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- Physicians using the Norwegian Surveillance System for Communicable Diseases (MSIS) encountered similar challenges with reporting during the COVID-19 epidemic as they were seeing before the epidemic.
- The most important challenges were: missing information to complete the MSIS reporting form, too long time to fill the reporting form, uncertainty about what clinical information is needed to report, having one universal data entry form to report all notifiable diseases.
- Challenges specifically related to the work during the COVID-19 epidemic were IT problems with electronic MSIS reporting forms and confusion about responsibility related to reporting COVID-19 cases.
- Almost one third of respondents said that they did not always report diagnosed cases of notifiable diseases. The mandatory reporting during the COVID-19 epidemic was considered less of a priority by municipal doctors than by other health personnel.
- More than half of respondents, especially in primary health care, observed a reduction in the number of consultations for infectious diseases during the COVID-19 epidemic. According to respondents, the reduction in consultations can be attributed to the introduction of infection control measures that led to fewer infections, and to the reduction in visits of patients with milder symptoms.
- Most respondents were satisfied with the access to MSIS data on fhi.no, www.msis.no and www.fhi.no. However, some study participants expressed confusion about the diversity of platforms and untimely updating of data, which made the platforms less useful.
- Study participants indicated that the preferred form of feedback from MSIS is newsletters via e-mail and reports published on the FHI website.
Norwegian clinical microbiological laboratories and health care providers report 72 notifiable diseases to the Norwegian Surveillance System for Communicable Diseases (MSIS). During the previous two years, the Norwegian Institute of Public Health (FHI) has worked to improve MSIS functionality in collaboration with health authorities, professional associations and laboratories. However, the COVID-19 epidemic has placed a considerable burden on the healthcare system and could affect the functioning of MSIS. Since April 2020, FHI has seen a drastic reduction in cases of notifiable diseases reported to MSIS and has been closely following MSIS function (www.fhi.no/publ/2020/covid-19-msis/). In this project we surveyed MSIS users to map perceived barriers and facilitators of notifiable diseases reporting into MSIS before and during the COVID-19 epidemic.
We examined various steps that determine reporting to MSIS: (a) access to healthcare services for patients seeking medical attention; (b) access to laboratory testing for diagnosing physicians; (c) physicians' experience with reporting to MSIS; (d) feedback from FHI to MSIS users. The target study population for this cross-sectional survey were healthcare professionals using MSIS between June 2019 and December 2020. We collected data using an anonymous electronic questionnaire created and distributed using Questback software.
Out of the 164 responses to the survey, we included 161 valid responses from physicians working in all Norwegian counties. Of all respondents, 67 % were municipal doctors, 14 % were other primary health physicians, 13 % were specialists in hospital or doctors in specialization, and 6 % were other healthcare personnel. Of all study participants, 41 % had more than 20 years of work experience.
Almost 60 % of respondents observed a reduction in the number of consultations for infectious disease symptoms during the COVID-19 epidemic. Reduction in consultations was more often reported by general practitioners (68 %), while no effect of the epidemic on healthcare consultations was more often reported by hospital specialists (19 %). 92 % respondents opined that the reduction was a result of infection control measures that led to fewer infections, and 71 % indicated less health consultations by patients with milder symptoms. 14 % respondents reported challenges with access to laboratory testing during the COVID-19 epidemic. Of these, 38 % said that the reason for limited laboratory testing were changed laboratory routines and 33 % pointed to limited availability of reagents for testing.
Of all respondents, 72 % have always reported diagnosed cases to MSIS during the evaluation period. The reported reasons for not notifying cases were lack of time, confusion about the responsibility to report various diseases or technical difficulties. The reporting obligation during COVID-19 was more often considered a low or medium priority by municipal doctors than by other health personnel (29 % vs. 15 %). There were no major differences in perceived challenges with reporting notifiable diseases during the COVID-19 epidemic, compared with the period before. In both periods, respondents indicated the following challenges: 1. Lack of information to complete the MSIS reporting form (before the epidemic: 47 %, during the epidemic: 48 %); 2. Reporting takes too long (45 % vs. 41 %), 3. Uncertainty about what clinical information is needed to report (33 % vs. 39 %). Reported IT issues related specifically to the COVID-19 epidemic period, included challenges with accessing the web-based reporting form and the lack of integration of MSIS reporting with the electronic patient journal.
Of the 145 study participants, 80 % reported receiving support from the MSIS team during the covid-19 epidemic. 115 respondents have used www.fhi.no, 74 have used www.msis.no and 44 have used statistikk.fhi.no. Most respondents were satisfied with the data presentation on the three platforms. However, some study participants expressed confusion about the diversity of platforms and the lack of timeliness of MSIS data, which made the data less useful. Several municipal doctors mentioned in the free text comments that they are satisfied with the new platform Sykdomspulsen for municipal services where they have access to many relevant indicators for the municipality and their region. Study participants indicated that the preferred form of feedback from MSIS is newsletters via e-mail (64 %), and reports published on the NIPH website (43 %).
This survey aimed to evaluate the user experience of health care providers with MSIS reporting before and during the COVID-19 epidemic, and to collect their views on how MSIS can be further strengthened. The municipal doctors were overrepresented, which probably reflects increased use of MSIS by this group during the epidemic.
Reported challenges with MSIS reporting included time constraints and unclear guidance on reporting requirements. According to several respondents, the universal MSIS reporting form aimed for all 72 notifiable diseases, makes it difficult for health care providers to understand which variables are mandatory and crucial for reporting immediately, and which variables could be completed and updated after the initial MSIS notification.
To motivate users to report to MSIS, FHI needs to assure both the access to surveillance data and provide feedback on how MSIS data are used to interpret disease trends and detect outbreaks. MSIS data is accessible through three different platforms. Until 2010, FHI sent out regular newsletter with selected indicators and interpretations of MSIS data to its end-users. Study participants indicated that the preferred feedback from MSIS would be an e-mail newsletter with selected MSIS indicators and interpretations.
Our survey showed that there were no major increases in challenges in the MSIS reporting during the COVID-19 epidemic compared to the reference period before and no large differences between experiences of primary and secondary health care providers. The main challenges reported by health care providers included: unclarity regarding disease-specific guidelines on reporting and division of responsibilities, having one universal MSIS form to report all notifiable diseases, how to balance timely submission of MSIS notification forms with providing complete case data, accessing MSIS data from three different platforms and the lack of feedback that could be useful for the participant’s daily work. We recommend continuing to improve the MSIS functionality to strengthen the feeling of ownership among MSIS users and improve system flexibility.