The Snow Agent System

The snow agent system automatically extracts anonymous data from electronic health record systems in general practice offices, hospitals, microbiology laboratories and decision support systems for patients. The anonymous data is presented to general practitioners, laboratory doctors, hospital doctors, disease pevention officers, public health nurses, local, regional and national disease prevention authorities and patiens. We reuse the extracted anonymous data to support self care for patients, several types of e-consutation services for patient - health service collaboration and enable epidemiologists and others to view how diseases spread in the chronological and spatial dimensions.

Health surveillance

Health surveillance based on laboratory tests has two potential weaknesses, it may take a long time before the diagnosis is ready, and testing is not done for all kinds of diseases. An example of the last case is the giardiasis outbreak in Bergen in 2004 where thousands of citizens where exposed to Giardia through drinking source contamination, got ill, but everyone were not tested for Giardia in the laboratory. Also, each general practitioner did not see many cases, making it difficult to raise an alert based on large number of patients with similar symptoms. However, in sum a large number of people were exposed to this disease agent.

Disease surveillance systems typically collects data about rare but dangerous diseases. In our system we also extract data about common communicable diseases as well, as many of these diseases normally don´t need treatment. This creates the potential to support patient in avoiding health care service consumption by providing self care information.

We are now deploying the Snow disease surveillance system that uses additional data sources as the general practitioners offices and data directly from the patients. Data from these sources predates laboratory testing and avoids systematic errors in testing practice among general practitioners and mircobiology laboratories. The extracted data can be used for automatic outbreak detection and we also provide a disease forcast service predicting the incidence one week ahead. We also use the disease statistics to help patients find self help resources for the diseases spreading in their neighbourhood by matching the patients symptoms to likely diseases.

Goals

  • Make it possible to detect epidemics and outbreaks earlier
  • Earlier diagnosis and intervention
  • Contribute to a lower number of infected
  • Reduced costs connected to outbreaks of infectious diseases

Method

The project  examines if sharing of epidemiological data between patients, general practitioners and microbiology laboratories changes clinical practice for testing, diagnosis and treatment of infectious diseases among general practitioners. Our method for investigating this question is to deploy the Snow system in the northern health region. We will divide the geographic areas where the system is deployed into two types. Areas where we only monitor the situation by collecting data and areas where the system is used to provide information about the epidemiological situation to the patients and the GPs. By comparing these areas we hope to be able to document a significant difference.

Project description

The Snow disease surveillance system give patients, general practitioners, hospital doctors, microbiology laboratory doctors, disease surveillance officers, public health nurses, epidemiologists, local, regional and national disease prevention authorities and others information about how communicable diseases spread chronologically and geographically.

The patients can use our symptom based search engine to find self help resources for common infectious diseases, symptoms, conditions and primary care diagnosis codes provided by general practitioners. The general practitioners and microbiology laboratory doctors can also use the symptom monitoring functionality to monitor the development of systems of patients using the search engine for symptom reporting. In addition to symptom monitoring, we will aslo provide a text and video based e-consultation service for hospital or general practitioners communcation with the patient participating in our study.       

We are now deploying the Snow system in the northern and mid health regions of Norway. We extract data from the Microbiology laboratory at the University Hospital in North Norway,  the Mircobiology laboratory at Norland county Hospital (in Bodø), covering the counties of Norland, Troms and Finnmark. Deployment in the mid health region of Norway is also underway.

We want to recruit GP offices that wants to participate in the study of the effects of the system. All participants will get access to the patient symptom monitoring service, text and video based e-consultation service. 

