Lessons Learned in the Development of a Web-based Surveillance Reporting System and Dashboard to Monitor Acute Febrile Illnesses in Guangdong and Yunnan Provinces, China, 2017-2019

Development and Utility of an Interactive Online Dashboard for Monitoring Data Collection and Data Processing During a School-Based Health Survey

We built an interactive online dashboard using Google Looker Studio to monitor data collection and data processing activities during the Adolescent Health Survey (AHS) 2022, a large-scale nationwide survey conducted among school-going adolescents in Malaysia. Through user testing and training, refinements were made to the initial dashboard, resulting in a more streamlined and concise dashboard design. The dashboard comprised 2 pages that provided key metrics on the progress of data collection and data processing, respectively. The introduction of the dashboard enhanced the quality and ease of weekly progress reporting during meetings of the survey's central coordinating team, while its drill-down and filtering functionalities helped us detect arising issues early and supported collaborative problem-solving. Research teams coordinating comparable school-based health surveys are invited to duplicate the dashboard using Looker Studio's built-in "Make a copy" function and customize it further based on their country- or survey-specific requirements.

A toolkit for planning and implementing acute febrile illness (AFI) surveillance

Acute febrile illness (AFI) is a broad clinical syndrome with a wide range of potential infectious etiologies. The lack of accessible, standardized approaches to conducting AFI etiologic investigations has contributed to significant global gaps in data on the epidemiology of AFI. Based on lessons learned from years of supporting AFI sentinel surveillance worldwide, the U.S. Centers for Disease Control and Prevention developed the toolkit for planning and implementing AFI surveillance, described here. This toolkit provides a comprehensive yet flexible framework to guide researchers, public health officials, and other implementers in developing a strategy to identify and/or monitor the potential causes of AFI. The toolkit comprises a cohesive set of planning aids and supporting materials, including an implementation framework, generic protocol, several generic forms (including screening, case report, specimen collection and testing, and informed consent and assent), and a generic data dictionary. These materials incorporate key elements intended to harmonize approaches for AFI surveillance, as well as setting-specific components and considerations for adaptation based on local surveillance objectives and limitations. Appropriate adaptation and implementation of this toolkit may generate data that expand the global AFI knowledge base, strengthen countries' surveillance and laboratory capacity, and enhance outbreak detection and response efforts.

Developing public health surveillance dashboards: a scoping review on the design principles

BACKGROUND

Public Health Dashboards (PHDs) facilitate the monitoring and prediction of disease outbreaks by continuously monitoring the health status of the community. This study aimed to identify design principles and determinants for developing public health surveillance dashboards.

METHODOLOGY

This scoping review is based on Arksey and O'Malley's framework as included in JBI guidance. Four databases were used to review and present the proposed principles of designing PHDs: IEEE, PubMed, Web of Science, and Scopus. We considered articles published between January 1, 2010 and November 30, 2022. The final search of articles was done on November 30, 2022. Only articles in the English language were included. Qualitative synthesis and trend analysis were conducted.

RESULTS

Findings from sixty-seven articles out of 543 retrieved articles, which were eligible for analysis, indicate that most of the dashboards designed from 2020 onwards were at the national level for managing and monitoring COVID-19. Design principles for the public health dashboard were presented in five groups, i.e., considering aim and target users, appropriate content, interface, data analysis and presentation types, and infrastructure.

CONCLUSION

Effective and efficient use of dashboards in public health surveillance requires implementing design principles to improve the functionality of these systems in monitoring and decision-making. Considering user requirements, developing a robust infrastructure for improving data accessibility, developing, and applying Key Performance Indicators (KPIs) for data processing and reporting purposes, and designing interactive and intuitive interfaces are key for successful design and development.

Digital dashboards visualizing public health data: a systematic review

Introduction

Public health is not only threatened by diseases, pandemics, or epidemics. It is also challenged by deficits in the communication of health information. The current COVID-19 pandemic demonstrates that impressively. One way to deliver scientific data such as epidemiological findings and forecasts on disease spread are dashboards. Considering the current relevance of dashboards for public risk and crisis communication, this systematic review examines the state of research on dashboards in the context of public health risks and diseases.

Method

Nine electronic databases where searched for peer-reviewed journal articles and conference proceedings. Included articles (n = 65) were screened and assessed by three independent reviewers. Through a methodological informed differentiation between descriptive studies and user studies, the review also assessed the quality of included user studies (n = 18) by use of the Mixed Methods Appraisal Tool (MMAT).

Results

65 articles were assessed in regards to the public health issues addressed by the respective dashboards, as well as the data sources, functions and information visualizations employed by the different dashboards. Furthermore, the literature review sheds light on public health challenges and objectives and analyzes the extent to which user needs play a role in the development and evaluation of a dashboard. Overall, the literature review shows that studies that do not only describe the construction of a specific dashboard, but also evaluate its content in terms of different risk communication models or constructs (e.g., risk perception or health literacy) are comparatively rare. Furthermore, while some of the studies evaluate usability and corresponding metrics from the perspective of potential users, many of the studies are limited to a purely functionalistic evaluation of the dashboard by the respective development teams.

