Health information systems and China's COVID-19 response

Digital databases used to collect important health information are crucial in China's fight against infectious diseases, but such systems don’t exist without flaws, writes Rebecca Borg

On 30 December 2019, China started to trace “unknown pneumonia” (COVID-19) cases, before being officially included in China’s National Disease Reporting System (NDRS) 20 days later when SARS-Cov-2 virus was identified as the cause.

China’s national online reporting platform was unsuitable for detecting unknown emerging infectious diseases such as COVID-19, but a second Health Information System (HIS ) structured as a traffic light scheme to manage the virus’ transmission between citizens, was more efficient. Residents underwent health assessments to obtain a health code: “green indicating no risk, yellow indicating moderate risk and red indicating high risk”. Those who failed to obtain a green health code were refused entry into cities and venues not of their address.

“Health information systems can serve purposes ranging from the upstream prevention strategies to the downstream coping activities through information generation, dissemination and communication,” says Professor George Liu, the Director of International Partnerships for the School of Psychology and Public Health at La Trobe University. “They can also encourage the public to comply with relevant legislation and shape the entire culture of the communities.”

Health information systems play a fundamental role in the continuous battle against the COVID-19 pandemic, with many countries utilising modern information technologies to keep the public informed, educated and to exert some control over the virus.

For China, the implementation of such technologies was one of the country’s first steps towards managing the coronavirus, but as Professor Liu explains in his paper Health information systems amid COVID-19 outbreak: Lessons from China, the country’s utilisation of health information systems in response to the pandemic was not without flaws.

“Unfortunately, China’s reporting system lacked capacity to capture unknown emerging infectious diseases. Medical practitioners and health facilities are obligated to report only diseases already defined in the reporting system, with COVID-19 not being one of them initially.”

China’s national online infectious disease reporting system was established in 2003 in response to the SARS pandemic, as the country’s previous public health information system had proved to be inadequate.

“The current health information system is mostly reliable, but its major flaw is that it follows a legally defined list of infectious diseases, rather than detecting clues of all kinds of threats through shared data from the existing clinical information systems” says Professor Liu. “This did not help with detection of unknown diseases such as COVID-19, as nobody knew if it was something worth reporting.”

Australia is also  approaching the COVID-19 pandemic by using health information systems including the location tracking COVIDSafe app . While it can be argued that China’s system may have been more effective than Australia’s COVIDSafe application, Australia is unable to follow suit due to strong privacy policies and legislations. The information systems of Medicare and My Health Record in Australia also played a limited role, if any, in the control over COVID-19.

“No country possesses a perfect health information system, and if we didn’t have modern technologies, we’d be extremely slow to respond to emergencies,” says Professor Liu. “There would be no way for us to identify the early signs of the outbreak, and it would be very difficult to reach a wide audience.”

These systems have also fast-tracked the creation of several COVID-19 vaccines, as the data collected including the early decoding of the virus’ gene sequence which were shared widely online.

“China’s health information system was able to improve through the collection of big data from multiple sectors beyond health,” says Professor Liu. “But issues of lacking public acceptance and inadequate infrastructure make it difficult to implement such strategies in other countries.”

“COVID-19 has resulted in serious damage to the economy and population health, but it also stimulated innovative ideas and the use of modern information technologies. It is important to note that there is no one-size-fits-all solution to the control of COVID-19, and countries can learn from each other.”