Funding

  • Northern Norway Regional Health Authority ‘s Telemedical Research Program
  • Tromsø Telemedicine Laboratory
  • Norwegian Centre for Ingtegrate care and Telemedicine, University Hospital of Northern Norway
  • UiT The Arctic University of Norway

Project partners

  • University of Tromsø, Department for Computer Science, Department for Community Medicine, Department of Clincal Medicine
  • Tromsø Telemedicine Laboratory
  • Norwegian Centre for Telemedicine

Peer reviewed papers

Yigzaw, Kassaye Yitbarek, Bellika, Johan Gustav. Evaluation of Secure Multi-Party Computation for Reuse of Distributed Electronic Health Data. Proceedings of 2014 International Conference on Biomedical and Health Informatics, Valencia, IEEE BHI 2014. June 1-4.

Marco, Luis;   Traver, Vicente;   Maldonado, José Alberto;   Karlsen, Randi;   Bellika, Johan Gustav. Meta-Architecture for the Interoperability and Knowledge Management of Archetype-Based Clinical Decision Support Systems. Proceedings of 2014 International Conference on Biomedical and Health Informatics, Valencia, IEEE BHI 2014. June 1-4.

Yigzaw, Kassaye Yitbarek, Bellika, Johan Gustav. A Communicable Disease Prediction Benchmarking Platform. Proceedings of 2014 International Conference on Biomedical and Health Informatics, Valencia, IEEE BHI 2014. June 1-4.

Bellika, Johan Gustav; Yigzaw, Kassaye Yitbarek; Henriksen, Torje Starbo; Ilebrekke, Lars; Skrøvseth, Stein Olav; Bakkevoll, Per Atle; Bønes, Erlend; Leer, Eirik; Johansen, Monika Alise; Chomutare, Taridzo; Simonsen, Gunnar Skov; Geilhufe, Marc; Berntsen, Gro; Gjelstad, Svein; Hartvigsen, Gunnar; Godtliebsen, Fred. The Snow system – a distributed medical data processing system. Helseinformatikkuka i Trondheim; 2013-09-17 - 2013-09-19

Skrøvseth, Stein Olav; Yigzaw, Kassaye Yitbarek; Henriksen, Torje Starbo; Ilebrekke, Lars; Bakkevoll, Per Atle; Simonsen, Gunnar Skov; Gutteberg, Tore Jarl; Bellika, Johan Gustav. The Snow communicable disease outbreak detection approach. Helseinformatikkuka i Trondheim; 2013-09-17 - 2013-09-19

Yigzaw, Kassaye Yitbarek; Andersen, A; Hartvigsen, Gunnar; Bellika, Johan Gustav. Towards privacy preserving comparative effectiveness research. Helseinformatikkuka i Trondheim; 2013-09-17 - 2013-09-19

Yigzaw, Kassaye Yitbarek; Bellika, Johan Gustav; Andersen, Anders; Hartvigsen, Gunnar; Fernandez-Llatas, Carlos. Towards Privacy-Preserving Computing on Distributed Electronic Health Record Data. I: MDS '13: Proceedings of the 2013 Middleware Doctoral Symposium. Association for Computing Machinery (ACM) 2013 ISBN 978-1-4503-2548-6. s. –

Yigzaw, Kassaye Yitbarek; Gutteberg, Tore Jarl; Bellika, Johan Gustav. The Snow infectious disease forecast service. Helseinformatikkuka i Trondheim; 2013-09-17 - 2013-09-19

Bellika, Johan Gustav; Traver, Vicente; Berntsen, Gro. Ehealth systems and information needs of physicians. ITACA - Universitat Politècnica de València, Spain 2012 ISBN 978-84-695-5184-4.s 13 - 17.

Skrøvseth, Stein Olav; Godtliebsen, Fred; Bellika, Johan Gustav. Causality in Scale Space as an Approach to Change Detection. PLoS ONE 2012; Volum 7 (12). ISSN 1932-6203.s e52253 - .s doi: 10.1371/journal.pone.0052253.