Conclusion

The results suggest that applied research on public health intervention tools like dashboards would gain in complexity through a theory-based integration of user-specific risk information needs.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=200178, identifier: CRD42020200178.

Etiology of acute febrile illnesses in Southern China: Findings from a two-year sentinel surveillance project, 2017–2019

Background

Southern China is at risk for arborvirus disease transmission, including Zika virus and dengue. Patients often present to clinical care with non-specific acute febrile illnesses (AFI). To better describe the etiology of AFI, we implemented a two-year AFI surveillance project at five sentinel hospitals in Yunnan and Guangdong Provinces.

Methods

Between June 2017 and August 2019, we enrolled patients between 2 and 65 years of age presenting at one sentinel hospital in Mengla County, Yunnan, and four in Jiangmen City, Guangdong, with symptoms of AFI (acute onset of fever ≥ 37.5°C within the past 7 days) without respiratory symptoms or diarrhea. Demographic, epidemiologic, and clinical information was obtained and entered into a web-based AFI surveillance database. A custom TaqMan Array card (TAC) was used to test patients’ whole blood specimens for 27 different pathogens using real-time polymerase chain reaction assays.

Results

During the two-year project period, 836 patients were enrolled; 443 patients from Mengla County and 393 patients from Jiangmen City. The median age was 33 years [range: 2–65], and most were hospitalized [641, 77%]. Of 796 patients with valid TAC results, 341 (43%) were positive for at least one of the 10 unique pathogens detected. This included 205 (26%) patients positive for dengue virus, 60 (8%) for Orientia tsutsugamushi, and 42 (5%) for Coxiella burnetii. Ten patients (1%) in Jiangmen City tested positive for malaria, 8 of whom reported recent travel outside of China. TAC results were negative for 455 (57%) patients. None of the patients had a positive TAC detection for Zika virus.

Conclusions

The project detected variability in the etiology of AFI in Southern China and highlighted the importance of differential diagnosis. Dengue, O. tsutsugamushi, and C. burnetii were the most frequently identified pathogens among enrolled AFI patients. As a non-notifiable disease, the frequent detection of C. burnetii is noteworthy and warrants additional investigation. The project provided a framework for routine surveillance for persons presenting with AFI.

Using a One Health approach to prioritize zoonotic diseases in China, 2019

Background

China is vulnerable to zoonotic disease transmission due to a large agricultural work force, sizable domestic livestock population, and a highly biodiverse ecology. To better address this threat, representatives from the human, animal, and environmental health sectors in China held a One Health Zoonotic Disease Prioritization (OHZDP) workshop in May 2019 to develop a list of priority zoonotic diseases for multisectoral, One Health collaboration.

Methods

Representatives used the OHZDP Process, developed by the US Centers for Disease Control and Prevention (US CDC), to prioritize zoonotic diseases for China. Representatives defined the criteria used for prioritization and determined questions and weights for each individual criterion. A review of English and Chinese literature was conducted prior to the workshop to collect disease specific information on prevalence, morbidity, mortality, and Disability-Adjusted Life Years (DALYs) from China and the Western Pacific Region for zoonotic diseases considered for prioritization.

Results

Thirty zoonotic diseases were evaluated for prioritization. Criteria selected included: 1) disease hazard/severity (case fatality rate) in humans, 2) epidemic scale and intensity (in humans and animals) in China, 3) economic impact, 4) prevention and control, and 5) social impact. Disease specific information was obtained from 792 articles (637 in English and 155 in Chinese) and subject matter experts for the prioritization process. Following discussion of the OHZDP Tool output among disease experts, five priority zoonotic diseases were identified for China: avian influenza, echinococcosis, rabies, plague, and brucellosis.

Conclusion

Representatives agreed on a list of five priority zoonotic diseases that can serve as a foundation to strengthen One Health collaboration for disease prevention and control in China; this list was developed prior to the emergence of SARS-CoV-2 and the COVID-19 pandemic. Next steps focused on establishing a multisectoral, One Health coordination mechanism, improving multisectoral linkages in laboratory testing and surveillance platforms, creating multisectoral preparedness and response plans, and increasing workforce capacity.

Development, Implementation, and User Evaluation of COVID-19 Dashboard in a Third-Level Hospital in Iran

INTRODUCTION

The implementation of a dashboard enables managers to make informed and evidence-based decisions through data visualization and graphical presentation of information. This study aimed to design and implement a COVID-19 management dashboard in a third-level hospital in Mashhad, Iran.

