In 2005, China launched an electronic Tuberculosis Information Management System (TBIMS), which was the largest in the world. All TB dispensaries across the country now enter TB case information into the system via the internet in real time (1).
In November 2011, the General Office of the State Council issued the National TB Control Program (2011 to 2015), which requires that, in principle, each county in China should designate at least one hospital to diagnose, treat, and register TB patients. In June 2012, the former Ministry of Health and the State Administration of Traditional Chinese Medicine issued the Guiding Opinions on Strengthening the Construction of Health Information System, which clarifies the overall framework, basic principles, work goals, key tasks, and safeguard measures of the health information system.
By the end of 2012, 48% of health facilities nationwide had built electronic medical record systems (2), but could not exchange data with the TBIMS. All the surveillance data related to TB need to be re-entered into TBIMS, although these data were already electronically stored in the hospital information system. In November 2016, the National Development and Reform Commission issued the National Health Security Project Construction Plan, which required data aggregation and business collaboration of six major business application systems including public health. By the end of 2017, more than 75% of secondary public hospitals had established electronic medical record systems, and the overall information construction situation of China’s secondary and higher medical institutions has improved (3).
TBIMS serves as the main data source to evaluate the implementation of the National TB Control Program. Yet with advancements in information technology, changes to TB service delivery, and the requirements of the national health information system, it was necessary to develop a new TB surveillance system. The National Health Commission of China-Bill & Melinda Gates Foundation TB Collaboration project organized a pilot of a new TB surveillance system from 2016 to 2019. The system was designed to be applicable to the current state of TB control and prevention and to be able to exchange data automatically with regional health information platforms.
The pilot first developed a unified TB surveillance dataset and data exchange interface specifications. China CDC then developed the new TB surveillance system, and the pilot areas accordingly upgraded their local hospital information systems and regional health information platforms. With these processes and systems in place, the pilot achieved automatic data exchange and sharing between the various platforms—a requirement of the national health information system construction. The pilot further aimed to provide experience and lessons learned that could be used to build infectious disease surveillance models for other diseases or for an entire public health information system.
According to the characteristics of China’s TB service delivery models, the pilot project selected one health facility each from the eastern, central, and western regions of China. The eastern region chose the Central Hospital of Huzhou City in Zhejiang Province as a designated hospital model; the central region chose the TB dispensary of Jilin City in Jilin Province as an independent TB dispensary model; and the western region chose the Fourth People’s Hospital of Ningxia Hui Autonomous Region as an integrated model.
The pilot first unified the standards for TB surveillance datasets (Figure 1), which included basic information, physical examination screening history, medical history/disease, epidemiological investigation history, and so on. All the collected information was transformed into an electronic disease record (EDR) with the patient ID at its core, thereby making data exchange and full lifecycle monitoring possible. In the process of data exchange, unsuccessful exchanges and data inconsistencies were analyzed and corrected in real time. Moreover, the function of data extraction and collation of hospital information systems was improved constantly and so was data verification and logical checking of national and regional health information. The goal was to reduce the data entry burden of medical staff and ultimately improve the timeliness and accuracy of surveillance data.
After preparing for national system development and regional system upgrade, the pilot officially started in July 2018 and ended in June 2019. During the pilot period, each region automatically uploaded relevant data of TB patients to the new national TB surveillance system through the regional health information platform. According to the requirements, the infectious disease report card and medical record information of TB patients were entered into the National Notifiable Disease Reporting System (NNDRS) and TBIMS respectively. Three indicators were analyzed for each pilot area during the pilot period.
The three indicators—data exchange rate, infectious disease report card filing rate, and medical record filing rate—have all improved, reaching 95% and above by June 2019, with some indicators approaching or reaching 100% (Figure 2).
Figure 2. Pilot result of the new Tuberculosis (TB) integrated health surveillance system, three regions, 2018–2019. (A) Percentage of TB patients records successfully transmitted from regional health information platform to new national TB surveillance system; (B) Percentage of TB infectious disease report cards reported from National Notifiable Disease Reporting System (NNDRS) to new national TB surveillance system; (C) Percentage of TB medical records registered from TBIMS to new national TB surveillance system.