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

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.

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.

Keywords:

• Syndromic surveillance
• covid-19
• general practice
• influenza-like illness
• acute respiratory infection

Acknowledgements

The authors sincerely thank Sherihane Bensemmane, research scientist at Sciensano, for her statistical support. We would also like to thank all the general practitioners who participated in the COVID-19 Barometer project and contributed to the data collection.

Ethical approval

This study was approved by the Ethics Committee Research (EC Research) of the University Hospitals Leuven (UZ Leuven) (S63869).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

The Health Care Insurance Committee of the NIHDI financed the COVID-19 Barometer project in the convention ‘Monitoring of the evolution of the COVID-19 pandemic in Belgium via ‘syndromic’ surveillance in general practices’.