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David Oliver: Covid-19 highlights the need for effective government communications

BMJ 2020; 369 doi: (Published 13 May 2020) Cite this as: BMJ 2020;369:m1863

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Re: David Oliver: Covid-19 highlights the need for effective government communications

Dear Editor

Big data analytics has improved healthcare by analyzing electronic medical records, socio-demographic information, and environmental factors, to optimize treatment outcomes [1, 2]; moreover, its predictive and tracking roles in emerging infectious diseases such as the coronavirus pandemic have also been discussed [2, 3]. In countries with single-payer universal healthcare systems (UHS), claimed healthcare data of payers could become an abundant source of massive database due to universal coverage, indicating that the intersection of public health policies and technology could bring about additional benefits of healthcare reform through integrated real-time data analytics platform during the epidemic [4].

Taking Taiwan as an example, cloud computing-based healthcare databases within the UHS are part of the critical national infrastructure. The platform allows healthcare providers to query travel history on a real-time basis, as well as manage the distribution of surgical masks. Collected data of beneficiaries (> 99.5% of all residents) regarding medical records, lab data, images, and prescriptions from all healthcare providers, of the past 24 years are retrievable [5]. With the help of data analysis, combining artificial intelligence and cloud technology, both personalized medicine and public health policy-making could be practicable. Thus when it comes to the implementation cost of epidemic prevention policies, Taiwan authorities adopt low stringent level strategies compared with other high income countries, but still have achieved epidemic control in the early outbreak [6].

After the 2003 severe acute respiratory syndrome outbreak in Taiwan, Taiwan CDC (TCDC) started transferring registered real-time infectious disease data to this established monitoring system, and since 2016 real-time analytics were enabled via cloud computing, concatenation of intramural data on all severe influenza cases was practiced. Therefore, alerts were indicated prior to the official recognition of COVID-19 outbreak [2, 3], which travel history databases were subsequently concatenated to trace the source. Establishment of travel history tracking system required data transfers as well as managerial issues such as governance and ownership, which interdepartmental communication was efficient within UHS. Specifically, the tracking system was co-operated by the Immigration Agency and TCDC, which the traveling history of beneficiaries and their corresponding history of contact were retrievable with insurance or passport numbers. As the UHS provider, government also gave access of the above information to healthcare providers external to the universal insurance plan, including dental, aesthetic, or physiotherapy clinics, as well as nursing home and blood donation sites, to reduce iatrogenic COVID-19 exposure and postponed care.

[1] Kevin Vigilante, Steve Escaravage, and Mike McConnell. Big Data and the Intelligence Community — Lessons for Health Care. N Engl J Med 2019; 380:1888-1890
[2] Olson SH, Benedum CM, Mekaru SR, et al. Drivers of emerging infectious disease events as a framework for digital detection. Emerg Infect Dis. 2015 Aug; 21(8): 1285–1292.
[3] C. Jason Wang, Chun Y. Ng, Robert H. Brook. Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. JAMA. 2020; 323(14): 1341-1342.
[4] Jaime S. King. Covid-19 and the Need for Health Care Reform. DOI: 10.1056/NEJMp2000821
[5] NHCC [National Health Command Center]. Taiwan Centers for Disease Control. Updated February 1, 2018. Accessed May 6, 2020.
[6] Hale, Thomas, Sam Webster, Anna Petherick, Toby Phillips, and Beatriz Kira (2020). Oxford COVID-19 Government Response Tracker, Blavatnik School of Government. Data use policy: Creative Commons Attribution CC BY standard.

Competing interests: No competing interests

14 May 2020
Kevin Sheng-Kai Ma
Alice Shin-Yi Tsai, MD, MS, DrPH
Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.