MATERIALS AND METHODS

This descriptive developmental applied study was conducted in the second half of 2020 in three stages, using user-centered design methodology in four phases: (1) specification of the application context, (2) specification of requirements, (3) creation of design solutions, and (4) evaluation of designs. Data collection in each phase was performed through holding group discussions with the main users, nominal group techniques, interviews, and questioners. The dashboard prototype for the data display was designed using the Power BI Desktop software. Subsequently, users' comments were obtained using the focus group method and included in the dashboard.

RESULTS

In total, 25 indicators related to input, process, and output areas were identified based on the findings of the first stage. Moreover, eight items were introduced by participants as dashboard requirements. The dashboard was developed based on users' feedback and suggestions, such as the use of colors, reception of periodic and specific reports based on key performance indicators, and rearrangement of the components visible on the page. The result of the user satisfaction survey indicated their satisfaction with the developed dashboard.

CONCLUSION

The selection of proper criteria for the implementation of an effective dashboard is critical for the health care organization since they are designed with a high-tech and content-based environment. The dashboard in the present study was a successful combination of clinical and managerial indicators. Future studies should focus on the design and development of dashboards, as well as benchmarking by using data from several hospitals.

Features Constituting Actionable COVID-19 Dashboards: Descriptive Assessment and Expert Appraisal of 158 Public Web-Based COVID-19 Dashboards

Background

Since the outbreak of COVID-19, the development of dashboards as dynamic, visual tools for communicating COVID-19 data has surged worldwide. Dashboards can inform decision-making and support behavior change. To do so, they must be actionable. The features that constitute an actionable dashboard in the context of the COVID-19 pandemic have not been rigorously assessed.

Objective

The aim of this study is to explore the characteristics of public web-based COVID-19 dashboards by assessing their purpose and users (“why”), content and data (“what”), and analyses and displays (“how” they communicate COVID-19 data), and ultimately to appraise the common features of highly actionable dashboards.

Methods

We conducted a descriptive assessment and scoring using nominal group technique with an international panel of experts (n=17) on a global sample of COVID-19 dashboards in July 2020. The sequence of steps included multimethod sampling of dashboards; development and piloting of an assessment tool; data extraction and an initial round of actionability scoring; a workshop based on a preliminary analysis of the results; and reconsideration of actionability scores followed by joint determination of common features of highly actionable dashboards. We used descriptive statistics and thematic analysis to explore the findings by research question.

Results

A total of 158 dashboards from 53 countries were assessed. Dashboards were predominately developed by government authorities (100/158, 63.0%) and were national (93/158, 58.9%) in scope. We found that only 20 of the 158 dashboards (12.7%) stated both their primary purpose and intended audience. Nearly all dashboards reported epidemiological indicators (155/158, 98.1%), followed by health system management indicators (85/158, 53.8%), whereas indicators on social and economic impact and behavioral insights were the least reported (7/158, 4.4% and 2/158, 1.3%, respectively). Approximately a quarter of the dashboards (39/158, 24.7%) did not report their data sources. The dashboards predominately reported time trends and disaggregated data by two geographic levels and by age and sex. The dashboards used an average of 2.2 types of displays (SD 0.86); these were mostly graphs and maps, followed by tables. To support data interpretation, color-coding was common (93/158, 89.4%), although only one-fifth of the dashboards (31/158, 19.6%) included text explaining the quality and meaning of the data. In total, 20/158 dashboards (12.7%) were appraised as highly actionable, and seven common features were identified between them. Actionable COVID-19 dashboards (1) know their audience and information needs; (2) manage the type, volume, and flow of displayed information; (3) report data sources and methods clearly; (4) link time trends to policy decisions; (5) provide data that are “close to home”; (6) break down the population into relevant subgroups; and (7) use storytelling and visual cues.

Conclusions

COVID-19 dashboards are diverse in the why, what, and how by which they communicate insights on the pandemic and support data-driven decision-making. To leverage their full potential, dashboard developers should consider adopting the seven actionability features identified.

Digital microbiology

BACKGROUND

Digitalization and artificial intelligence have an important impact on the way microbiology laboratories will work in the near future. Opportunities and challenges lie ahead to digitalize the microbiological workflows. Making efficient use of big data, machine learning, and artificial intelligence in clinical microbiology requires a profound understanding of data handling aspects.

OBJECTIVE

This review article summarizes the most important concepts of digital microbiology. The article gives microbiologists, clinicians and data scientists a viewpoint and practical examples along the diagnostic process.

SOURCES

We used peer-reviewed literature identified by a PubMed search for digitalization, machine learning, artificial intelligence and microbiology.

CONTENT

We describe the opportunities and challenges of digitalization in microbiological diagnostic processes with various examples. We also provide in this context key aspects of data structure and interoperability, as well as legal aspects. Finally, we outline the way for applications in a modern microbiology laboratory.

IMPLICATIONS

We predict that digitalization and the usage of machine learning will have a profound impact on the daily routine of laboratory staff. Along the analytical process, the most important steps should be identified, where digital technologies can be applied and provide a benefit. The education of all staff involved should be adapted to prepare for the advances in digital microbiology.