Bellika, Johan Gustav; Berntsen, Gro; Simonsen, Gunnar Skov; Rygh, Ellen. Do GPs need online access to epidemiological data of communicable diseases from the local patient population?. 17th Nordic Congress of General Practice; 2011-06-14 - 2011-06-17

Johansen, Monika Alise; Berntsen, Gro; Shrestha, Neema; Bellika, Johan Gustav; Johnsen, Jan-Are Kolset. An Exploratory Study of Patient Attitudes towards Symptom Reporting in a Primary Care Setting Benefits for Medical Consultation and Syndromic Surveillance?. Methods of Information in Medicine 2011; Volum 50 (5). ISSN 0026-1270.s 479 - 486.s doi: 10.3414/ME11-02-0005.

Rygh, Ellen; Berntsen, Gro; Simonsen, Gunnar Skov; Bellika, Johan Gustav. The Snow disease surveillance system study. 7th Nordic Congress of General Practice; 2011-06-14 - 2011-06-17

Simonsen, Gunnar Skov; Chomutare, Taridzo; Ilebrekke, Lars; Bakkevoll, Per Atle; Sjøveian, Anja; Bellika, Johan Gustav. Real-time local epidemiological data through the internet as a management tool for infections in the community. 21st European Congress of Clinical Microbiology and Infectious Diseases (ECCMID); 2011-05-07 - 2011-05-10

Johansen, Monika Alise; Johnsen, Jan Are Kolset; Shrestha, Neema; Bellika, Johan Gustav. Symptoms from patients as the primary information source for real-time surveillance.. Studies in Health Technology and Informatics 2010; Volum 160. ISSN 0926-9630.s 427 - 431.s doi: 10.3233/978-1-60750-588-4-427.

Johansen, Monika Alise; Johnsen, Jan Are Kolset; Hartvigsen, Gunnar; Ellingsen, Gunnar; Bellika, Johan Gustav. Bridging the Gap between Patients’ Expectations and General Practitioners’ Knowledge through Disease Surveillance. Studies in Health Technology and Informatics 2009; Volum 150. ISSN 0926-9630.s 423 - 427.

Henriksen, Eva; Johansen, Monika Alise; Baardsgaard, Anders; Bellika, Johan Gustav. Threats to Information Security of Real-Time Disease Surveillance Systems. Studies in Health Technology and Informatics 2009; Volum 150. ISSN 0926-9630.s 710 - 715.

Bellika, Johan Gustav; Ilebrekke, Lars; Bakkevoll, Per Atle; Johansen, Håvard; Scholl, Jeremiah; Johansen, Monika Alise. Authentication and Encryption in the Snow Disease Surveillance Network. Studies in Health Technology and Informatics 2009; Volum 150. ISSN 0926-9630.s 725 - 729.

Andreassen, Kristian Martin; Bellika, Johan Gustav. The Reliability of the XMPP Protocol Extensions as a File Transfer Mechanism in Dedicated Healthcare Networks. Journal on Information Technology in Healthcare 2009; Volum 7 (1). ISSN 1479-649X.s 68 - 76.

Hartvigsen, Gunnar; Årsand, Eirik; Botsis, Taxiarchis; Van Vuurden, Klaske; Johansen, Monika Alise; Bellika, Johan Gustav. Reusing Patient Data to Enhance Patient Empowerment and Electronic Disease Surveillance. Journal on Information Technology in Healthcare 2009; Volum 7 (1). ISSN 1479-649X.s 4 - 12.

Bellika, Johan Gustav. Electronic health surveillance: from John Snow to a network health information system. 2008 ISBN 978-91-633-1112-3.s 14 - 14.

Johansen, Monika Alise; Scholl, Jeremiah; Hasvold, Per Erlend; Ellingsen, Gunnar; Bellika, Johan Gustav. "Garbage in, garbage out": extracting disease surveillance data from epr systems in primary care. ACM Press 2008 ISBN 978-1-60558-007-4.s 525 - 534.

van Vuurden, Klaske; Hartvigsen, Gunnar; Bellika, Johan Gustav. Disease outbreak detection through clique covering on a weighted ICPC-coded graph. Studies in Health Technology and Informatics 2008; Volum 136. ISSN 0926-9630.s 271 - 276.

