Too many ways to say ‘positive’ slows COVID-19 test count
A language barrier is the reason why Quebec’s public health authorities are chained to their antiquated fax machines to receive positive COVID -19 test results.
The barrier isn’t French-english. It isn’t even mismatched computer programming languages.
The problem is rooted in the different codes or words that laboratories across Quebec have used for years in their test results to say the same things.
“A really simple example is if you receive a COVID -19 test that says ‘positive,’ ” said Laurent Bellavance, the general manager and one of the partners in Nosotech, a Rimouski-based software firm the Quebec government has contracted to untangle the jargon.
“Some places will say ‘positive,’ some places will say ‘confirmed,’ and in some other cases the code will just be ‘POS’ or a plus sign.”
Nosotech, which got the government mandate in late March, has developed an automated system to convert the different codes found in lab reports to a common language so the test results can be sent electronically in real time to the regional public health offices that have the job of tracing anyone who came into close contact with those who are testing positive for COVID -19.
“What we’re doing is to put a kind of translator to extract that data, translate it to a common language, a common format, and then send it back to the central database,” Bellavance said, adding that the dozens of hospital labs across Quebec already input their results into a central database.
Nosotech is calling its product IRIS, and it’s almost ready for launch, he said. The company is currently conducting quality testing, he said.
As the Montreal Gazette reported last week, the regional public health department for Montreal Island said it had recruited 24 people to do thousands of hours of manual entry of positive COVID-19 lab results, which are coming in on paper by fax instead of by electronic transmission as exists in other provinces.
A common naming convention should have been developed years ago, Bellavance said. But it’s become glaring now that Quebec is facing the COVID -19 crisis. “Now it’s urgent, so we have to put it in place very quickly,” he said.
Standardized codes are now used for new variables in test results, Bellavance said. But it would be difficult to go back and recode everything that already exists.
IRIS has been developed for COVID -19 but could be used later to track other infections, such as influenza, he said.
David Buckeridge, who is medical director of the research data warehouse at the Mcgill University Health Centre, agreed that the lack of standardized coding has impeded data flow from labs to public health agencies in Quebec.
However, he also noted that the health-care reform of the previous Liberal government and its health minister, Gaétan Barrette, slashed one-third of the budget for public health.
Contrary to Quebec, places in Europe and in the United States have completely automated reporting of lab results to public health agencies, he said.
Automation delivers test results faster, Buckeridge said, and studies show it also provides more information and brings to light more cases than manual data entry. That’s because data fields can be left blank and information can fall through the cracks when it’s typed from a lab report, he said.
IRIS will send lab results electronically to public health departments using the provincial health ministry’s secure internal network, Bellavance said.
The old argument that fax machines are more secure than electronic transmission for transmitting data doesn’t hold anymore, he said. “You can’t say that now,” Bellavance said. “There are ways of making sure that you protect privacy.”
Nosotech was already working for the Institut national de santé publique to implement software for infection-control surveillance in hospitals across the province, he said. There was a lack of standardization there as well. Why the name IRIS?
“Iris was the Greek goddess of the rainbow,” Bellavance said, laughing.