Despite the warnings of epidemiologists, the coronavirus pandemic has taken the entire planet by surprise. Societies have been divided into doctors and patients, and often even doctors have ended up in hospital. In this race against the clock for life, the authorities have had to deal with an unprecedented situation and an unknown virus. However, the work of those directly involved in the fight against the novel coronavirus would have been much more difficult without the support of a series of eHealth platforms and solutions developed by the Republic of Moldova, a process that has highlighted the importance of digital solutions, supported by the European Union through its EU4Digital initiative across the Eastern Partnership.
Alexei Ceban is an epidemiologist at the National Agency for Public Health (NAPH). The doctor acknowledges that in the event of a pandemic, the importance of the data available to all actors involved in solving the problem is crucial. “It is the data that underlie the decisions and actions that are taken in the short, medium and long term,” Ceban explains.
Martynas Daugirdas, eHealth expert for the EU4Digital Facility, agrees on the vital importance of electronic data management, one of the priority areas for the EU-funded programme, which supports the Republic of Moldova across the full range of digitalisation of the economy and society, including eHealth.
“From well before the pandemic,” says Daugirdas, “EU4Digital has been working to assess the state of health data management in the Republic of Moldova and the other Eastern partner countries, and to develop guidelines so that the capabilities of health information exchange and management are in harmony with EU best practices.”
“Ideally, this means that data that conforms to the same norms is interoperable among various organisations, stakeholders and even across borders, which is important in providing better care for patients, no matter where they are,” the EU4Digital expert explained.
Interactive map of COVID-19 cases
With the pandemic, the importance of integrated data platforms quickly became apparent. As the number of COVID-19 infections increased, the Moldovan authorities, together with national and external partners, set out to create a real-time data platform to assess how the pandemic was evolving both in the country and abroad.
“The data platform on the COVID-19 epidemic situation in the Republic of Moldova has been created. This platform has been developed at the request of the Ministry of Health, Labour and Social Protection, with the support of the UN Population Fund (UNFPA), to ensure real-time monitoring of the situation regarding COVID-19 cases in the Republic of Moldova. The platform has been placed on the official websites of the Ministry of Health, Labour and Social Protection and of the National Agency for Public Health,” Alexei Ceban says.
The active map of COVID-19 cases ensures transparency and accessibility of information in real time.
The epidemiologist explains that not only does the map show the geographical distribution of COVID-19 cases by locality, but the platform also has data on active cases by age, sex and locality, as well as on deaths.
“These data are used both by health professionals and by the authorities, the media, the general population, but also by external partners who can view the evolution of the epidemiological situation in the country. The system base on which it was created makes possible the transmission of up-to-date data to other international platforms that compile global data,” Ceban explains.
Another tool that helps doctors and relevant authorities to investigate outbreaks of communicable diseases through the collection of field data during public health emergencies is the GoData platform. The tool includes features for case investigation, laboratory data, contact tracing, transmission chain viewing, including secure data exchange. It is designed for flexibility in the field, to adapt to the wide range of outbreak scenarios.
GoData is the initiative of a group of public health partners and is managed by the Global Outbreak Alert and Response Network (GOARN), coordinated by the WHO. The tool has been used since 2019 in response to the Ebola outbreaks in the Democratic Republic of Congo and Uganda. WHO is now working with Member States and partners to make Go.Data also available for the response to COVID-19. The Republic of Moldova has implemented this tool for investigating COVID-19 cases and for tracking contacts at the local level.
“It has been installed on the NAPH server and adjusted for our country’s context. The platform is also available in Romanian. It is currently being piloted and tested in several administrative territorial units to investigate infections of health workers, following the transmission chains,” Alexei Ceban says.
Reporting COVID-19 data to NAPH through the national surveillance system
Another tool that has facilitated the work of healthcare staff is the possibility of reporting COVID-19 data to the National Agency for Public Health through a national surveillance system. NAPH specialists claim this system ensures the detection, notification, reporting and investigation of infections with the novel coronavirus, and contributes to prevention and control measures.
All these processes are carried out jointly with primary, hospital and laboratory care.
“When a suspected COVID-19 case is reported, a special form (urgent report sheet on the detection of an infectious disease case 058/e) will be completed and sent from primary or inpatient care facility to the NAPH as a matter of urgency, within no more than 24 hours. This fact sheet itself contains valuable data for the investigation of the case. Subsequently, when the nasopharyngeal swab (laboratory sample) has been collected, a form accompanying the laboratory sample is completed (specifying the person’s data and the disease). All these data are digitised and entered in an electronic disaggregated database,” the epidemiologist explains.
