Part of the Interoperability DAC2021 Session: Wednesday 23nd June 14:00
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John Stelling and Adam Clark, Brigham and Women’s Hospital, Boston, United States
Julhas Sujan, International Vaccine Institute CAPTURA-Bangladesh, Dhaka, Bangladesh
Topic Summary: WHONET and DHIS2 interoperability for antimicrobial resistance surveillance and pilot testing in Bangladesh
Antimicrobial resistance (AMR) is an emerging public health threat causing significant morbidity, mortality, and healthcare costs especially in low- and medium-income countries, but to date few groups have explored advanced AMR data management within DHIS2. In this work, we describe a collaboration between the Bangladesh Ministry of Health and Family Welfare’s Directorate General of Health Services (DGHS), the CAPTURA Project (Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia) led by the International Vaccine Institute (Republic of Korea) supported by the UK Department of Health Fleming Fund, and the WHONET development team at the WHO Collaborating Centre for Surveillance of Antimicrobial Resistance (United States).
WHONET, www.whonet.org, is a free software promoted by the World Health Organization supporting local, national, regional, and international resistance surveillance activities in over 2,500 human, animal, and food microbiology laboratories in over 130 countries. WHONET supports advanced automated features for interpretation of antimicrobial susceptibility test measurements by CLSI and EUCAST standards; multidrug-resistance profiles; 190 public health, clinical, and quality control isolate alerts; and statistical detection of hospital and community outbreaks using SaTScan. WHONET supports international guidelines for the management of “repeat” isolates, e.g. “first isolate per patient per species per data stratification and data subset”, which is not supported by DHIS2 core functionality. WHONET’s import tool BacLink permits the capture and standardization (ETL-extract, transform, and load) of microbiology data from diverse laboratory information systems, test instruments, and desktop applications.
To support WHONET and DHIS2 interoperability, we have developed pre-defined and user-defined data export options of two types: 1) aggregate statistics (and associated metadata) to DHIS2 Data Sets; and 2) isolate listings (and associated metadata) to DHIS2 Event Programs. These WHONET listing and analysis exports can be visualized within DHIS2 dashboards, pivot tables, charts, and maps. Metadata exports are consistent across all WHONET installations, permitting simple data exchange between DHIS2 instances.
In Bangladesh, we have installed WHONET in 31 laboratories and trained more than 140 microbiologists, clinicians, IT staff, and national AMR policymakers. Three years of laboratory data from 41 governmental and private hospitals in eight divisions are being submitted to the DGHS AMR-dedicated DHIS2 server through the WHONET-DHIS2 interoperability features described, leveraging both WHONET’s advanced data management and alert capabilities for AMR data with existing Bangladesh DHIS2 platforms for web-based visualization for all communicable diseases supporting the development, implementation, monitoring, and impact evaluation in near real-time of national resistance containment strategies.