submitted in parallel to the City's Policy and Finance Committee and the Board of Health. The report was vetted by the Chair and Vice-Chair of the Board, both of whom are members of the Board's Budget Sub-committee.

Since the Policy and Finance Committee meets on July 20, 1999 (two days before the Board of Health), report is submitted to the Board for information only and a verbal report will be provided on the Committee's decision.

Respectfully submitted,

Dr. Sheela V. Basrur

Medical Officer of Health

July 12, 1999

To: Policy and Finance Committee

From: Dr. Sheela V. Basrur, Medical Officer of Health

Subject: Amalgamation of Reportable Diseases Information System (RDIS)

Purpose:

To secure one-time funds in 1999 to amalgamate Reportable Diseases Information

System (RDIS) databases.

Source of Funds:

The amalgamation of RDIS Database Project will cost approximately $250,000 to implement. These funds can be made available from the balance remaining in the Vaccine Preventable Diseases (VPD) Program Redesign Project. All the essential components of the VPD Project will be completed in 1999. Provincial cost-sharing will be sought for this initiative.

Recommendations:

It is recommended that:

(1)the six existing Reportable Diseases Information System (RDIS) databases be amalgamated; and

(2)the funding for this project amounting to $250,000 be reallocated from the VPD Redesign Project which was approved as part of the 1998 Capital Budget - Transitions Projects.

Background:

The Reportable Diseases Information System (RDIS) is a provincially-mandated system which supports the delivery of the Communicable Disease Control Program. Under the Health Protection and Promotion Act each health unit is required to investigate all reports of over 65 designated diseases from physicians, laboratories, hospitals and other institutions. This must be done in a timely manner in order to prevent and control morbidity and mortality. Toronto Public Health responds to approximately 25,000 disease reports each year. These include such high risk diseases as bacterial meningitis, Group A Strep (flesh-eating disease), Tuberculosis and AIDS as well as outbreaks in schools and other settings.

The RDIS program is used to:

(i)support the case management process

(ii)enable analysis of disease incidence to identify trends and emerging issues

(iii)electronically transmit information to the Ministry of Health as legally required Comments:

Currently the Communicable Disease Control Program is offered in multiple offices across the city, using six separate RDIS databases one for each of the former local municipalities. These systems are unable to communicate with each other, posing severe operational issues and inefficiencies in program delivery. These include:

(1)It is difficult to have a city-wide picture of communicable diseases to enable early identification of trends and potential outbreaks.

(2)With a highly transient population there are likely duplicate or multiple records for an individual on different RDIS databases. High-risk individuals with multiple infections or ongoing reinfections are difficult to identify and track.

(3)Unnecessary delay in response to a disease notification due to manual transfer of information from the office receiving the notification to the office where the client resides.

(4)For clients with sexually transmitted diseases (comprising about half of all reports), there is significant duplication of data entry. This occurs when the physician and client addresses are in different databases.

(5)It is difficult to do effective program planning and evaluation on a city-wide basis.

(6)Six RDIS databases must be maintained, containing duplicate information on physicians, institutions, etc. This is inefficient and costly over the long term.

(7)Cumbersome and time consuming to implement and maintain standardized forms and letters on six separate systems.

(8)Inability to access information across the city, which hampers efficient workload distribution.

(9)Response to Freedom of Information requests requires checking six databases.

The capital investment required to amalgamate the six RDIS databases is approximately $250,000. This is primarily salaries for technical support assistance to standardize RDIS tables and supporting databases, merge the client databases, eliminate duplicate records and provide staff training and support. The database amalgamation will be done in conjunction with Y2K work, in order to maximize the efficient use of the existing infrastructure and skilled staff. The Ministry of Health has covered approximately $150,000 of the cost to date (including one server and replacement of PC s) and will provide limited in-kind programming and technical support in the amalgamation. Given that the VPD project funds are 100% municipal and that the Ministry of Health has agreed to cost-share Public Health programs on a 50/50 basis, the Medical Officer of Health will seek Ministry cost-sharing for this project.

In the meantime it is critical that the amalgamation of RDIS databases proceed. The required funds are available in the VPD Redesign Project. As the VPD project completes its first year of redesign, savings have been achieved through:

(a)utilization of existing technology for the Call Centre;

(b)the Ministry of Health undertaking development of a provincial Physician Vaccine Monitoring & Inspection System; and

(c)deferral of development of a Vaccine & Drug Ordering System (this will be considered in conjunction with redesign of the Communicable Disease Surveillance Unit in future).

Conclusion:

Capital investment in the amalgamation of the six RDIS databases is critical to the delivery of the Communicable Disease Control Program. Since significant savings have been achieved in the implementation of the VPD Redesign Project, the required funds should be transferred to enable implementation of RDIS amalgamation in the year 1999.

Due to time constraints this report will be routed in parallel to the Budget Sub-committee of the Board of Health for consideration prior to the meeting of the Policy & Finance Committee on July 20th.

Contact Name:

Dr. Barbara Yaffe

Director, Communicable Disease Control & Associate Medical Officer of Health

Tel: 392-7405

Fax: 392-0713

Dr. Sheela V. Basrur

Medical Officer of Health