Bellika, Johan Gustav; Johansen, Monika Alise; Hasvold, Per Erlend; Nystad, Johanna; Bakkevoll, Per Atle; Hartvigsen, Gunnar. Eight Challenges for Developing Telemedicine Applications. Journal on Information Technology in Healthcare 2008; Volum 6 (4). ISSN 1479-649X.s 295 - 302.

Johansen, Monika Alise; Scholl, Jeremiah; Aronsen, Gudleif; Hartvigsen, Gunnar; Bellika, Johan Gustav. An exploratory study of disease surveillance systems in Norway. (data) Journal of Telemedicine and Telecare 2008; Volum 14 (7). ISSN 1357-633X.s 368 - 371.s doi: 10.1258/jtt.2008.007010.

Andreassen, Kristian; Bellika, Johan Gustav. THE RELIABILITY OF THE XMPP PROTOCOL EXTENSIONS AS FILE TRANSFER MECHANISM IN DEDICATED HEALTHCARE NETWORKS. International Conference On Information Communication Technologies in Health 2008. ISSN 1790-3904.s 24 - 30.

Granberg, Ove; Bellika, Johan Gustav; Årsand, Eirik; Hartvigsen, Gunnar. Automatic Infection Detection System. IOS Press 2007; Volum 129 (Part 1) ISBN 978-1-58603-774-1. ISSN 0926-9630.s 566 - 570.

Bellika JG, Sue H, Bird L, Goodchild A, Hasvold T, Hartvigsen G. Properties of a federated epidemiology query system. Int J Med Inform. 2007 Sep;76(9):664-76.

Bellika JG, Hasvold T, Hartvigsen G. Propagation of program control: a tool for distributed disease surveillance. Int J Med Inform. 2007 Apr;76(4):313-29.

Master thesis

Gebeyehu, Leykun Melkamu. Enabling medical research on clinically collected data using openEHR archetypes. Master thesis. Department of Computer Science, University of Tromsø. 2012.

Sjøveian, Anja Lisbeth Laitinen. A web/mobile app for internet based survey of gastrointestinal and respiratory symptoms. Master thesis. Department of Computer Science, University of Tromsø. 2012.

Yigzaw, Kassaye Yitbarek. Snow Integrated Communicable Disease Prediction Service. Master thesis. Department of Computer Science, University of Tromsø. 2012.

Dhakal, Sanjaya Babu. Interactive Disease Maps for the Snow Agent System. Master thesis. Department of Computer Science, University of Tromsø. 2009.

Orlin, Karsten. Improving the performance of the in-band byte stream file transfer XMPP extension. Master thesis. Department of Computer Science, University of Tromsø. 2009.

Andreassen, Kristian Martin. THE RELIABILITY OF XMPP FOR FILE TRANSFER. Master thesis. Department of Computer Science, University of Tromsø. 2008.

Aronsen, Gudleif. Visualization of contagious disease outbreak information for primary care physicians. Master thesis. Department of Computer Science, University of Tromsø. 2008.

Reports

Henriksen E, Johansen M.A., Baardsgaard A, Bellika J.G. Threats to Information Security of Real-time Disease Surveillance Systems. Medical Informatics Europe (MIE) 2009. Appendix: Definition of likelihood, consequence and risk levels.

Design of snow epidemiology service r04.pdf 249 KB
Protokoll (in norwegian) 167 KB
Agent mission specification 0.14 231 KB
Practice week report - Taridzo Chomutare 172 KB
Practice week report - Sokol Dhana 356 KB
Practice week report - Joe Hurley 64 KB
Practice week report - Giorgio Badaini 1 MB
Practice week report - Agbor Annemarie Ayuktakoh 148 KB
Risk assessment report 314 KB
Security policy 177 KB

Project manager

Johan Gustav Bellika Johan Gustav Bellika

Project period

2007 - 2015

Last updated

15 December 2016