DOI: 10.1002/hpm.

3163

LETTER TO THE EDITOR

Digitisation and realtime sharing of unified

surveillance tool and clinicopathological data for
efficient management of disease outbreaks

Abstract
Existing chronic co‐morbidities in a population affect the clinical outcome of infectious diseases. In
order to devise better management strategies at community level, patients related clinicopatho-
logical as well as local health care infrastructure data is required. The use of digitised, unified,
multilingual surveillance tool may facilitate real‐time sharing of clinicopathological data and better
service delivery to the affected communities. In this article, we discuss that how digital collection,
collation and sharing of health‐related data may improve planning and management of disease
outbreaks.

KEYWORDS
digital platform, healthcare delivery, outbreak

The dynamics of infectious diseases vary in different population depending on the existing comorbidities. The
morbidity, mortality and healthcare infrastructure data of a population is vital information for devising better
planning, containment and management strategies for disease outbreaks in a particular geopolitical area. The
regular monitoring of emerging and re‐emerging infectious diseases with effective public healthcare infrastructure
and surveillance system helps in containment of disease outbreak at local and national level.1 Though, a number of
surveillance tools such as WHOQOL‐BREF, WHO STEPS and eSTEPS, Service Availability and Readiness Assess-
ment (SARA), Verbal Autopsy Standards are available for assessment of different aspect of human health, yet an
effective, digital, unified survey tool to record and share clinicopathological as well as healthcare infrastructure
data of even single disease is not available. The recent pandemic has forced us to relook at type and mode of
metadata collection for the efficient management disease outbreaks. There is no doubt that the sharing of patient
and pathogen data at national and international level is vital for greater good. However, there are ethical and
practical considerations in sharing the patient level information across geopolitical boundaries for re‐evaluation.2
The development of deidentified curated data set of patients collected from various sources (Government websites,
official social media accounts, peer reviewed publications and online reports)3 is a welcome step in this order.
Though, this data set includes very important details on demographics, comorbidity, dates of admission and
discharge, movement history and outcome of patients but lacks the important information on methods & results of
diagnosis, treatment administered and outcomes observed. Moreover, a data set may not represent a true picture
of an outbreak in an area until unless the case definition for different sources is same. However, such an instrument
may be strengthened by inclusion of essential elements of diagnosis, treatment administered & outcome, SARA4
and Verbal Autopsy Standards.5 This sort of standard unified, multilingual, digital tool may serve as an important

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resource to assess the different aspects of human health, infrastructure and management of disease outbreaks in
developing and developed countries. Moreover, developing a digital platform for documentation and sharing

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clinicopathological data at national and or international level in the line of Research data Alliance, FAIRsharing.org6
and Global Alliance for Genomics and Health7 may be very useful for countries like India.
India is vulnerable to infectious diseases due to varied tropical climatic conditions, poor water and sanitation,
huge population below poverty line, overcrowded living conditions, and weak health care infrastructure. Health-
care services in India are mainly provided by public sector in rural/tribal areas whereas private sector dominates in
urban clusters. The availability of healthcare infrastructure in different states of India is variable and depends on
economic conditions of the state. The inclusion of information on healthcare infrastructure along with clinico-
pathological data is very vital for management of disease outbreaks in India. Lack of information and subsequently
inadequate implementation of control measure adversely affects readiness and service delivery especially in rural
parts of India. For instance, every year there is an outbreak of Japanese encephalitis in eastern part of Uttar
Pradesh8 and acute encephalitis syndromes in Muzaffarpur region of Bihar,9 however, inadequate preparation and
poor healthcare infrastructure results in death of innocent children. Adoption of unified disease centric ‘clin-
icoinfratool’ (containing clinicopathological information of disease/patients and healthcare infrastructure of area)
will facilitate the development of disease centric infrastructure and better management of disease in particular
area. Such a unified digital surveillance tool may be implemented in the line of hub‐spoke model as a part of
National digital health mission. In hub‐spoke model, Primary Healthcare Center/Community Healthcare Center
(PHC/CHC) with basic digital infrastructure serves as spokes whereas district head quarter as hub. Similarly,
district headquarters will work as spokes for one state hub and state hubs as spoke for national framework. Such a
system will facilitate sharing of clinicopathological and healthcare infrastructure data on real‐time basis and taking
appropriate measures on time. Moreover, easily available information (digital records) about morbidity and
mortality profile of the population will help policy makers in issuing early warning(s) and adopting appropriate
control measures for the next disease outbreak or pandemic. However, active participation and cooperation of
various states and union territories would be required at local and national level for optimum benefit of the society
and nation at large. This is the high time for India to speed up the process of development and implementation of
national digital health mission,10 a digital platform and support system to radically improve the delivery of
healthcare services. Further, there is need to develop a reserve healthcare work force for emergency situations.
This will strengthen the outbreak response framework to control the spread of emerging and re‐emerging in-
fections by allowing the rapid exchange of patient information, resources and infrastructure.

A CK N O W LE D G E M E N T
The authors acknowledge the financial support to Dr. Suyesh Shrivastava and Dr. Tapas Chakma by Indian Council
of Medical Research (letter vide no. Tribal/114/2018‐ECD‐II). The manuscript has been approved by the Publi-
cation Screening Committee of ICMR‐NIRTH, Jabalpur and assigned with the number ICMR‐NIRTH/PSC/14/2021.
The authors duly acknowledge the funding from Indian Council of Medical Research, New Delhi, India.

C O NF LIC T O F IN T ER E S T
We declare no competing interests.

E T HIC S S T A T E M E N T
The study was approved by the Institutional Ethics Committee of ICMR‐National Institute of Research in Tribal
Health, Jabalpur, India (IEC ref no. 201803).

D A T A A V A I LA BI LI T Y S TA T E M EN T
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Suyesh Shrivastva1
Tapas Chakma1
LETTER TO THE EDITOR
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Aparup Das2
Anil Kumar Verma2

1
Division of Non‐Communicable Diseases, ICMR‐National Institute of Research in Tribal Health,
Jabalpur, Madhya Pradesh, India
2
Division of Vector Borne Diseases, ICMR‐National Institute of Research in Tribal Health,
Jabalpur, Madhya Pradesh, India

Correspondence
Anil Kumar Verma, Division of Vector Borne Diseases,
ICMR‐National Institute of Research in Tribal Health,
PO‐Garha, Nagpur Road, Jabalpur‐482003, Madhya Pradesh, India.
Email: anilv228125@gmail.com

O R CI D
Suyesh Shrivastva https://orcid.org/0000-0002-1311-7895

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