Shortly after the novel coronavirus started spreading, the Danish government ordered a lockdown. A few months later, large parts of society could open again, thanks to mass testing, and the Scandinavian kingdom was also among the first countries to scrap all restrictions.
The swift responses to the virus were made possible by the Danish National Microbiology Database (MiBa).
The reporting and surveillance infrastructure was already in place, so it was simple to build a corona solution,”noted Marianne Voldstedlund, Head of Section at the Danish National Public Health Institute, called Statens Serum Institut (SSI), which owns the database.
She was joined by Peter Steenberg and Ulrika Granroth from Autonik AB on Mylab’s Anniversary Seminar stage in Tampere in September 2022 to tell the story of MiBa.
Steenberg is Creative Director and Granroth Operative Chief in the Swedish-Danish LIS supplier Autonik, part of the Mylab Group since 2021. Autonik delivered one of the laboratory report database systems, wwSync, that MiBa is built on.
From regional project to national database
What is today known as MiBa, originally started as a project in the Copenhagen Capital Region in 2006. In 2008, SSI adopted the database, and two years later it was ready for national deployment.
Although the idea of one microbiology database for the whole of Denmark, in Voldstedlund’s words, is “every epidemiologist´s wet dream”, it was met with some scepticism from laboratories and other parties that were afraid that the government would take authority of their data or push standardisation down their throats.
Nevertheless, there were also visionaries. And so, the project continued.
All reports one click away
The national database was built with two objectives in mind: Giving nationwide access to all reports and gathering data for national surveillance.
It first became widely known among healthcare professionals in Denmark when the so-called MiBa button was introduced. Suddenly, all laboratories’ reports for one patient were but a click away. It proved a success, and hospitals started integrating MiBa into their EPR systems.
The number of web requests shows an increase related to the integration of MiBa services into regional EPR systems, Steenberg explained, noting that there was a clear need for sharing information.
For information to be shared, it needs to be uniform, but in Denmark, no national classification system existed.
Locally developed classifications had to be combined into a “Central Dynamic Mapping” with national and international classifications. As the name suggests, central dynamic mapping is, well, dynamic, in practice meaning two parallel databases: one with local codes (source reports) and one with central codes.
Real-time info controls hospital infections
The benefit of a national, standardised and updated database was emphasised with the introduction of the so-called Mibalerts. A young microbiologist, frustrated with the spread of resistant bacteria going rampant in Danish hospitals, came up with an idea: Could MiBa be used in real-time to stop infections from spreading?
In came the Mibalert, instantly informing healthcare personnel to isolate patients who were known to carry antibiotic-resistant bacteria. The alert also offers a link to the database with more info on the background of the alarm, so doctors can handle each case optimally.
This function was first piloted in 2015 when the Capital Region was ridden by a VRE outbreak. MiBa showed its worth by helping to control it, and the alert is now being rolled out to the rest of the country.
Key role in Denmark’s Covid response
When Covid-19 hit Denmark’s shores in February 2020 and rapidly started spreading, the country had a head start thanks to MiBa.
MiBa played a significant role in Denmark’s response. The basic functions were in place before the pandemic hit, and citizens were familiar with the digital solution – sundhed.dk – where all their health information can be found, said Voldstedlund.
In spring 2020, when the country started mass testing its population to keep society up and running, it was technically “quite simple,” she added. Tests, reports, and vaccination booking were all in one place, interacting seamlessly.
Voldstedlund stressed the importance of real-time data. Close to real-time statistics were delivered to the central authorities for timely decisions. “Citizens could see the same data on public dashboards as the ministers referred to on TV. People could, so to speak, imagine their own tests in the daily figures, which countered fake news.” Researchers also got used to having access to real-time statistics, which has now become a new standard.
At the peak of mass testing, 10% of the Danish population was tested each day. 150,000 PCR tests and half a million antigen test results – negative and positive – were added to the national microbiology database every single day. Although tests were offered practically anywhere, all results were instantly reported to the database.
We had to make simple solutions for reporting test results at schools for example. Here, data was manually fed into the system without problems, Ulrika Granroth from Autonik said, adding “MiBa is extremely robust, so we were able to scale it up without breaking it.”
The Danish microbiology database has been included in the portfolio of governmental systems that are regarded as critical infrastructure components in line with water, heat, and communication.
“Don’t lose the dynamic”
The Danish microbiology database started as a grassroots project nobody wanted to pay for. Now, it is famous for its efficient use of surveillance data to prevent disease outbreaks and has naturally sparked interest from many sides.
Could the model be copied elsewhere? Could Denmark’s national database be extended to the Nordics? Europe? The world?
Yes, answered Voldstedlund and hesitated. But you must be careful not to lose the dynamic. It can easily become too heavy. We need standards, but also freedom. It’s not one size fits all.
MiBa started without government interference or steering groups.
We lacked funding, but we had the freedom to just do our thing, Voldstedlund explained after the seminar in Tampere.
For years, she fought to receive funding. Then, the pandemic hit.
Suddenly I got all the money I wanted, but we had no time to use it. It takes 4-5 years to educate someone for this cross field between medicine and IT.
Now, Voldstedlund takes part in two big programmes on EU level. She finds all the discussions back and forth time-consuming, but there is no other way to go as she sees it. “We have to talk and learn from each other.”
A microbiology database for the whole of Denmark is “every epidemiologist´s wet dream”, said Marianne Voldstedlund from the Danish National Public Health Institute at Mylab’s Anniversary Seminar. Here, she is joined by co-speakers Peter Steenberg and Ulrika Granroth from the system provider Autonik.
Read more about Mylab Anniversary Seminar and how during Mylab’s 35 years of existence, Mylab has evolved from a small start-up in Tampere, Finland, to the leading expert in clinical laboratory and diagnostics information systems in the Nordic countries.