以防疫資訊交換平台為基礎利用LOING的標準建構實驗室疫情監測系統

Implementation of a Nationwide Automated Laboratory Reporting System for Infectious Disease Surveillance Based On the Epidemic Information Exchange Platform and the Use of LOINC Standard

傳染病流行疫情的監視與防治已被全球視為公共衛生重要的工作，結合資訊科技來輔助流行疫情的監視，即時的發現病毒變異與擴散趨勢，可以快速的掌握疫情的發展並有效的防治。防疫雲計畫結合醫院資訊系統，利用電子病歷的基礎進行自動化的傳染病通報作業，並且為了解病原體的流行趨勢，即時蒐集醫院端的病原體檢驗資料，利用醫院實驗室通報的陽性檢體資料，以建立病原體流行趨勢及波動之監測。本研究定義15項病原體檢驗項目，利用LOINC編碼，建立六個軸向的代碼，以醫院的實驗室檢驗資料，進行陽性檢體個案的通報，其結果如流感病毒與TCDC的病毒性合約實驗室監測系統有一致性的流行趨勢，利用LOINC的標準以流感病毒檢出趨勢，可以進行流感疫情監測，未來在增加參與醫院通報下，期能建立病原體流行趨勢及波動之監測。

The surveillance and control of infectious disease epidemics are among the global public health priorities. With the application of information technology in disease surveillance, it is possible to detect the changes of circulating viruses and the spread of diseases in real-time. This facilitates rapid detection of ongoing epidemics and timely delivery of effective control measures. The goals for the project of 'Applications of using cloud computing for communicable disease surveillance' are comprised of improving the reporting timeliness of the national notifiable disease surveillance system by developing direct reporting modules based on the hospital electronic medical record system and developing an automated laboratory reporting system (ALRS) using positive test results from the hospital laboratory information system to monitor the trend and anomaly of the selected pathogens. To standardize the names of test results used by different hospital laboratories, this study defined code sets based on the six parts of the LOINC codes for the selected 15 pathogens. Positive test results are transmitted to Taiwan Centers for Disease Control (TCDC) electronically through the Epidemic Information Exchange Platform. The weekly numbers of positive tests for influenza received from 20 hospitals participating ALRS correlated well with the numbers of influenza positives received through the TCDC's contracted virological laboratories. The trend of the influenza positive test results from the ALRS have shown the potential for using the data from ALRS to monitor the influenza epidemic. With increasing numbers of hospitals participating ALRS in the future, we expect ALRS to become a robust and timely surveillance system for monitoring the trends and detecting outbreaks of selected pathogens.