COVID-19 surveillance - Extending the national PHE-RCGP-Oxford Primary Care influenza surveillance with rapid system-wide informatics and deployment

Problem

The UK general practice is highly computerised but there have been no codes to record COVID-19 or countries where people have visited. The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) system is an established national influenza surveillance system. We worked with computerised medical record (CMR) system suppliers to make the system fit for purpose for COVID-19 surveillance

Approach

We collaborated to create new codes to record both COVID-19 details and countries visited as well as training materials for practices. A model was developed for weekly data returns and a dashboard to provide data quality feedback and information of cases. Extended virology surveillance for COVID-19 will be undertaken in the mildly unwell, with additional serological surveillance of those who are well.

Findings

In less than two weeks, we created the required codes across all CMR systems which included clinical codes for recording COVID-19 specific events, local codes that will map 1 to 1 with the official emergency release of the Sytematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and country codes of travel history. We have used an ontological approach to classify cases into confirmed cases, cases under investigation and those who have been under investigation and now excluded from having COVID-19 infection. We have created an online network observatory and individual practice dashboard updated weekly to provide information similar to RCGP RSC reporting of influenza and other conditions, with the additional option of twice-weekly reporting.

Consequences

Strong relationships and collaboration between RCGP, PHE, and the primary care informatics community has enabled national deployment of the means to monitor the COVID-19 outbreak in under two weeks.