D3.1 Report on the member states survey on hospital surveillance and description of piloting plans

The aim of WP3 Hospital surveillance is to build a foundation for timely, comparable, and representative surveillance of severe infections leading to hospitalisation. To understand the current status of surveillance, a Survey was launched for the 16 participating Member States, with sections on current surveillance systems, new data sources, legal or technical barriers, and description of piloting plans. A workshop on the Survey results was held in May 2023.

Current surveillance systems: In general, the majority of the surveillance systems for respiratory viruses were established during or after 2020 and were founded on some form of national legislation, half operating under a permanent legal basis. Most countries reported the need for improved or new legislation in the future. Individual (case-based) data was collected in all Member States, and in most countries could be linked with other data sources.

Barriers: Data availability or accessibility was a major obstacle for surveillance, as specific medical data in  many countries are not accessible in electronic form, or electronic patient data may not be available in a  structured and standardized format. Also delays cause problems for surveillance, as hospital registers coding is mostly done on discharge, not on admission. That leads to a considerable delay in serious events leading to long hospitalisations. Legislation is an issue for all countries. For the Covid pandemic new national legislation was enacted, allowing linking of different data source, but this legal basis is temporary. Also there are different interpretations of the GDPR in Member States. Lack of ICT and EHealth competence and resources make it difficult to digitalize surveillance and employ IT-specialists. Importance of reliable infectious disease surveillance is not prioritised by decision makers between the pandemics and therefore the resources are hard to obtain and there may not be a national plan for developing the surveillance further.

Future data sources identified: For countries relying on clinical information, laboratory notifications of  confirmed cases is a useful new data source. Data on all laboratory tests performed could be used to calculate the proportion of positive cases. Lastly further typing of the microbe, test results of antimicrobial resistance, or genotyping information were identified for future use. Daily data on hospital outpatient visits and hospitalisations from hospital registers is valuable information for the surveillance of severe infections. In some countries hospital registers contain information on severity of the case, by including a marker for oxygen support or mechanical ventilation needed. More refined clinical information sources can be intensive care registers or registers containing prescribed medication. Electronic patient records can be used for detailed patient background information such as chronical diseases and conditions and medication history.

Piloting plans will study, clarify and solve hurdles on the route from paper-based, aggregated, manually  collected surveillance information to designing and implementing a full-blown digitalised, automated  integrated surveillance tool. Slovenia will take first steps to develop a digitalized SARI surveillance system, by identifying the core data items needed and respective coding for them, mapping the availability of relevant data etc. With the help of a stakeholder analysis Netherlands will aim for a robust and sustainable sentinel surveillance system. Latvia will develop a sentinel computerized reporting system between two hospitals, reference laboratory and the CDPC. Malta plans to develop a Patient Dashboard for use in the main state hospital, allowing systematic inputting of symptoms data by clinicians and automated electronic reporting. In Italy the aim is to link clinical data from Intensive Care Units network and microbiological data from the network of Antimicrobial Resistance laboratories. Poland and Finland will add new data sources to the existing national infectious disease registers, for example vaccination register data. Norway plans to design a concept for development, implementation, and maintenance of a scalable, secure, and robust nation-wide register based surveillance system.