Monitoring COVID-19 in Belgian general practice: A tool for syndromic surveillance based on electronic health records.

European Journal of General Practice 2024, VOL. 30, NO. 1, 2293699 https://doi.org/10.1080/13814788.2023.2293699 RESEARCH ARTICLE Monitoring COVID-19 in Belgian general practice: A tool for syndromic surveillance based on electronic health records Bénédicte Vosa , Laura Debouveriea , Kris Doggena Robrecht De Schreyea and Bert Vaesb , Nicolas Delvauxb , Bert Aertgeertsb , Health Services Research, Sciensano, Brussels, Belgium; bDepartment of Public Health and Primary Care, KU Leuven, Leuven, Belgium a KEY MESSAGES • Data extracted daily from electronic medical records can be used to monitor the COVID-19 pandemic in general practice. • The Barometer provided rapidly available data to support data-driven decision-making. • Improvements such as a greater standardisation were identified for a potential future tool using the same technology. ABSTRACT Background: COVID-19 may initially manifest as flu-like symptoms. As such, general practitioners (GPs) will likely to play an important role in monitoring the pandemic through syndromic surveillance. Objectives: To present a COVID-19 syndromic surveillance tool in Belgian general practices. Methods: We performed a nationwide observational prospective study in Belgian general practices. The surveillance tool extracted the daily entries of diagnostic codes for COVID-19 and associated conditions (suspected or confirmed COVID-19, acute respiratory infection and influenza-like illness) from electronic medical records. We calculated the 7-day rolling average for these diagnoses and compared them with data from two other Belgian population-based sources (laboratory-confirmed new COVID-19 cases and hospital admissions for COVID-19), using time series analysis. We also collected data from users and stakeholders about the syndromic surveillance tool and performed a thematic analysis. Results: 4773 out of 11,935 practising GPs in Belgium participated in the study. The curve of contacts for suspected COVID-19 followed a similar trend compared with the curves of the official data sources: laboratory-confirmed COVID-19 cases and hospital admissions but with a 10-day delay for the latter. Data were quickly available and useful for decision making, but some technical and methodological components can be improved, such as a greater standardisation between EMR software developers. Conclusion: The syndromic surveillance tool for COVID-19 in primary care provides rapidly available data useful in all phases of the COVID-19 pandemic to support data-driven decision-making. Potential enhancements were identified for a prospective surveillance tool. Introduction When COVID-19 hit, impacting the life and health of millions of people, general practitioners (GPs) were more than ever the first point of contact for health problems [1]. During the pandemic, GPs’ primary role was to manage patients with symptoms of influenza-like ARTICLE HISTORY Received 16 November 2022 Revised 24 November 2023 Accepted 4 December 2023 KEYWORDS Syndromic surveillance; covid-19; general practice; influenza-like illness; acute respiratory infection illness (ILI) and acute respiratory infections (ARI), to distinguish COVID-19 from other possible infections (influenza, ARI) and to follow up with ill patients and refer them to hospital if necessary. Because at the beginning of the pandemic early symptomatic COVID-19 often included fever and cough at the beginning of the pandemic, ILI and ARI were used as CONTACT Laura Debouverie Health Services Research, Sciensano, Rue Juliette Wytsman 14, Hainaut, Brussels, Belgium. Supplemental data for this article can be accessed online at https://doi.org/10.1080/13814788.2023.2293699. © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 B. VOS ET AL. early markers to monitor COVID-19 in primary care settings [2,3]. Therefore, GPs played an important role in monitoring the pandemic through syndromic surveillance to support data-driven decision-making [4]. During the COVID-19 pandemic, monitoring the public health was essential to anticipate spread and evolution, including hospital capacity surges [5]. Syndromic surveillance is a real-time tool for early identification and monitoring of infectious disease outbreaks in the community, tracking disease evolution and informing governments and policymakers on public health [4,6]. It can also provide reassurance that no outbreak has occurred [6]. To monitor the incidence of acute syndromes, data using standardised clinical terminology from general practices are preferred [7]. Belgian primary care settings have a history of surveillance [8,9]. During the first wave of the COVID-19 pandemic (March 2020-Sept. 2020), GPs were asked to count and record the daily number of patient consultations and the percentage related to respiratory problems. This first COVID-19 surveillance tool helped monitor the pandemic in Belgian general practices [10]. In September 2020, we developed an updated COVID-19 syndromic surveillance tool, called Barometer, based on the aggregation and centralization of data from electronic medical records (EMR) in Belgian general practices, to monitor the pandemic. This paper’s objective was to present our experience with a COVID-19 syndromic surveillance tool (Barometer) in Belgian general practices. This study will highlight the lessons learned from a surveillance tool set up during a health crisis for future epidemics. Methods Design and setting We implemented a nationwide observational prospective study in Belgian general practices. Belgium is a federal state comprising three regions: Flanders in the north, Wallonia in the south and the Brussels-Capital Region in the country’s centre. In 2021, Belgium had 11,935 practicing GPs [11]. Recruitment All Belgian general practices with electronic medical record (EMR) software were eligible to participate in the study. We recruited voluntary GPs from September to October 2020 in different ways: invitations were sent to GPs who participated in the initial version of the COVID-19 surveillance tool, as well as professional association newsletters and promotional advertisements in specialised journals. A financial incentive was provided through the National Institute for Health and Disability Insurance (NIHDI) from 26/10/2020 to 31/03/2021 and GPs were paid based on their participation level: sending COVID-19 related data via the Barometer 4-5 days a week was considered high participation, and 2-3 days a week was considered medium participation. The results presen (...truncated)