MiBa, the Danish Microbiology Database
MiBaMiBa is an important milestone in the development of a digital surveillance system for infectious diseases integrated in the Danish heath care infrastructure.
MiBa is a nationwide, automatically updated database of microbiological test results.
The objectives of MiBa are:
- to provide access for healthcare professionals to microbiological test results from all of Denmark for patients in their care.
- to provide the fundament for a flexible, timely and complete national surveillance of infectious diseases and micro-organisms.
- to serve as a shared resource for research Projects.
- to ensure automatic transfer of data to other databases monitoring e.g. antibiotic resistance and hospital infections.
MiBa was launched in 2010 as the result of collaborative efforts made by the departments of clinical microbiology, providers of laboratory information systems, MedCom and Statens Serum Institut (SSI).
Each month, microbiology-reports of more than 150.000 unique patients are accessed through different direct-access solutions from the local EHR. In addition, the patients themselves have access to their own reports.
MiBa is one of the key data sources for HAIBA - a digital surveillance system for hospital-acquired infections.
The development of the MiBa-based surveillance of infectious diseases and microorganisms are in progress. This is a complex process involving collaboration across professions and organizations. The tasks include standardization of data, clarification of concepts and goals that are constantly moving, a revision of the legislation, as well as the technical and economic issues.
Our prime visions are that data should be used intelligently and for as many purposes as possible for the benefit of patients, for an efficient health-care system and for the achievement of new insights within health sciences.
Link to MiBa article: www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20667
National display of search results
Only relevant healthcare professionals who are involved in counselling, diagnosing and treating individual patients are allowed to perform MiBa searches. The objective is for MiBa to become accessible directly from local ICT systems with no extra login requirements. GPs do not have direct access to MiBa, but can find microbiological test results via the Laboratory Portal found on the national health portal: Sundhed.dk, which draws on MiBa data. Using an employee certificate, all physicians have access to the Laboratory Portal. GPs can speed up access to the Laboratory Portal via their requisition system WebReq. Patients have access to their own MiBa data also via the Laboratory Portal on Sundhed.dk.
For more information on access options to MiBa, please click here (in Danish language).
MiBa has now become an integrated part of the daily work routines for a growing number of physicians and nurses, and its use increases in step with the implementation of new access solutions, Figure 1.
Data model
The principle of MiBa is that whenever a DCM sends a test report to the requestor, an electronic copy is submitted to the database, Figure 2. By means of a standard transfer protocol (MedCom XRPT05) and automatic "translation" from local codes to shared codes (mapping), it is possible to collect data in MiBa with a relatively uniform structure despite considerable local variation.
Surveillance of infectious diseases
Today, a timely surveillance and control and targeted prevention of infectious diseases are needed. The establishment of MiBa constitutes the initial phase of a modernisation of the national Danish preparedness measures to counter infection.
The SSI's surveillance has so far been based on monitoring of individual clinical cases (through paper forms such as Form 1515) and on notifications from laboratories that had detected micro-organisms or other markers for the conditions in question. This surveillance is based on manual procedures; and notification, submission and reporting of these data therefore generate a considerable workload. Experience has shown that several infections are under-reported and notifications are frequently late.
Using MiBa for surveillance offers a number of advantages. As data are transferred simultaneously with the clinical test results, data are available for analysis without delay. Any changes in the trends and disease outbreaks may therefore be detected earlier, and any new infectious diseases or changes to known micro-organisms can be monitored as needed. It is possible to analyse the number of detected cases relative to the number of tests made. Knowledge of the denominator and hence the positive rate will provide improved opportunities to interpret the data and will make it possible to monitor the testing activity in diseases for which this is of particular importance. When comparing data from the previous surveillance scheme with data from MiBa, good agreement has been found for whooping cough and invasive meningococcal and pneumococcal disease, whereas the figures for neuroborreliosis and Clostridium difficile indicate previous under-reporting. The transition to MiBa-based surveillance will be gradual, and the final phase-out of the active laboratory notification and the use of forms will take place some time in the future.
Online surveillance data is accessible from: SSI smitteberedskab
A number of challenges remain with regard to the use of MiBa for surveillance purposes. No national Danish standard existed for the communication of information on subtypes and microbial properties (e.g. toxin production and virulence factors). As these items of information are currently not uniformly structured, standardisation of the data structure is challenging for data originating from various DCMs and from the SSI. Under the Danish Society for Clinical Microbiology (DCCM), a national collaborative project has been established to solve these issues and a new national data transfer protocol has been developed, which is now being implemented. Other laboratories exist that work with microbiological diagnostics (clinical biochemistry and immunology) and do not report to MiBa. This means that for a small number of significant virus infections, MiBa data are incomplete. A notification solution including laboratory results from these units is in the pipeline.
Legal framework
Any surveillance will be performed in accordance with Executive Order on Notification of Infectious Diseases (Executive order no. 277 of 14/4/2000) including subsequent amendments. Furthermore, specific resistant micro-organisms are monitored through collaborative efforts made by the DCMs and the SSI (DANRES, a working group under the DCCM). The Danish Health and Medicines Authority in cooperation with the SSI and other relevant stakeholders are revising the executive order and adapting it to a more flexible surveillance based extensively on MiBa data.
Applying for MiBa data extraction
MiBa data may be used for research, surveillance and quality assurance projects, but this requires the approval of the DCMs in addition to the official permissions from e.g. the Danish Data Protection Agency. Instructions explaining how to apply for permission to use MiBa data are available on the MiBa website (in Danish)..
Conclusion
Access to the patients reports in MiBa provide an overview of microbiological diagnoses made across Denmark and therefore serve to support the diagnostics and treatment of the individual patient. MiBa renders possible a far-reaching automatisation of the national Danish surveillance of infectious diseases and will therefore provide a strong starting point for the prevention of infectious diseases. In future, MiBa will provide unique opportunities for the implementation of national surveillance and research projects.