Accordingly, everyone has an identification code, and subsequently, depending on the laboratory result (positive or negative), it is submitted to the database of people confirmed with SARS-CoV-2.
“The database is updated in real time during the day by the epidemiologists at the national level jointly with the epidemiologists at the territorial level. Each person is investigated separately and this is supplemented with additional data from the epidemiological investigation,” Ceban says.
The epidemiologist adds that contacts are monitored in parallel – a process of identifying, evaluating and managing people who have been exposed to a person confirmed with SARS-CoV-2 to prevent further transmission.
“The contact data is filled in based on an electronic questionnaire (socio-demographic data, contact data, etc.). After completing this online questionnaire, the data is automatically entered into the single contact monitoring base, which is then transmitted daily to the NAPH territorial directorates, primary health care and the Ministry of Internal Affairs. This ensures the monitoring of people who have been in contact with a confirmed case,” the specialist says.
Electronic COVID-19 database
Officials from the NAPH say the institution has comprehensive disaggregated databases for each person confirmed with COVID-19. This is possible due to the complex investigation of each case. “Electronic databases are disaggregated, in other words, we currently have data on more than 100,000 people who have tested positive for SARS-CoV-2. This data ensures the quality of a very detailed analysis process. The databases are updated several times a day, which enables us to have real-time data,” Alexei Ceban said.
The epidemiologist specifies that the real purpose of such databases is action. Following their consultation, daily and weekly reports are produced. That information also serves as basis for calculating the territorial and national epidemiological indicators. The data also underpins the decisions made by the authorities to prevent and limit the spread of SARS-CoV-2 in the country.
A group of volunteer IT experts has developed an online application called the Medcast chatbot. Through the application, users can pre-diagnose COVID-19, monitor their symptoms, and report the data to their family doctor. At the same time, the platform provides details about the rules imposed during the state of emergency and lockdown.
The IT solution also works for medical workers, who after registering with their medical credentials, can obtain information from patients under monitoring and download reports on their health.
How does the application work?
1. Having logged in to the platform, users answer 18 questions about their health condition.
2. The data and results are reported to the family doctor.
3. If the condition of one of the users with COVID-19-related symptoms suddenly worsens, the application offers the possibility of immediate reporting to the 112 service.
4. If a high risk of infection is identified after the pre-diagnosis, the user will receive alerts, once every two hours, to report their trends of temperature, headaches, cough and other symptoms.
Shared experience and shared data: the added value of collaboration
In June, all the data systems developed by the Republic of Moldova to tackle the pandemic were presented at an EU4Digital eHealth Network meeting to discuss COVID-19 and data sharing of disease statistics, as well as country best practices in managing the pandemic.
During the online meeting, a representative of the European Commission presented the EU’s COVID-19 statistical dashboard on the European Commission Crisis Management Laboratory (ECML) Covid website, particularly focusing on the different collection methods and types of data used to populate the database.
“By bringing together the European Commission and the Eastern partner countries, the EU4Digital eHealth team facilitated an opportunity for information sharing and the inclusion of Eastern partner country data on the EC dashboard,” EU4Digital’s Martynas Daugirdas explained.
Beyond 2021, EU4Digital is looking to support Moldova and its neighbours in three priority areas of eHealth: cross-border interoperability of eHealth systems, the adoption of national eHealth strategies, and the launch of initiatives and pilots to achieve cross-border eHealth services between Eastern partner countries and the EU.
An imperative response to the pandemic
The health crisis has highlighted the importance of technology at national and global levels, emphasising the need for rapid digital transformation, at all levels of society and the economy.
“The COVID-19 pandemic has left its global footprint on all areas of activity,” Prime Minister of the Republic of Moldova Ion Chicu said recently. “This crisis further tests the limits of such systems as the health or economic ones, by emphasising the role of technologies. In a complex and ever-changing world, digital transformation is a necessity. Building an information society accessible to all citizens is imperative. In order to respond adequately to the challenges brought about by the pandemic crisis, we are learning to appreciate the advantages of digitalisation even more,” the Prime Minister said.
EU4Digital is a programme funded by the European Union to support digital economy and society. The programme aims to extend the benefits of the European Union’s Digital Single Market to the Eastern Partner states, channelling EU support to develop the potential of the digital economy and society, in order to bring economic growth, generate more jobs, improve people’s lives and help businesses.
Through EU4Digital, the EU supports Eastern Partnership countries in reducing roaming tariffs, developing high-speed broadband to boost economies and expand e-services, harmonising digital frameworks across society in areas ranging from logistics to health, building cyber security and developing digital skills.