The ability of pathogens to change over time and no longer respond to medicines makes infections harder to treat, increasing the risk of disease spread, severe illness, and death.
Prevention, appropriate antibiotic prescribing, and proper dispensation are key factors in combating this threat. Systematic collection of data on antimicrobial resistance (AMR) is essential for monitoring the incidence of specific bloodstream infections. Since the inappropriate use of antimicrobial drugs is a major contributor to AMR, the EU has set a target to reduce their use by 20% by 2030. At European level data on antimicrobial resistance are collected by the European Centre for Disease Prevention and Control (ECDC) by means of a specific Network: the European Antimicrobial Resistance Surveillance Network (EARS-Net).
The ESAC-Net, represents a network of national surveillance systems also coordinated by ECDC, that gathers reference data on antimicrobial consumption (AMC) across Europe. It collects and analyzes data from EU and EEA countries, covering both community and hospital settings.
This data is used to provide insights and feedback to EU and EEA countries on antimicrobial consumption indicators. These indicators help track progress toward the responsible use of antimicrobials.
Data on antimicrobial resistance and consumption collected by EARS-Net and ESAC-Net represent an important instrument for antimicrobial surveillance and antimicrobial consumption monitoring in Europe. Data are submitted on a predefined schedule after being transformed to align with a specified metadata schema.
With the EEHRxF data from laboratories as well as information on antimicrobial consumption could be made available in almost real-time both at national level and at international level for public health purposes without the need for error-prone data transformations. This enables data to be used for real-time monitoring and for anticipating critical issues thus allowing timely decision-making and prompt intervention.
Document Version: V1.0
Responsible Party: xShare WP4
Source:
As-Is Situation
Little or no harmonization exists in the field of microbiology across laboratories in Europe. Some organizations such as groups HL7 Europe ESCMID are organizing working groups to address this issue, Some countries have established their own national data models—such as the Danish MiBa[5] or the model included in the Austrian ELGA Laboratory Guidelines[6]. The former uses national standards, while the latter is based on HL7 CDA. Germany has recently published a data model[7] for microbiology that relies on international standards such as FHIR, SNOMED CT, and LOINC.
An international approach is essential to ensure timely communication across systems in the field of AMR and AMC and real-time availability of data at national and European level for critical decision making. EARS-Net and ESAC-Net represent an important instrument to collect comparable AMR and AMC data and to analyze their temporal and spatial trends in Europe. However, at the moment, each country collects data according to its own national procedures and then transforms it according to the metadata schema and its coding conventions before submitting it to the ECDC via TESSy according to a pre-fixed schedule.
Currently available products/services and its vendors
The European Surveillance System (TESSy) and the metadata schema by ECDC
Which health-related standard does your organisation uses and its alignment to the EEHRxF?
To support data collection, the ECDC has developed a metadata schema aimed at harmonizing AMR and AMC information across Europe. This is a valuable step toward European-level standardization. However, many AMR-related concepts still rely on local or protocol-specific coding systems rather than international standards, particularly for epidemiological variables and answer value sets. In contrast, data on antimicrobial consumption follow the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) system to classify antimicrobial substances and measure consumption. Data can be submitted directly to the TESSy System or via CSV and XML files.
Actors/Users and their Roles
| Laboratories | Detect drug-resistant microorganisms |
| Patients | Take antibiotic medications. |
| Healthcare providers and laboratories | Prescribe /Administer antibiotic medications. Send EEHRxF compliant data to PH national agencies |
| Public Health regional/national agencies | Receive data from local healthcare providers in a common EEHRxF format and efficiently merge them for local real-time monitoring and for sending to ECDC |
| ECDC | Receives data from regional/national authorities and is enabled to do real-time monitoring |
User Perspective
The same EEHRxF format is used in laboratories Healthcare providers, EHRs and public health systems for efficient data transmission.
System Perspective
EEHRxF-enabled systems can collect and exchange antimicrobial resistance and consumption data using the same format. Ideally also Tessy will be enabled to receive EEHRxF-compliant data.
Health Information Domain(s) – HIDs:
- Electronic prescription
- Electronic dispensiation
- Laboratory Results
National/regional strategy
National and regional public health authorities are enabled to receive and send data according to the EEHRxF and establish near real-time monitoring programs
Strategy towards EHDS
Exploit the EEHRxF to make antimicrobial data for resistance and consumption readily available for secondary use.
Business Goals/Benefits and KPIs
Administrative simplification by enabling “only once” strategies from laboratories to public health authorities. Enable Public Health authorities to establish real-time dashboards for antimicrobial resistance and consumption for critical decision-making
KPIs
- Number laboratories adopting the format
- Number of submissions of EEHRxF compliant data to ECDC
- Number of real-time monitoring systems
Application
Import/Export functionalities for EEHRxF data
Data Preconditions
EEHRxF – IPS+R compliant data model for antimicrobial resistance and consumption data.
System Preconditions
Laboratory information systems, healthcare providers and ECDC systems need to enable to import and export of data according to the EEHRxF
User Preconditions
Laboratories and healthcare providers can send data in EEHRxF format. ECDC can receive data in the same format
Trigger
AMR occurance, antimicrobial consumption
Challenges/Limitations
Enable TESSy to receive data in a EEHRxF –compliant format
Involved stakeholders in the BUC definition
Charité, EHTEL, Sciensano
Application of pseudonymisation filters
No
Basic Workflow
- ECDC needs to urgently collect information on how many cases of a specific resistant bacterium were detected in Europe, which resistance tests were performed and the results. Additionally. ECDC intends to run a near real-time survey on antimicrobial consumption and adherence.
- Thanks to the EEHRxF, ECDC can quickly collect laboratory and prescription data from national authorities because they all use the same format.
- National authorities and ECDC are enabled to monitor antimicrobial resistance and consumption in near real-time.
